Abstract Context Evidence on etiology and function of adrenal masses in younger adults is scarce. Objective To characterize the clinical, imaging, and biochemical presentation of adrenal masses in 18–40-year-olds. Design Retrospective cohort study, January 2016-December 2021. Setting Tertiary academic medical center. Patients Young adults (18-40 years) with adrenal masses identified through radiologic registry. Exclusion criteria included pre-existing adrenal masses before 2016, hyperplasia, or masses 1cm. Outcomes Adrenal mass diagnosis, as determined by reference standard of histopathology, radiologic surveillance, and biochemical evaluation. Results A total of 255 patients (women 142(56%); white 156(61%); median age 35 years (IQR 30-39)) were included. Comorbidities included genetic predisposition syndromes (16, 6.3%), pre-existing malignancy (70, 27%), obesity (100, 48%), hypertension (89, 35%), and diabetes (25, 10%). Majority of adrenal masses were incidentally found (184, 72%) and median size was 1.9cm (IQR 1.4-2.7cm) upon detection. Among adrenal masses in young adults, prevalence of malignancy and pheochromocytoma was 16% and 4%, respectively; among adrenal incidentalomas, a 5% malignant. Factors associated with malignancy or pheochromocytoma in multivariable analysis included non-incidental mechanism of discovery (OR 15.5, 95% CI 7.2-35.7, p0.001), and larger size (OR 1.5, 95% CI 1.2-2.0, p0.001). Hormonal evaluation was performed in only 57 (22%) patients and was positive for hormone hypersecretion in 16 (28%) of tested individuals. Conclusions We demonstrated a high prevalence of malignancy and pheochromocytoma in our cohort of young adults with adrenal masses. Completion of appropriate hormonal work up was infrequent, potentially missing patients with functioning adrenal adenomas.
Jacob et al. (Tue,) studied this question.