{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:47:35Z","timestamp":1785422855758,"version":"3.56.0"},"reference-count":34,"publisher":"Societatea Romana de Morfologie","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rom J Morphol Embryol"],"published-print":{"date-parts":[[2025,8,27]]},"abstract":"<jats:p>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\u20132022 compared to 2001\u20132011. 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\u2019 prevalence was lower in both intervals (7.4% in 2012\u20132022 vs. 16.3% in 2001\u20132011, 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.<\/jats:p>","DOI":"10.47162\/rjme.66.2.07","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T12:31:18Z","timestamp":1756729878000},"page":"343-351","source":"Crossref","is-referenced-by-count":1,"title":["Clinicopathological spectrum of adrenal tumors: a retrospective study from a Romanian tertiary referral center"],"prefix":"10.47162","volume":"66","author":[{"name":"Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u015f, Romania; Department of Endocrinology, Emergency County Hospital, T\u00e2rgu Mure\u015f, Romania","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona Teodora","family":"C\u0103tan\u0103","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adela Corina","family":"Nechifor-Boil\u0103","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u015f, Romania; Department of Pathology, Mure\u015f County Hospital, T\u00e2rgu Mure\u015f, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorina","family":"Moica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Faculty of Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u015f, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Chinezu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u015f, Romania; Institute of Forensic Medicine, T\u00e2rgu Mure\u015f, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Borda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u015f, Romania; Department of Pathology, Emergency County Hospital, T\u00e2rgu Mure\u015f, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26736","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"[1] Ebbehoj A, Kaur RJ, Li D, Singh S, Zhang C, Atkinson EJ, Achenbach SJ, Rocca WA, Khosla S, Bancos I. SAT-176 epidemiology of adrenal tumors: a population based study of 1287 patients. J Endocr Soc, 2020, 4(Suppl 1):SAT-176. https:\/\/doi.org\/10.1210\/jendso\/bvaa046.189","DOI":"10.1210\/jendso\/bvaa046.189"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"[2] Ebbehoj A, Li D, Kaur RJ, Zhang C, Singh S, Li T, Atkinson E, Achenbach S, Khosla S, Arlt W, Young WF, Rocca WA, Bancos I. Epidemiology of adrenal tumors in Olmsted County, Minnesota, USA: a population-based cohort study. Lancet Diabetes Endocrinol, 2020, 8(11):894-902. https:\/\/doi.org\/10.1016\/S2213-8587(20)30314-4","DOI":"10.1016\/S2213-8587(20)30314-4"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"[3] Zahir ST, Aalipour E, Barand P, Kaboodsaz M. Clinicopathological features of adrenal tumors: a ten-year study in Yazd, Iran. Asian Pac J Cancer Prev, 2015, 16(12):5031-5036. https:\/\/doi.org\/10.7314\/APJCP.2015.16.12.5031","DOI":"10.7314\/APJCP.2015.16.12.5031"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"[4] Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, Borasio P, Fava C, Dogliotti L, Scagliotti GV, Angeli A, Terzolo M. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest, 2006, 29(4):298-302. https:\/\/doi.org\/10.1007\/BF03344099","DOI":"10.1007\/BF03344099"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"[5] Al Subhi AR, Boyle V, Elston MS. Systematic review: incidence of pheochromocytoma and paraganglioma over 70 years. J Endocr Soc, 2022, 6(9):bvac105. https:\/\/doi.org\/10.1210\/jendso\/bvac105","DOI":"10.1210\/jendso\/bvac105"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"[6] Ebbehoj A, Stochholm K, Jacobsen SF, Trolle C, Jepsen P, Robaczyk MG, Rasmussen \u00c5K, Feldt-Rasmussen U, Thomsen RW, S\u00f8ndergaard E, Poulsen PL. Incidence and clinical presentation of pheochromocytoma and sympathetic paraganglioma: a population-based study. J Clin Endocrinol Metab, 2021, 106(5):e2251-e2261. https:\/\/doi.org\/10.1210\/clinem\/dgaa965","DOI":"10.1210\/clinem\/dgaa965"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"[7] Sharma ST, Nieman LK, Feelders RA. Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol, 2015, 7:281-293. https:\/\/doi.org\/10.2147\/CLEP.S44336","DOI":"10.2147\/CLEP.S44336"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"[8] Savas M, Mehta S, Agrawal N, van Rossum EFC, Feelders RA. Approach to the patient: diagnosis of Cushing syndrome. J Clin Endocrinol Metab, 2022, 107(11):3162-3174. https:\/\/doi.org\/10.1210\/clinem\/dgac492","DOI":"10.1210\/clinem\/dgac492"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"[9] Hundemer GL, Vaidya A. Primary aldosteronism diagnosis and management: a clinical approach. Endocrinol Metab Clin North Am, 2019, 48(4):681-700. https:\/\/doi.org\/10.1016\/j.ecl.2019.08.002","DOI":"10.1016\/j.ecl.2019.08.002"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"[10] Low G, Sahi K. Clinical and imaging overview of functional adrenal neoplasms. Int J Urol, 2012, 19(8):697-708. https:\/\/doi.org\/10.1111\/j.1442-2042.2012.03014.x","DOI":"10.1111\/j.1442-2042.2012.03014.x"},{"key":"ref10","unstructured":"[11] Reddy KK, Yuganeswary S, Kailash K, Norhashimah K, Teik CY. Virilizing adrenal tumor: case report. IOSR J Dent Med Sci, 2019, 18(5):76-77."},{"key":"ref11","unstructured":"[12] Sciarra F, Tosti-Croce C, Toscano V. Androgen-secreting adrenal tumors. Minerva Endocrinol, 1995, 20(1):63-68."},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"[13] Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM, Jolly S, Miller BS, Giordano TJ, Hammer GD. Adrenocortical carcinoma. Endocr Rev, 2014, 35(2):282-326. https:\/\/doi.org\/10.1210\/er.2013-1029","DOI":"10.1210\/er.2013-1029"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"[14] Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A. Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress? World J Surg, 2006, 30(5):872-878. https:\/\/doi.org\/10.1007\/s00268-005-0329-x","DOI":"10.1007\/s00268-005-0329-x"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"[15] Sharma E, Dahal S, Sharma P, Bhandari A, Gupta V, Amgai B, Dahal S. The characteristics and trends in adrenocortical carcinoma: a United States population based study. J Clin Med Res, 2018, 10(8):636-640. https:\/\/doi.org\/10.14740\/jocmr3503w","DOI":"10.14740\/jocmr3503w"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"[16] Lib\u00e9 R, Huillard O. Adrenocortical carcinoma: diagnosis, prognostic classification and treatment of localized and advanced disease. Cancer Treat Res Commun, 2023, 37:100759. https:\/\/doi.org\/10.1016\/j.ctarc.2023.100759","DOI":"10.1016\/j.ctarc.2023.100759"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"[17] Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol, 2016, 175(2):G1-G34. https:\/\/doi.org\/10.1530\/EJE-16-0467","DOI":"10.1530\/EJE-16-0467"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"[18] Conzo G, Pasquali D, Colantuoni V, Circelli L, Tartaglia E, Gambardella C, Napolitano S, Mauriello C, Avenia N, Santini L, Sinisi AA. Current concepts of pheochromocytoma. Int J Surg, 2014, 12(5):469-474. https:\/\/doi.org\/10.1016\/j.ijsu.2014.04.001","DOI":"10.1016\/j.ijsu.2014.04.001"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"[19] Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab, 2009, 94(6):1853-1878. https:\/\/doi.org\/10.1210\/jc.2008-2291","DOI":"10.1210\/jc.2008-2291"},{"key":"ref19","unstructured":"[20] ***. Popula\u0163ie Jude\u0163ul Mure\u015f. Popula\u0163ia.ro, 2025."},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"[21] Kleihues P, Sobin LH. World Health Organization classification of tumors. Cancer, 2000, 88(12):2887. https:\/\/doi.org\/10.1002\/1097-0142(20000615)88:12<2887::aid-cncr32>3.0.co;2-f","DOI":"10.1002\/1097-0142(20000615)88:12<2887::AID-CNCR32>3.0.CO;2-F"},{"key":"ref21","unstructured":"[22] DeLellis RA, Lloyd RV, Heitz PU, Eng C (eds). Pathology and Genetics of Tumors of Endocrine Organs. World Health Organization (WHO) Classification of Tumours, 3rd edition, vol. 8, International Agency for Research on Cancer (IARC) Press, Lyon, France, 2004, 57-66."},{"key":"ref22","unstructured":"[23] Lloyd RV, Osamura RY, Kl\u00f6ppel G, Rosai J (eds). World Health Organization (WHO) Classification of Tumours of Endocrine Organs. WHO Classification of Tumours, 4th edition, vol. 10, International Agency for Research on Cancer (IARC) Press, Lyon, France, 2017, 180-207."