The Evaluation of Incidentally Discovered Adrenal Masses |
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| Institution: | 1. Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;2. Division of Endocrinology, Johns Hopkins Hospital, Baltimore, Maryland;3. Division of Endocrinology, Mayo Clinic, Rochester, Minnesota;4. Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Oregon Health & Sciences University, Portland, Oregon;5. Division of Endocrinology, University of Florida and the Malcolm Randall VAMC, Gainesville, Florida.;1. II. Department of Medicine, Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czechia;2. Bone Metabolism Unit, Affidea Prague, Prague, Czechia;3. Faculty of Medicine, Charles University, University Hospital, OsteoCentre, Institute of Clinical Biochemistry and Diagnostics, Hradec Kralove, Czechia;4. Hemodialysis Centre, University Hospital, Faculty of Medicine, Charles University Hradec Kralove, Czechia.;1. Department of Anesthesia and Intensive Care, Cochin University Hospital, 27 rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France |
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| Abstract: | Objective: The objective of this Disease State Clinical Review is to provide clinicians with a practical approach to the evaluation of incidentally discovered adrenal masses.Methods: A case-based clinical approach to the evaluation of adrenal masses is presented. Recommendations were developed using available prospective and randomized studies, cohort studies, cross-sectional studies, anecdotal observations, and expert opinions.Results: Incidentally discovered adrenal masses are common. The approach to the patient with an adrenal mass should involve assessment of malignant potential via imaging characteristics and adrenal hormone excess via clinical and biochemical features. The roles of biopsy, surgical or medical therapy, and longitudinal surveillance are also important to consider and are influenced by case-specific factors. Inappropriate or inadequate evaluations may put patients at increased risk for developing preventable adverse cardiometabolic outcomes or cancer.Conclusion: Incidentally discovered adrenal masses require a multimodal assessment that involves interpretation of multiple imaging characteristics, dynamic and static hormonal measurements, and a nuanced approach to considering interventional diagnostics, treatments, and longitudinal surveillance. Herein, we review these evaluations and provide a practical approach for clinicians.Abbreviations: ACTH = adrenocorticotropic hormone; CS = Cushing syndrome; CT = computed tomography; DHEAS = dehydroepiandrosterone sulfate; HU = Hounsfield units; MRI = magnetic resonance imaging; UFC = urinary free cortisol |
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