Adrenal Incidentalomas: Diagnostic Evaluation and Long-Term Follow-up

Vilar, Lúcio; Freitas, Maria da Conceição; Canadas, Viviane; Albuquerque, José de Lima; Botelho, Carlos; Egito, Célia S.; Arruda, Maria Juliana; Silva, Lidiane Moura e; Coelho, Carlos E.; Casulari, Luíz Augusto; Naves, Luciana Ansaneli

doi:10.4158/ep.14.3.269

Cited by 20 publications

(10 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…• Included: We identified 37 studies for inclusion in the systematic review (49,52,61,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112), with only 18 of them fulfilling the criteria for inclusion in the actual meta-analysis (61,79,80,81,82,83,84,85,86,87,88,89,90,91...…”

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,307

1,571

View full text Add to dashboard Cite

By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

show abstract

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,307

1,571

View full text Add to dashboard Cite

show abstract

“…Subclinical Cushing's syndrome has been associated with a higher prevalence of obesity, hypertension, hyperlipidemia, glucose intolerance, and osteopenia [7], and subclinical pheochromocytomas may lead to hypertension but yet be missed even on hormonal screening. These subclinical variants make the evaluation more complex.…”

Section: Functional Tumorsmentioning

confidence: 99%

“…In their 1999 review of the literature, Neri and Nance [3] described 34% of all adrenal cysts presenting incidentally, with 39% presenting due to abdominal pain or mass/fullness; however, the true percentage of incidental lesions is likely higher, as the data represented a mixture of historical and modern imaging eras. Adrenal incidentalomas, a blanket term for adrenal masses (>1 cm) serendipitously identified on radiologic imaging studies [6,7], may be seen in 5-9% of the general population [8,9]. Of these, it is estimated that 4-22% represent adrenal cysts (Table 1) [6, 7, 10, 11•].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of the Adrenal Cyst

Wedmid

Palese

2010

Curr Urol Rep

View full text Add to dashboard Cite

Adrenal cysts, first described in 1670, typically presented with abdominal pain or palpable mass. In the modern era, incidentally identified adrenal cysts are commonplace, as imaging studies have become a mainstay in patient evaluation. The rubric of adrenal cysts comprises a broad differential diagnosis, rendering definitive diagnosis and subsequent management difficult. These cysts are categorized into four subtypes: endothelial, pseudocyst, epithelial, and parasitic. Endocrine workup should rule out functional status. Radiologic differentiation is helpful; however, imaging characteristics, such as hemorrhage in a pseudocyst, can confound identification of benign versus malignant lesions. Any functional lesion, potentially malignant lesion, or benign lesion more than 5 cm in diameter deserves surgical treatment. For small, benign lesions, conservative management is a viable option, although no surveillance protocols have been described.

show abstract

“…Over 600 cases of adrenal cysts have been documented worldwide in medical literature. Most of these are found incidentally on imaging 12. The presentation of symptomatic cysts varies considerably from abdominal fullness to hypovolaemic shock.…”

Section: Discussionmentioning

confidence: 99%

A unique presentation of a complex haemorrhagic adrenal pseudocyst

et al. 2016

View full text Add to dashboard Cite

A man aged 33 years presented with a 3-day history of left-sided testicular discomfort. Clinical examination revealed a large left-sided varicocele. He was referred for a testicular ultrasound, which demonstrated a moderate left-sided varicocele and an associated large suprarenal mass. An urgent (CT) scan was arranged which confirmed this, with associated compression of adjacent structures, including the left kidney and left renal vessels. The patient was admitted 1 week following the CT scan with features of sepsis. An inpatient adrenal MRI scan suggested the presence of a large left-sided haemorrhagic adrenal cyst. This was removed surgically through a left subcostal incision. Histology confirmed there was no malignancy. The patient was discharged and a follow-up CT scan at 6 months showed complete resolution of the cyst with no further testicular discomfort. This is the first known case of an adrenal cyst presenting with a varicocele.

show abstract

Adrenal Incidentalomas: Diagnostic Evaluation and Long-Term Follow-up

Cited by 20 publications

References 39 publications

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Diagnosis and Treatment of the Adrenal Cyst

A unique presentation of a complex haemorrhagic adrenal pseudocyst

Contact Info

Product

Resources

About