Definition of an optimal strategy to evaluate and follow-up adrenal incidentalomas: time for further research

Abstract

Clinical endocrinologists have to deal frequently with adrenal incidentalomas in their practice. However, no comprehensive guidelines have been published by professional societies to guide assessment and management of adrenal incidentalomas and current recommendations are mainly based on the NIH state-of-the-science statement or expert opinions. An accompanying paper in this issue of the journal provides a critical revision of the relevant literature on this clinically important topic. The provocative conclusion of the authors is that current recommendations are burdened by high costs, little clinical benefit and also risk of inducing cancer. This paper has the merit to outline the limits of proposed protocols and to stimulate fruitful discussion; however, many aspects represent the personal view of the authors rather than evidence-based assumptions. The purpose of the present comment is to provide a more balanced view addressing the arguments that are condivisible and those that are based on inconsistent data. To add further to the argument of discussion, we also outline a clinically-oriented strategy for follow-up. In conclusion, the need for further research appears evident to define more efficient guidelines.European Journal of Endocrinology 161 529-532

AME Position Statement on adrenal incidentaloma

“…Accordingly, Nieman (163) advocated surgical treatment for patients with mild hypercortisolism when medical treatment fails or there is progression of clinical features. Patients who develop clinical signs of hormone excess, or experience worsening of their metabolic status and cardiovascular risk profile despite optimal medical treatment, should be re-tested for endocrine hyperfunction (164).…”

“…Patients with small tumors, !2 cm, do not need further imaging in most cases, but for larger tumors, the decision to proceed or not with follow-up imaging study should be judged on an individual basis, taking into consideration the characteristics of the mass, patient age, and history and results of endocrine work-up (164). Patients with SCS who do not reach the treatment goals of associated diseases potentially linked to hypercortisolism (i.e.…”

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

“…Control tests (both imaging and laboratory) should be planned individually taking into consideration such factors as tumour size, image and growth dynamics, clinical manifestations, hormonal tests results, as well as concomitant diseases, including neoplasms [57][58][59][60][61][62][63]. …”

“…Badania kontrolne (obrazowe i laboratoryjne) należy ustalać indywidualnie, biorąc pod uwagę między innymi wielkość, obraz i dynamikę wzrostu guza, objawy kliniczne, wyniki badań hormonalnych oraz choroby współistniejące (w tym choroby nowotworowe) [57][58][59][60][61][62][63].…”

Long-term study of subclinical Cushing^|^rsquo;s syndrome shows high prevalence of extra-adrenal malignancy in patients with functioning bilateral adrenal tumors

“…established because of variability of autonomous cortisol secretion among patients [3,4]. Although the dexamethasone suppression test (DST) has been recommended as a screening test for SCS, cortisol cutoff values differ by current criteria.…”