Endocrinology Book

Adrenal Disease

  • Adrenal Mass

Growth Disorders

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Adrenal MassAka: Adrenal Incidentaloma

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  1. Epidemiology
    1. Incidental adrenal mass found on up to 1.3% CT Scans
    2. Incidental adrenal masses found in 20% of autopsies
  2. Differential Diagnosis of Incidental Adrenal Mass
    1. Adrenal Adenoma (51%)
      1. Non-functioning adenoma
      2. Functioning adenoma
        1. Cushing's Syndrome
        2. Pheochromocytoma
        3. Hyperaldosteronism
    2. Metastatic cancer (31%)
    3. Adrenal Carcinoma (4%)
    4. Adrenal Cyst (4%)
    5. Pheochromocytoma (4%)
    6. Adrenal Hyperplasia (2%)
    7. Lipoma (2%)
    8. Myelolipoma (2%)
  3. Labs
    1. Pheochromocytoma Screening
      1. Consider plasma free metanephrines (in all patients)
      2. 24-hour Urine Metanephrines
      3. 24-hour Urine Vanillylmandelic Acid (VMA)
    2. Cushing's Syndrome Screening
      1. Dexamethasone Suppression Test (in all patients)
      2. 24-hour Urinary free cortisol level
    3. Hyperaldosteronism Screening (hypertensive patients)
      1. Serum Potassium
      2. Plasma aldosterone to renin activity ratio
  4. Radiology: Reassuring CT signs suggestive of benign mass
    1. Lesions smaller than 4 cm with smooth borders
    2. Low attenuation (<10 Hounsfield Units) homogeneous mass
  5. Management
    1. Adrenal mass on CT Scan <4 cm in greatest diameter
      1. Asymptomatic with normal screening laboratory tests
        1. Repeat Adrenal CT in 3 months, then
        2. Repeat Adrenal CT every 6 months for 2 years
      2. Symptoms or signs of functioning adrenal adenoma
        1. Endocrinology referral
        2. Surgery usually indicated (esp. Pheochromocytoma)
    2. Adrenal mass on CT Scan 4 to 6 cm in greatest diameter
      1. Monitoring most often indicated unless functional
      2. Endocrinology or General Surgery referral
      3. Adrenal MRI
    3. Adrenal mass on CT Scan >6 cm in greatest diameter
      1. General Surgery referral
  6. References
    1. Cook (1996) Am J Med 101:88
    2. Grumbach (2003) Ann Intern Med 138:424
    3. Higgins (2001) Am Fam Physician 63:288

Adrenal mass (C0342500)

ConceptsDisease or Syndrome (T047)
EnglishAdrenal mass
Spanishmasa suprarrenal
Parent ConceptsMass of body structure (C0577559), Adrenal Gland Diseases (C0001621), Retroperitoneal mass (C0267771)
SourcesNCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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