Clinical analysis of the etiological spectrum of bilateral adrenal lesions: A large retrospective, single-center study

Purpose: To investigate the clinical characteristics, endocrinological function, and etiologies of patients with bilateral adrenal lesions.Methods: A retrospective study of 777 patients with bilateral adrenal lesions was conducted at the Chinese General Hospital of the People’s Liberation Army between January 2013 and January 2018. Patient demographic features, hormonal profiles, imaging findings, and histopathological findings were reviewed from the database records. Results: Of the 777 patients with bilateral adrenal lesions, 495 were men, and the mean age at diagnosis was 52.0±13.0 years. A total of 511 (65.8%) cases were benign, followed by adrenal metastases (n=224, 28.8%), pheochromocytoma (n=26, 3.3%), adrenal lymphoma (n=9, 1.2%), and adrenal corticocarcinoma (ACC) (n=7, 0.9%). Hormonal evaluation revealed that 34.3% of bilateral adrenal lesions were functional. The primary etiologies of functional lesions were primary aldosteronism (16.6%, 129/777) , and PBMAH (8.8%, 68/777). Patients with lymphoma and metastases were significantly older than those with benign nonfunctional lesions (60.4±11.0 years vs. 54.5±10.4 years and 57.9±10.8 years vs. 54.5±10.4 years, respectively; PConclusion: Benign adrenal lesions and metastases to the lungs are the most common causes of bilateral adrenal lesions, and primary aldosteronism and BMAH are the most prevalent functional lesions. In addition, our findings suggest that patients with lymphoma or metastases are older and possess larger masses.