Presentation and Clinical Patterns of Bilateral Adrenal Lesions: A Retrospective Cohort Study

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ID: 313822
2026
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Abstract
Abstract Context The clinical relevance of etiologic concordance and temporal presentation in bilateral adrenal masses remains poorly defined, creating uncertainty in diagnostic evaluation and management. Objective To characterize the etiologic spectrum of bilateral adrenal masses, evaluate patterns by concordance and synchronicity, and identify predictors of discordance and malignant or pheochromocytoma contralateral lesions. Design Retrospective cohort study (2010–2025). Setting Tertiary referral center. Participants Adults with bilateral adrenal masses. Main Outcome Measures Etiology, concordance, synchronicity, interval to contralateral lesion, and factors associated with discordance and malignant or pheochromocytoma contralateral lesions. Results Among 1,035 patients (median age 59.6 years; 51% women), 85% had concordant and 15% discordant etiologies. Concordant cases were predominantly bilateral benign cortical lesions (76%), whereas discordant cases were heterogeneous (benign 35%, malignant 31%, indeterminate 34%). Presentation was synchronous in 84% and asynchronous in 16%, with a median interval of 45 months (IQR 15–87). Asynchronous disease was associated with higher discordance (23% vs 13%, P=0.001) and greater prevalence of malignant lesions (bilateral malignant: 17% vs 7%; discordant malignant: 8% vs 4%; overall P<0.001). Among asynchronous cases, shorter interval to contralateral lesion (<2 vs ≥5 years) was independently associated with malignant or pheochromocytoma etiology (adjusted OR 2.63, 95% CI 1.01–6.85), as was larger tumor size (adjusted OR 1.06 per mm, 95% CI 1.02–1.09). Conclusions Most bilateral adrenal masses are benign and concordant; however, discordant or asynchronous disease identifies a higher-risk subgroup enriched for malignancy. Early contralateral lesion development and larger tumor size are key risk factors.
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Authors Haibo Lu, Eishvauk Aggarwal, Alaaeldin Y Hodhod, Sara J Achenbach, Elizabeth J Atkinson, Kai Yu, Cayse M. Powell, Irina Bancos
Journal the journal of clinical endocrinology & metabolism
Year 2026
DOI
10.1210/clinem/dgag199
URL
https://doi.org/10.1210/clinem/dgag199
Keywords Keywords not found

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