Incidentally Discovered Adrenal Tumors: A Lesson from Observation of 1444 Patients

Kasperlik-Załuska, A; Otto, Maciej; Cichocki, Andrzej; Rosłonowska, E; Słowińska-Srzednicka, J; Jeske, Wojciech; Papierska, Lucyna; Zgliczyński, Wojciech

doi:10.1055/s-2008-1073167

Cited by 50 publications

(45 citation statements)

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“…Incydentaloma nadnercza jest nieprawidłową masą tkankową o średnicy ≥ 1 cm wykrytą przypadkowo w badaniu obrazowym klatki piersiowej lub jamy brzusznej [1][2][3][4]. Każda zmiana ogniskowa w rzucie nadnerczy stwierdzona w badaniu ultrasonograficznym (USG) wymaga potwierdzenia w badaniu tomografii komputerowej (CT, computed tompography) lub rezonansu magnetycznego (MR, magnetic resonance).…”

Section: Jakie Są Podstawowe Cele Diagnostyki I Leczenia Przypadkounclassified

“…An adrenal incidentaloma is a previously unsuspected adrenal mass with a diameter ≥ 1 cm discovered on chest or abdomen imaging examination [1][2][3][4]. Every suspicion of an adrenal lesion observed during ultrasound (US) must be confirmed by computed tomography (CT) or magnetic resonance imaging (MRI).…”

Section: The Basic Goals In the Diagnosis And Treatment Of Adrenalmentioning

confidence: 99%

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

Bednarczuk

Bolanowski

Sworczak

et al. 2016

Endokrynologia Polska

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Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations. Methods: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations. Imaging and hormonal assessment: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia. Treatment: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases. (Endokrynol Pol 2016; 67 (2): 234-258)

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Section: Jakie Są Podstawowe Cele Diagnostyki I Leczenia Przypadkounclassified

Section: The Basic Goals In the Diagnosis And Treatment Of Adrenalmentioning

confidence: 99%

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

Bednarczuk

Bolanowski

Sworczak

et al. 2016

Endokrynologia Polska

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“…[1][2][3] As mentioned above, SCS is considered to be related to certain metabolic derangements and clinical signs, such as glucose intolerance or diabetes mellitus, lipid abnormalities, hypertension, diffuse obesity and low bone mass, [14][15][16][17][18][19]51,153,154 which significantly improved after adrenalectomy. 14,16,18,51,153,154 In completely asymptomatic patients with normal plasma ACTH concentrations and in patients older than 75 years, a non-surgical approach is recommended. 2,51 Adrenalectomy is the treatment of choice for both PHEOs and aldosteronomas.…”

Section: B Non-surgical Managementmentioning

confidence: 99%

Adrenal incidentaloma: a diagnostic challenge

Anagnostis¹,

Karagiannis²,

Τζιόμαλος³

et al. 2009

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The widespread application of abdominal imaging procedures has resulted in an increased frequency of clinically silent adrenal masses. Adrenal incidentaloma (AI) is a term applied to an accidentally discovered adrenal mass on imaging performed for the investigation of an unrelated complaint. Adrenal incidentalomas (AIs) are a cluster of different pathologies, the majority of which are benign and non-functioning adrenal adenomas. However, mild hormonal alterations as well as metabolic abnormalities may be present in patients with AIs. Thus, a multidisciplinary approach with biochemical and radiologic evaluation is needed to characterize these lesions and identify patients who are at high risk for hormonal or malignant evolution. Significant new information has helped resolve controversies regarding the most reliable approach to this clinical problem. The present review considers the prevalence, pathology and natural history of AIs. We also discuss the reliability of available screening methods and localization techniques and consider optimal management and follow-up strategies.

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“…The prevalence of such incidentally discovered adrenal masses increases with age and is reported in more than 7% of patients aged over 70 (1). The major clinical concern in adrenal incidentaloma is the risk of malignancy and hormone overproduction, but the vast majority of adrenal masses are non-functional benign cortical adenomas that require no treatment (2,3,4,5,6).incidentaloma need to have high sensitivity and specificity in order to capture all the clinically important adrenal lesions and to avoid a high rate of false positive results. Guidelines for the management of adrenal incidentalomas suggest multiple repetitions of radiological and biochemical tests.…”

Section: Introductionmentioning

confidence: 99%

The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations?

Kaštelan

Kraljević

Dušek

et al. 2015

European Journal of Endocrinology

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Objective: The current guidelines for the management of adrenal incidentaloma advise hormonal and radiological follow-up of patients for 2-5 years after the initial diagnosis. However, the vast majority of adrenal incidentaloma are non-functional benign cortical adenomas that require no treatment, so the routine application of the current strategies often results in a number of unnecessary biochemical and radiological investigations. The aim of this study was to analyse the clinical course of patients with adrenal incidentaloma and to provide a critical review of the current management strategy of the disease. Design and methods: This was a retrospective study performed in the Croatian Referral Center for adrenal gland disorders. The study included 319 consecutive patients with adrenal incidentaloma, 174 of which were followed for at least 24 months. Results: The vast majority of patients were diagnosed with benign adrenal masses, whereas in about 5% of them adrenal tumor corresponded to adrenal carcinoma or metastasis. Tumor density was found to be superior to tumor size in distinguishing benign adrenal masses from malignant tumors and pheochromocytomas. During the follow-up, no patient demonstrated a clinically significant increase in tumor size. In addition, no changes, either in metanephrines and normetanephrines or in the activity of renin-aldosterone axis, were observed during the follow-up. Six patients developed subclinical Cushing's syndrome (SCS) whereas eight patients with SCS showed biochemical remission during follow-up. Conclusion: The study suggests that the risk of an adrenal mass initially diagnosed as benign and non-functional becoming malignant or hormonally active is extremely low. Therefore, the clinical management of those patients should be tailored on an individual basis in order to avoid unnecessary procedures.

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Incidentally Discovered Adrenal Tumors: A Lesson from Observation of 1444 Patients

Cited by 50 publications

References 10 publications

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

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

Adrenal incidentaloma: a diagnostic challenge

The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations?

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