Morpho-functional and biochemical characterization of adrenal masses in a heterogeneous cancer population

Background/Objectives: The aim of this retrospective study is to analyze the prevalence of adrenal masses in patients with different types of tumors who performed [18F]FDG PET/CT. Method: Eighty-eight patients who performed [18F]FDG PET/CT from 2019 to 2024 for oncologic purposes, with evidence of adrenal mass and different types of cancer, were retrospectively retrieved from our database. To assess the functionality of the adrenal lesions, ACTH, adrenal steroids, and a low-dose dexamethasone suppression test (DST-1 mg) was performed in the Endocrinology Unit. According to the results of DST-1 mg, the adrenal lesions were classified in cortisol-secreting lesions (CS) and non-secreting lesions (NS). Results: Adrenal masses were most prevalent in breast cancer (25/88, 28.4%), followed by kidney cancer (13/88, 14.8%), thyroid cancer (11/88, 12.5%), and the others. We report a global rate of 39.8% (34/88) cortisol-secreting amongst all adrenal lesions. Conclusions: Our study is the largest retrospective study available in the literature calculating the prevalence of adrenal lesions in several cancer patients. From our results there emerges a high prevalence of secreting lesions. Therefore, biochemical characterization of adrenal masses is crucial in oncological settings to address clinical and therapeutic management.