Vnitr Lek 2015, 61(10):852-857
Adrenal incidentaloma
- IV. interní hematologická klinika LF UK a FN Hradec Králové, přednosta doc. MUDr. Pavel Žák, CSc.
Incidentaloma is an adrenal mass discovered serendipitously. Because of increasing use of imaging techniques it is a common finding, being present in more than 1 % of adults. During work-up malignancy has to be ruled out. Classically imaging using CT or MRI is used. Recently PET-CT with FDG has been used more often as its sensitivity for diagnosis of malignancy is about 97 % and specificity 91 %. Hormonal evaluation should diagnose subclinical hypercortisolism. (Dexamethasone Suppression Test is the method of choice). Aldosterone and Renin should be measured only in patients with hypertension and catecholamines in tumours with higher native density than 10 HU. During follow-up repeated CT scan are needed only in selected patients and the need of routine biochemical follow-up has been questioned as well.
Keywords: adrenal adenoma; adrenal incidentaloma; hormonal tests; imaging; pheochromocytoma
Received: August 17, 2015; Accepted: September 25, 2015; Published: October 1, 2015 Show citation
References
- Lewinsky BS, Grigor KM, Symington T et al. The clinical and pathologic features of "non-hormonal" adrenocortical tumors. Report of twenty new cases and review of the literature. Cancer 1974; 33(3): 778-790.
Go to original source...
- Griffing GT. A-I-D-S: the new endocrine epidemic. J Clin Endocrinol Metab 1994; 79(6): 1530-1531.
Go to original source...
- Kloos RT, Gross MD, Francis IR et al. Incidentally discovered adrenal masses. Endocr Rev 1995; 16(4): 460-484.
Go to original source...
- Russi S, Blumenthal HT. Small adenomas of the adrenal cortex in hypertension and diabetes. Arch Intern Med 1945; 76: 284-291.
Go to original source...
Go to PubMed...
- Russell RP, Masi AT, Richter ED. Adrenal cortical adenomas and hypertension. A clinical pathologic analysis of 690 cases with matched controls and a review of the literature. Medicine (Baltimore) 1972; 51(3): 211-225.
Go to original source...
Go to PubMed...
- Herrera MF, Grant CS, van Heerden JA et al. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991; 110(6): 1014-1021.
Go to PubMed...
- Paterson F, Theodoraki A, Amajuoyi A et al. Radiology reporting of adrenal incidentalomas - who requires further testing? Clin Med 2014; 14(1): 16-21.
Go to original source...
Go to PubMed...
- Davenport C, Liew A, Doherty B et al. The prevalence of adrenal incidentaloma in routine clinical practice. Endocrine 2011; 40(1): 80-83.
Go to original source...
Go to PubMed...
- Annamalai AK, Gurnell M. Adrenal incidentaloma, What's new?, Practice points. Medicine 2013; 41(9): 532-535.
Go to original source...
- De Leo M, Cozzolino A, Colao A et al. Subclinical Cushing's syndrome. Best Pract Res Clin Endocrinol Metab 2012; 26(4): 497-505.
Go to original source...
Go to PubMed...
- Reincke M. Subclinical Cushing's syndrome. Endocrinol Metab Clin North Am 2000; 29(1): 43-56.
Go to original source...
Go to PubMed...
- Di Dalmazi G, Vicennati V, Rinaldi E et al. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur J Endocrinol 2012; 166(4): 669-677.
Go to original source...
Go to PubMed...
- Iacobone M, Citton M, Viel G et al. Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing's syndrome. Surgery 2012; 152(6): 991-997.
Go to original source...
Go to PubMed...
- Stewart PM. Is Subclinical Cushing's Syndrome an Entity or a Statistical Fallout from Diagnostic Testing? Consensus Surrounding the Diagnosis Is Required before Optimal Treatment Can Be Defined. J Clin Endocrinol Metab 2010; 95(6): 2618-2620.
Go to original source...
Go to PubMed...
- Mantero F, Terzolo M, Arnaldi G et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000; 85(2): 637-644.
Go to original source...
- Lau J, Balk E, Rothberg M et al. Management of clinically inapparent adrenal mass. Evid Rep Technol Assess (Summ) 2002; (56): 1-5.
- Mansmann G, Lau J, Balk E et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004; 25(2): 309-340.
Go to original source...
Go to PubMed...
- Boland GW, Lee MJ, Gazelle GS et al. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 1998; 171(1): 201-204.
Go to original source...
Go to PubMed...
- Hammarstedt L, Thilander-Klang A, Muth A et al. Adrenal lesions: variability in attenuation over time, between scanners, and between observers. Acta Radiol 2013; 54(7): 817-826.
Go to original source...
Go to PubMed...
- McDermott S, O'Connor OJ, Cronin CG et al. Radiological evaluation of adrenal incidentalomas - Current methods and future prospects. Best Pract Res Clin Endocrinol Metab 2012; 26(1): 21-33.
