Can the size of adrenal tumor impact hormonal secretion? A retrospective analysis of 170 adrenalectomies in a single center.

PURPOSE: Adrenal tumors are a heterogeneous group of neoplasms that may be hormonally active or inactive. Tumor size is a key factor in evaluating and managing these lesions. Understanding how size impacts hormonal activity, surgical outcomes, and complications can help guide treatment and follow-up. This study investigates the relationship between tumor size, hormonal secretion, and clinical outcomes in adrenal tumors. METHODS: We retrospectively analyzed data from patients who underwent adrenalectomy between 2007 and 2023 at the University Hospital of Basel. Tumors were categorized by pathology and stratified into three size groups based on histology results. RESULTS: A total of 170 patients who underwent adrenalectomy for adrenal tumors were analyzed. The most common adrenal pathologies were Conn`s syndrome followed by pheochromocytoma, Cushing syndrome and incidentalomas. Hormone-producing tumors were present in 61.2% of cases. Larger tumors (> 4 cm) were associated with longer operative times (p = 0.03). When tumor size was analyzed in relation to hormone production, small functional tumors (< 2 cm) were most commonly linked to Conn’s syndrome. Cushing syndrome was most prevalent among patients with tumors measuring between 2.1 and 4 cm. There were no significant differences in perioperative complication rates across the tumor size groups. CONCLUSION: Our results showed that tumor size was associated with both operative complexity and functional status. Larger tumors were linked to longer operative times. Smaller tumors were predominantly associated with Conn`s syndrome, while tumors of intermediate size were most often related to Cushing syndrome. These findings highlight the relevance of tumor size in preoperative planning and functional assessment.