Conservative management of perinatal adrenal masses in a single institution retrospective study

PURPOSE: Prenatal ultrasound screening has increased detection of adrenal masses during the fetal and neonatal periods, creating management dilemmas between immediate surgical intervention and observation. This study evaluates the outcomes of selective conservative management in perinatal adrenal masses. METHODS: We conducted a single-institution retrospective case series of nine patients with perinatal adrenal masses diagnosed at our institution between 2015 and 2025. Clinical presentation, imaging characteristics, biochemical markers, treatment decisions, and outcomes were analyzed. The cohort included five males and four females, with masses detected prenatally in five cases. All patients were initially managed conservatively with serial imaging surveillance to assess lesion volume over time. RESULTS: Neuroblastoma was confirmed in four patients; other diagnoses included four benign lesions and one adrenocortical carcinoma. Given the small sample size of this case series, the following proportions should be interpreted with caution and are not intended to reflect population-level outcomes. Spontaneous regression occurred in six cases, two remained stable, and one increased in size. Four patients underwent surgical intervention based on growth patterns or radiological suspicion of malignancy. Median follow-up was 42 months (range: 6 months to 10 years), with no mortality recorded. CONCLUSION: Among the nine case, we observed spontaneous regression in six of nine patients. Temporal evolution of lesion volume proved more informative for clinical decision-making than initial imaging characteristics. The adrenocortical carcinoma case illustrates that radiological trend alone does not always determine management, and that clinical context-including genetic predisposition-must guide decisions. Although our small cohort precludes generalizable conclusions, this institutional experience contributes to the growing evidence base supporting observational approaches in appropriately selected cases. Larger prospective studies incorporating molecular and genetic characterization remain essential to identify reliable predictors of lesion behavior and to optimize patient selection for conservative versus surgical management.