Clinical characteristics and follow‑up of Saudi patients with adrenal incidentalomas: single‑center experience

Abstract

Abstract Background Adrenal incidentalomas (AIs) are increasingly detected owing to the widespread use of cross-sectional imaging. However, real-world adherence to guideline-recommended evaluation remains variable. This study aimed to determine the prevalence, characteristics, and workup patterns of AIs at a tertiary care center in Saudi Arabia. Methods We conducted a retrospective observational study of 250 patients diagnosed with adrenal incidentalomas at King Fahad Medical City between March 2021 and August 2023. Demographic, radiologic, and hormonal data were collected and analyzed. Results The mean age was 59.9 ± 13.5 years, with a nearly equal sex distribution. Most lesions were small (57.2% were 1–2 cm) and unilateral (79.6%). Only 20% ( n = 50) of patients underwent a complete hormonal evaluation. Among these 50 patients, 12.0% ( n = 6) had a functioning tumor and 88.0% ( n = 44) were non-functioning; expresedd relative to the entire cohort, functioning tumors corresponded to only 2.4% ( n = 6), reflecting the impact of the 80% non-evaluation rate on the apparent overall prevelance. Adenomas were the most frequent diagnosis (52.8%), while malignancy was suspected or confirmed in 14.4%. Dedicated adrenal imaging was underutilized, with 94.8% lacking contrast washout studies. Multivariate analysis identified younger age (≤ 60 years), specialty referral, and absence of active malignancy as independent predictors of hormonal evaluation. Conclusion This study highlights a substantial gap between clinical guidelines and real-world practice in the evaluation of AIs. Standardized institutional protocols are urgently needed to prevent underdiagnosis of hormonally active or malignant lesions. Clinical trial number Not applicable.