Jun 01, 2010 approximately 3 to 4 percent of ct and mri studies of the abdomen reveal an adrenal incidentaloma. An adrenal incidentaloma is an adrenal mass detected on imaging studies performed for indications other than to evaluate the adrenal gland. The tumor may be asymptomatic or can causes excessive secretion of adrenal hormones and resulting symptoms. Advances in imaging and the widespread availability of imaging technology has resulted in detection of. Adrenal lesions may present as incidentaloma, or may produce symptoms due to local mass effects i. Imaging of adrenal masses with emphasis on adrenocortical tumors. Adrenal lesions larger than 4 cm are usually biopsied. Mar 11, 2014 adrenal incidentalomas, defined as masses discovered incidentally during imaging investigation of non adrenal disorders, have become a rather common finding in clinical practice. When evaluating an incidentaloma, previous imaging. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention e. An adrenal incidentaloma is an adrenal mass, generally 1 cm or more in diameter, that is discovered serendipitously during a radiologic examination performed for indications other than an evaluation for adrenal disease.
Drug resistance and refractory hypertension need for 3 antihypertensive agents are common hallmarks of primary aldosteronism spontaneous hypokalemia serum potassium adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination. The 2 main concerns with regard to an adrenal incidentaloma ai are 1 whether it is hormonally active functional and 2 whether it is malignant. The definition of incidentaloma excludes patients undergo. Adrenal incidentaloma that grow greater than 1 cm on followup imaging. Nih stateofthescience statement on management of the.
The majority of these tumours are silent and express subtle forms of hypercortisolism. Due to the cumulative nature of medical research, some of the information in this statement is likely to be out of date. Clinicians must determine the nature of the mass to decide what treatment, if any, is needed. The prevalence is not well characterized and varies among studies. In medical or research imaging, an incidental finding commonly known as an incidentaloma is an unanticipated finding which is not related to the original diagnostic inquiry.
Adrenal incidentalomas are defined as adrenal masses larger than 1 cm in patients for whom imaging studies are being performed for an unrelated indication. We recommend that all patients with adrenal incidentalomas undergo a 1 mg overnight dexamethasone suppression test to exclude cortisol excess oo. A rare entity med j malaysia vol 72 no 1 february 2017 67 discussion adrenal leiomyoma is a rare solid tumour of unknown aetiology. Large adrenal leiomyoma presented as adrenal incidentaloma. Adrenal incidentaloma 92% of adrenal cortical carcinomas are 6 cm 25% of adrenal masses 6 cm are cancers 6% of adrenal masses 46 cms are cancers 2% of adrenal masses adrenal incidentaloma m terzolo, a stigliano1, i chiodini2, p loli3, l furlani4, g arnaldi5, g reimondo, a pia, v toscano1, m zini6, g borretta7, e papini8, p garofalo9, b allolio10, b dupas11, f mantero12 and a tabarin. Objectives work up for incidental adrenal tumors evaluating and treating functioning tumors pheochromocytoma hypercortisolism and hyperaldosteronism. However, with most adrenal incidentalomas labeled as nonfunctional adrenocortical adenomas re. As with other types of incidental findings, they may represent a diagnostic, ethical, and philosophical dilemma because the significance is unclear. Functional hormonally active adrenal incidentaloma. Adrenal incidentaloma subclinical cushings syndrome silent pheochromocytoma aldosteroneproducing adenoma introduction the term adrenal incidentaloma ai is a comprehensive definition for any adrenal mass discovered by noninvasive abdominal imaging techniques performed for reasons other than suspected adrenal disease. Mar 06, 2020 adrenal incidentalomas ais are a common finding on crosssectional abdominal images. Adrenal incidentaloma 92% of adrenal cortical carcinomas are 6 cm 25% of adrenal masses 6 cm are cancers 6% of adrenal masses 46 cms are cancers 2% of adrenal masses 1 cm, on radiologic examination done for reasons other than to investigate for. These masses may be hormonally active or nonfunctional and malignant or benign. Incidentaloma definition of incidentaloma by medical.
This entity is the result of technological advances in imaging such as computed tomography ct and magnetic resonance imaging mri and their widespread use in clinical practice. Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas. Incidentally discovered adrenal masses are becoming more common with the development of imaging techniques and constitute a significant clinical problem. Adrenal incidentalomas ais are a common finding on crosssectional abdominal images. For more current information on this and other health topics, please visit medlineplus, a service of the u. An incidentaloma is a radiological neologism to denote a lesion found incidentally and of dubious clinical significance. Colloquially, some radiologists use the term interchangeably with adrenal adenoma, although.
Work up and management quanyang duh professor of surgery university of california, san francisco no conflicts to declare surgical approach to adrenal incidentalomas. This journal cme activity is available in print and online as full text html and as a pdf that can be viewed andor printed using adobe acrobat reader. The incidental adrenal mass is a serendipitously discovered adrenal lesion, 1 cm, on radiologic examination done for reasons other than to investigate for primary adrenal dis ease. Initial management nathan hitzeman, md, and erin cotton. Prevalence of adrenal incidentaloma in a contemporary. The presence of adrenal incidentalomas has been shown in autopsy studies to occur in about 6% cases and this is mirrored by ct series young 2007. Generalized anxiety disorder understanding the nature of worry and anxiety duration. An adrenal incidentaloma is an adrenal mass that is generally 1 cm or more in diameter found incidentally during abdominal imaging done for other reasons 4, 5. Approach to the patient with an adrenal incidentaloma.
All patients with initial presentation or imaging workup for adrenal. Department of radiology karolinska university hospital, stockholm sweden. This journal cme activity is available in print and online as full text html and as a pdf that can be. An alternative algorithm for the imaging and clinical workup of adrenal incidentalomas is presented in an attempt to bridge sometimes conflicting recommendations. Adrenal mass incidental on ct an adrenal incidentaloma is defined as a mass or nodule 10mm or greater in size found on a ct scan or other imaging performed for an indication other than the evaluation of the adrenal glands. American association of clinical endocrinologists and. The identification of an adrenal mass as an incidental finding is common. When incidentally discovered adrenal masses are bilateral, a refined diagnostic approach is warranted since bilateral disease is more likely to be pathologic. The incidental adrenal lesion is the product of the expanding clinical indications of crosssectional imaging as well as the increasing spatial resolution of modern imaging techniques. Reported cases in the literature were less than 20.
Conclusion adrenal schwannoma is a rare type of adrenal incidentaloma discovered usually on imaging or autopsy. By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In medical imaging, an incidental finding commonly known as an incidentaloma is an unanticipated finding which is not related to the original diagnostic inquiry. A prediction model can accurately predict if an adrenal incidentaloma patient is at risk for malignancy or hormonal hyperfunction of the adrenal gland based on initial imaging features and patient demographics. Unsuspected adrenal masses, or incidentalomas, are increasingly found with the widespread use of thoracic and abdominal imaging. As with other types of incidental findings, those revealed during a medical or research imaging study may represent a diagnostic, ethical, and philosophical dilemma because the. National library of medicine, national institutes of health management of the clinically inapparent adrenal mass incidentaloma. The adrenal incidentaloma is an adrenal mass unexpectedly detected through an imaging procedure performed for reasons unrelated to adrenal dysfunction or suspected dysfunction 1. One percent of adrenal incidentalomas are associated with autonomous production of aldosterone.
Large adrenal leiomyoma presented as adrenal incidentaloma in an aids patient. The term incidentaloma refers to adrenal gland tumors greater than 1 cm in diameter and detected through an imaging procedure performed for unrelated reasons. Em medicina, um incidentaloma e um tumor oma encontrado por coincidencia incidental, sem sintomas clinicos ou suspeitas. Mar 06, 2020 terzolo m, bovio s, pia a, reimondo g, angeli a. Large adrenal leiomyoma presented as adrenal incidentaloma in.
Here, we present some background to the problem, an overview of adrenal disease, and a suggested approach to the adrenal incidentaloma. Clinicopathologic analysis and surgical outcome of adrenal lesionsa single centre experience a discrete focus of uptake in the thyroid gland by f18 fdg petct in a patient studied for nonthyroidal purposes is an incidentaloma. Adrenal incidentalomas, defined as masses discovered incidentally during imaging investigation of nonadrenal disorders, have become a rather common finding in clinical practice. Guidelines for the management of the incidentally discovered. An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination. Radiologic evaluation of incidentally discovered adrenal masses. The incidence of adrenal incidentaloma, a term coined in reference to the phenomenon of detecting an otherwise unsuspected adrenal mass on radiologic imaging, has been increasing and now approaches the 8.
Incidentaloma definition of incidentaloma by medical dictionary. Feb 24, 2010 approach to the patient with an adrenal incidentaloma. Management in british district general hospitals article pdf available in postgraduate medical journal 901065 march 2014 with 210 reads how we measure reads. Adrenal incidentaloma suny downstate medical center. The term adrenal incidentaloma ai is usually defined as an adrenal mass unexpectedly detected through an imaging procedure performed for reasons a priori unrelated to adrenal dysfunction or. N2 adrenal incidentalomas are incidentally discovered adrenal masses greater than 1 cm in diameter that appear to be clinically nonfunctioning. Size of an adrenal incidentaloma is an important variable in assessing malignant potential. Adrenal incidentaloma symptoms, diagnosis, treatments and. A tumor of the adrenal gland that is discovered incidentally while performing an imaging examination for reasons other than an adrenal tumor. Drug resistance and refractory hypertension need for 3 antihypertensive agents are common hallmarks of primary aldosteronism spontaneous hypokalemia serum potassium incidentalomas.
Estimated 5yr risk of adrenal incidentaloma enlargement or hyperfunction estimated at 20% so annual screening for phaeo and cortisol for 3 years. Management of the clinically inapparent adrenal mass. This helps in ruling out the other differential diagnosis. An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination 1. While some coincidental findings may lead to beneficial. The adrenal incidentaloma is a common incidental finding in our hospital. Biochemical investigation of an adrenal incidentaloma indication. Only 6 of 25 24% patients with an adrenal incidentaloma were further investigated with hormonal workup or imaging. Incidentally discovered adrenal masses incidentalomas are common and present challenges both in diagnosis and management. Correlation with the clinical presentation and, if necessary, serum chemical and urinalysis results should be used to determine whether an adrenal cortical adenoma is functional. Isolated adrenal metastasis multidisciplinary decision making required 7. The bosniak classification is a wellaccepted means of triaging renal incidentalomas. The incidental adrenal mass is a serendipitously discovered adrenal lesion, 1 cm, on radiologic examination done for reasons other than to investigate for primary adrenal disease.
In about 15% of all cases, abdominal computed tomography ct scans that are obtained for reasons other than the evaluation for possible adrenal neoplasm demonstrate an adrenal mass. Jeshtadi a et al schwannoma of adrenal gland j med allied sci 2014. The aim of the present study was to perform a prospective evaluation of the prevalence of adrenal incidentalomas among. However, there is no uniform policy for subsequent diagnostic procedure in these patients.
629 984 363 704 1016 41 1181 1178 1121 370 1022 1326 285 1397 122 846 1395 1326 1533 1456 1102 208 359 1081 95 729 24 1343 1316 1424 110 431 1119 797 51 692 845 602 1440 1076 1368 1178 657