Management of adrenal incidentaloma

• Published in: Journal of visceral surgery 2014-10, Vol.151 (5), p.355-364
• Main Authors: Menegaux, F, Chéreau, N, Peix, J.-L, Christou, N, Lifante, J.-C, Paladino, N.C, Sebag, F, Ghander, C, Trésallet, C, Mathonnet, M
• Format: Article
• Language: English
• Subjects: 3-Iodobenzylguanidine; Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - diagnostic imaging; Adrenal Gland Neoplasms - surgery; Adrenal Gland Neoplasms - therapy; Biopsy; Cortisone - blood; Humans; Incidental Findings; Positron-Emission Tomography; Surgery; Tomography, X-Ray Computed
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2014.07.002

Summary Improvements in medical imaging have resulted in the incidental discovery of many silent and unrecognized adrenal tumors. The term “adrenal incidentaloma” (AI) is applied to any adrenal mass ≥ 1 cm in its longest axis that is discovered incidentally during abdominal imaging that was not performed to specifically evaluate adrenal pathology. These incidentalomas may be either secretory or non-secretory, benign or malignant. Distinctive characteristics of these lesions must be determined by the clinician to determine appropriate management. Such distinctions are based on laboratory findings and imaging, principally CT with and without contrast injection. Investigations must be carefully chosen to avoid ordering unnecessary and expensive tests for too many patients while, at the same time, avoiding the risk of failing to diagnose a secreting malignant or tumor. These examinations will determine patient care: surgery or surveillance. When simple surveillance is chosen, specific criteria must be met with regard to diagnostic modalities (clinical, imaging, laboratory testing) and its duration.