Management of incidentally discovered adrenal masses and risk of malignancy

Favia, Gennaro; Lumachi, Franco; Basso, Stefano M.M.; D’Amico, Davide

doi:10.1067/msy.2000.109965

Cited by 79 publications

(33 citation statements)

References 20 publications

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“…In fact, the probability of malignancy increases as a function of mass size. A review of more than 1300 tumors reported in non-surgical series in the last 10 years (16,20,53,56,58,62,64) shows that incidence of malignant neoplasms is significantly higher for masses greater than 4 cm in size (Fig. 1).…”

Section: Side and Size Distributionmentioning

confidence: 99%

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

559

414

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Clinically silent adrenal masses discovered by imaging studies performed for unrelated reasons, i.e. adrenal incidentalomas, have become a rather common finding in clinical practice. However, only limited studies of incidence, prevalence, and natural history of adrenal incidentalomas are available. A comprehensive review of the literature shows the prevalence of adrenal incidentalomas to be 2.3% at autopsy and 0.5 -2% at abdominal computed tomography scan. Most lesions are adrenocortical adenomas at histology, whereas the prevalence of adrenocortical carcinomas is relatively low. The risk of malignancy over time for masses defined as benign at diagnosis is estimated at about 1/1000, even though 5-25% of masses increase in size during follow-up. Hyperfunction develops in about 1.7% of cases and the risk is higher in patients with lesions larger than 3 cm. Cortisol hypersecretion is the most likely disorder that may ensue, and it remains subclinical in about two-thirds of cases. The lack of controlled studies precludes making specific management recommendations. Large perspective controlled studies to define the epidemiology, natural history, and possible associated morbidity of adrenal incidentalomas and their impact on the quality of life of patients are needed.

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Section: Side and Size Distributionmentioning

confidence: 99%

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

559

414

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“…However, as this is a clinically frequent scenario, we will address this in a specific chapter (see 5.6.3). Previous recommendations and reviews (1,2,3,4,5,6,7,8,9,10,11,12,13) have not considered adrenal incidentalomas smaller than 1 cm. Although this cut-off is obviously somewhat arbitrary, we agree with this approach and would perform additional diagnostic work-up only in lesions ≥1 cm unless clinical signs and symptoms suggestive of adrenal hormone excess are present.…”

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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

1,310

1,571

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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...

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“…1,2 Although FNA biopsy of the adrenal gland is an rare sampling technique in all cytology services, several investigators have reported their experience with percutaneous image-guided (computed tomographic [CT] or ultrasonographic) FNA of this organ. [3][4][5][6][7][8][9][10][11] Those reports underscore the value of FNA biopsy of the adrenal glands.…”

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confidence: 99%