[Adrenocortical "incidentalomas" as a diagnostic and therapeutic problem].
P. Carpenter (1986) used the term "incidentalomas" in connection with all incidentally discovered adrenal masses. Previously these masses were frequent incidental discoveries at autopsies, but now, with the increasing use of abdominal computed tomography. In the last 10 years 5 patients with incidentally diseases, significant number of them have been detected. In the last 10 years 5 patients with incidentally discovered adrenal masses (4 males and 1 female, aged from 37 to 66 years) were examined and treated in our Department. Long-lasting arterial hypertension was found in all of them, and in one patient here was impaired glucose tolerance with further evolution of diabetes. A possible excessive secretion of glucocorticoids, mineralocorticoids, androgenes and catecholamines was excluded. However, markedly elevated urinary excretion of pregnanediol, proved in all patients, indicated to a possible preservation of the first reaction in the biosynthesis of cortisol, at least synthesis of pregnenolone from cholesterol. One patient, submitted to a regular functional and morphological evaluation of previously discovered 'incidentaloma', showed no sign of expansion or pathological hormonal activity. Four patients were operated because of the suspected expansion and malignant alteration of the adrenal nodus. The histological proof of adrenocortical adenoma or hyperplasia, composed of the 'fasciculata-like' cells, postoperatively maintained elevated values of steroid precursors in urine, and also a finding of adrenocortical noduses in remained adrenal noduses, confirmed the presumption that such masses could be the non-essential finding in long-lasting arterial hypertension and degenerative changes during aging.