The adrenal incidentaloma
- William F Young, Jr, MD, MSc
William F Young, Jr, MD, MSc
- Professor of Medicine
- Mayo Clinic College of Medicine
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Electron Kebebew, MD, FACS
Electron Kebebew, MD, FACS
- Senior Investigator
- Chief, Endocrine Oncology Branch
- National Cancer Institute
- Section Editors
- André Lacroix, MD
André Lacroix, MD
- Section Editor — Adrenal Disease
- Professor of Medicine
- University of Montreal, Quebec, Canada
- Sally E Carty, MD, FACS
Sally E Carty, MD, FACS
- Section Editor — Endocrine Surgery
- Professor, Chief, Division of Endocrine Surgery
- University of Pittsburgh School of Medicine
An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination . This entity is the result of technological advances in imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) and their widespread use in clinical practice. Discovery of an adrenal mass raises two questions that determine the degree of evaluation and the need for therapy :
●Is it malignant?
●Is it functioning?
The approach to the evaluation and management of adrenal incidentalomas is reviewed here. Detailed discussions of adrenal carcinoma and functioning adrenal tumors such as pheochromocytomas and aldosteronomas are found elsewhere. (See "Clinical presentation and evaluation of adrenocortical tumors" and "Clinical presentation and diagnosis of pheochromocytoma" and "Pathophysiology and clinical features of primary aldosteronism".)
Adrenal masses may be found incidentally when computed tomography (CT) scans or magnetic resonance imaging (MRI) is done for other reasons. In a study of 61,054 abdominal CT scans performed from 1985 to 1990, an incidental adrenal tumor (incidentaloma >1 cm) was detected in 259 patients (0.4 percent of all CT scans) . A subsequent study, utilizing higher resolution scanners, reported a prevalence of adrenal incidentaloma on abdominal CT of 4.4 percent . The prevalence of adrenal incidentaloma is higher in older patients (10 percent) .
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- Bilateral masses
- EVALUATION FOR MALIGNANCY
- Imaging phenotype
- - CT scan
- - MRI
- Imaging characteristics
- - Benign adenomas
- - Pheochromocytomas
- - Adrenocortical carcinoma
- - Adrenal metastases
- - Other
- Fine-needle aspiration biopsy
- EVALUATION FOR HORMONAL SECRETION
- Subclinical Cushing's syndrome
- - Clinical manifestations
- - Diagnosis
- Unilateral adrenal masses
- Bilateral adrenal masses
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS