Endocrinology Book

Adrenal Disease

  • Adrenal Mass

Growth Disorders

Thyroid Disease

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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
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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