Go to original source...
Go to PubMed...
- Caoili EM, Korobkin M, Francis IR et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 2002; 222(3): 629-633.
Go to original source...
Go to PubMed...
- Blake MA, Kalra MK, Sweeney AT et al. Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. Radiology 2006; 238(2): 578-585.
Go to original source...
Go to PubMed...
- Sangwaiya MJ, Boland GW, Cronin CG et al. Incidental adrenal lesions: accuracy of characterization with contrast-enhanced washout multidetector CT - 10-minute delayed imaging protocol revisited in a large patient cohort. Radiology 2010; 256(2): 504-510.
Go to original source...
Go to PubMed...
- Kamiyama T, Fukukura Y, Yoneyama T et al. Distinguishing adrenal adenomas from nonadenomas: combined use of diagnostic parameters of unenhanced and short 5-minute dynamic enhanced CT protocol. Radiology 2009; 250(2): 474-481.
Go to original source...
Go to PubMed...
- Boland GW, Dwamena BA, Jagtiani Sangwaiya M et al. Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology 2011; 259(1): 117-126.
Go to original source...
Go to PubMed...
- Kandathil A, Wong KK, Wale DJ et al. Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature. Endocrine 2015; 49(1): 6-26.
Go to original source...
Go to PubMed...
- Bencsik Z, Szabolcs I, Kovacs Z et al. Low dehydroepiandrosterone sulfate (DHEA-S) level is not a good predictor of hormonal activity in nonselected patients with incidentally detected adrenal tumors. J Clin Endocrinol Metab 1996; 81(5): 1726-1729.
Go to original source...
- Tanabe A, Naruse M, Nishikawa T et al. Autonomy of cortisol secretion in clinically silent adrenal incidentaloma. Horm Metab Res 2001; 33(7): 444-450.
Go to original source...
Go to PubMed...
- Eisenhofer G, Lenders JW, Linehan WM et al. Plasma normetanephrine and metanephrine for detecting pheochromocytoma in von Hippel-Lindau disease and multiple endocrine neoplasia type 2. N Engl J Med 1999; 340(24): 1872-1879.
Go to original source...
Go to PubMed...
- Masumori N, Adachi H, Noda Y et al. Detection of adrenal and retroperitoneal masses in a general health examination system. Urology 1998; 52(4): 572-576.
Go to original source...
Go to PubMed...
- van Berkel A, Lenders JW, Timmers HJ. Diagnosis of endocrine disease: Biochemical diagnosis of phaeochromocytoma and paraganglioma. Eur J Endocrinol 2014; 170(3): R109-R119.
Go to original source...
Go to PubMed...
- Leung K, Stamm M, Raja A et al. Pheochromocytoma: The Range of Appearances on Ultrasound, CT, MRI, and Functional Imaging. AJR Am J Roentgenol 2013; 200(2): 370-378. Erratum in AJR Am J Roentgenol 2013; 200(3):705.
Go to original source...
Go to PubMed...
- Sane T, Schalin-Jantti C, Raade M. Is biochemical screening for pheochromocytoma in adrenal incidentalomas expressing low unenhanced attenuation on computed tomography necessary? J Clin Endocrinol Metab 2012; 97(6): 2077-2083.
Go to original source...
Go to PubMed...
- Fischer E, Beuschlein F, Bidlingmaier M et al. Commentary on the Endocrine Society Practice Guidelines: Consequences of adjustment of antihypertensive medication in screening of primary aldosteronism. Rev Endocr Metab Disord 2011; 12(1): 43-48.
Go to original source...
Go to PubMed...
- NIH state-of-the-science statement on management of the clinically inapparent adrenal mass (incidentaloma). NIH Consens State Sci Statements 2002; 19(2).
- Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 2007; 356(6): 601-610.
Go to original source...
Go to PubMed...
- Zeiger MA, Thompson GB, Duh QY et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract 2009; 15(5): 450-453.
Go to original source...
Go to PubMed...
- Nieman LK. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab 2010; 95(9): 4106-4113.
Go to original source...
Go to PubMed...
- Terzolo M, Stigliano A, Chiodini I et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol 2011; 164(6): 851-870.
Go to original source...
Go to PubMed...
- Arnaldi G, Boscaro M. Adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab 2012; 26(4): 405-419.
Go to original source...
Go to PubMed...
- Cawood TJ, Hunt PJ, O'Shea D et al. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur J Endocrinol 2009; 161(4): 513-527.
Go to original source...
Go to PubMed...
- Pantalone KM, Gopan T, Remer EM et al. Change in adrenal mass size as a predictor of a malignant tumor. Endocr Pract 2010; 16(4): 577-587.
Go to original source...
Go to PubMed...
- Kastelan D, Kraljevic I, Dusek T et al. The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations? Eur J Endocrinol 2015; 173(2): 275-282.
Go to original source...
Go to PubMed...