Clinicopathological spectrum of adrenal tumors: a retrospective study from a Romanian tertiary referral center

Adrenal tumors represent an uncommon and heterogeneous group of lesions with diverse clinical and histopathological features. Their detection has increased in recent years due to the widespread use of advanced imaging techniques. However, epidemiological data regarding the various types of adrenal tumors in Eastern Europe remain scarce and show considerable variability. In this study, we aimed to analyze the clinicopathological characteristics, distribution, and temporal trends of adrenal tumors diagnosed in a Romanian tertiary referral center between 2001 and 2022. We conducted a retrospective review of 116 adrenalectomy specimens documented in the Pathology Database of our institution. Demographic characteristics, tumor laterality, histological subtypes, and temporal distribution patterns were analyzed. Adrenal adenomas were the most common tumors (31.9%), followed by pheochromocytomas (24.1%), and adrenal cortical carcinomas (11.2%); other lesions (e.g., cysts, myelolipoma, etc.) were rare. The number of adrenal surgeries increased by 36% in the period 2012-2022 compared to 2001-2011. The prevalence of adrenal adenomas almost doubled in the second study period (38.8% vs. 22.4%, p=0.014). Pheochromocytomas remained constant, revealing a similar prevalence (around 24%) in both time periods. Carcinomas' prevalence was lower in both intervals (7.4% in 2012-2022 vs. 16.3% in 2001-2011, p=0.405). Our findings highlight temporal changes in the histological spectrum of adrenal tumors, with an increasing trend in cortical adenomas and persistently low rates of adrenocortical carcinoma. These results offer insight into local patterns of adrenal pathology and underscore the need for ongoing clinicopathological monitoring.