},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"[24] Kerkhofs TMA, Verhoeven RHA, Van Der Zwan JM, Dieleman J, Kerstens MN, Links TP, Van de Poll-Franse LV, Haak HR. Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993. Eur J Cancer, 2013, 49(11):2579-2586. https:\/\/doi.org\/10.1016\/j.ejca.2013.02.034","DOI":"10.1016\/j.ejca.2013.02.034"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"[25] Pedersen J, Jarl\u00f8v AE, Rasmussen \u00c5K, Stochholm K. Incidence, treatment, and survival of adrenocortical carcinoma in Denmark 2003-2019. J Endocr Soc, 2024, 8(3):bvae012. https:\/\/doi.org\/10.1210\/jendso\/bvae012","DOI":"10.1210\/jendso\/bvae012"},{"key":"ref25","unstructured":"[26] Li L, Dou J, Gu W, Yang G, Du J, Yang L, Zang L, Wang X, Jin N, Ouyang J, L\u00fc Z, Ba J, Mu Y, Lu J, Li J, Pan C. [Clinical analysis of 4 049 hospitalized cases of adrenal lesions]. Zhonghua Yi Xue Za Zhi, 2014, 94(42):3314-3318."},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"[27] Berends AMA, Buitenwerf E, de Krijger RR, Veeger NJGM, van der Horst-Schrivers ANA, Links TP, Kerstens MN. Incidence of pheochromocytoma and sympathetic paraganglioma in the Netherlands: a nationwide study and systematic review. Eur J Intern Med, 2018, 51:68-73. https:\/\/doi.org\/10.1016\/j.ejim.2018.01.015","DOI":"10.1016\/j.ejim.2018.01.015"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"[28] Ponzoni M, Bachetti T, Corrias MV, Brignole C, Pastorino F, Calarco E, Bensa V, Giusto E, Ceccherini I, Perri P. Recent advances in the developmental origin of neuroblastoma: an overview. J Exp Clin Cancer Res, 2022, 41(1):92. https:\/\/doi.org\/10.1186\/s13046-022-02281-w","DOI":"10.1186\/s13046-022-02281-w"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"[29] Allolio B, Fassnacht M. Clinical review: adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab, 2006, 91(6):2027-2037. https:\/\/doi.org\/10.1210\/jc.2005-2639","DOI":"10.1210\/jc.2005-2639"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"[30] Hsing AW, Nam JM, Co Chien HT, McLaughlin JK, Fraumeni JF Jr. Risk factors for adrenal cancer: an exploratory study. Int J Cancer, 1996, 65(4):432-436. https:\/\/doi.org\/10.1002\/(SICI)1097-0215(19960208)65:4<432::AID-IJC6>3.0.CO;2-Y","DOI":"10.1002\/(SICI)1097-0215(19960208)65:4<432::AID-IJC6>3.0.CO;2-Y"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"[31] Huang BL, Liu Q, Teng YY, Peng SQ, Liu Z, Li ML, Liang JY, Zhang Y, Wang M. Global trends and current status in pheochromocytoma: a bibliometric analysis of publications in the last 20 years. Front Endocrinol (Lausanne), 2023, 14:1167796. https:\/\/doi.org\/10.3389\/fendo.2023.1167796","DOI":"10.3389\/fendo.2023.1167796"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"[32] Wagnerova H, Lazurova I, Felsoci M. Adrenal metastases. Bratisl Lek Listy, 2013, 114(4):237-240. https:\/\/doi.org\/10.4149\/BLL_2013_049","DOI":"10.4149\/BLL_2013_049"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"[33] Samsel R, Cichocki A, Roszkowska-Purska K, Papierska L, Koalasi\u0144ska-\u0106wik\u0142a A, Karpeta E, Ostrowski T, Nowak K. Adrenal metastases - long-term results of surgical treatment, single-centre experience. Contemp Oncol (Pozn), 2020, 24(1):29-33. https:\/\/doi.org\/10.5114\/wo.2020.93679","DOI":"10.5114\/wo.2020.93679"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"[34] K\u00e4lvi\u00e4inen-Mej\u00eda HK, Sancho-Pardo P, Miguelena-Bobadilla JM, Casamayor-Franco MC, Dob\u00f3n-Rasc\u00f3n MA. Surgery of the adrenal metastases. Cir Cir, 2021, 89(6):728-732. https:\/\/doi.org\/10.24875\/CIRU.20000932\"","DOI":"10.24875\/CIRU.20000932"}],"container-title":["Romanian Journal of Morphology and Embryology"],"original-title":[],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T12:42:53Z","timestamp":1756730573000},"score":1,"resource":{"primary":{"URL":"https:\/\/rjme.ro\/archive\/66\/2\/7\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,20]]},"published-print":{"date-parts":[[2025,8,27]]}},"URL":"https:\/\/doi.org\/10.47162\/rjme.66.2.07","relation":{},"ISSN":["1220-0522","2066-8279"],"issn-type":[{"value":"1220-0522","type":"print"},{"value":"2066-8279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]}}}