Clinicopathological characteristics of adrenal tumors in older adults: a cohort study

Introduction: To investigate age-specific characteristics of adrenal tumors in older adults and to identify predictors for adrenal malignancy. Methods: Inpatients ≥60 years old with adrenal tumor evaluated at a large medical center between January 2011 and December 2023 were retrospectively enrolled. Results: Of 2,633 inpatients with adrenal tumor, 559 (21.2%, ≥60 years) were eligible for analysis, 52.8% were men, with a median age of 64 years. 58.7% patients were incidentally diagnosed. The median tumor size was 29 mm, and the median unenhanced computed tomographic (CT) attenuation was 15.0 Hounsfield units (HU). Older patients presented a relatively high prevalence of malignant adrenal tumors, accounting for 19.0% of all cases. Adrenal metastases were the most common malignant adrenal tumors, accounting for 59.4% of all malignant cases. A risk model was conducted to predict adrenal malignancy, and the area under the curve was 0.89. Predictors included incidental discovery, male, bilateral tumor, older age, higher HU, and lower weight. The optimal cutoff value was age=67.5 years, size=42.5 mm and CT attenuation=20.5 HU, respectively. Conclusions: Older patients presented the age-specific spectrum of diagnosis, in particular a high prevalence of adrenal metastases. Certain predictors may help to differentiate a malignant lesion from a benign one. This study helps to expand the current knowledge of the adrenal tumor in older adults and inspire robust therapies with better outcomes.