Adrenal Incidentaloma (Adrenaloma)

Abstract

The management of adrenalomas should include the following: 1. A detailed history and physical examination to detect subtle evidence of hormonal hypersecretion or the possibility of metastatic carcinoma. Hormonal studies:Short dexamethasone suppression test (2 mg of dexamethasone) followed by a high-dose dexamethasone suppression test (8 mg), CRH assay and analysis of the diurnal cortisol rhythm if serum cortisol value post dexamethasone is greater than 3ìg/dL 24-hour (or spot) urinary catecholamine metabolites (metanephrine and normetanephrine) In the hypertensive or normotensive patient with serum potassium less than 3.9 nmol/L, the upright aldosterone level to plasma renin activity (PRA) ratio. 3. Additional studies, such as Glucose tolerance test Bone mineral density evaluation Body composition and fat distribution by DEXA (Dual energy X-Ray absorptiometry). The role of .NA is limited. It may be helpful only in the patient with coexistent extradrenal carcinoma to confirm adrenal metastasis. Although genetic and molecular biology studies do not have wide clinical application, they should be encouraged and supported. Once all of these data are collected, the recommendations are: 1. All clearly nonfunctioning adrenalomas that are not suspicious for malignancy in asymptomatic patients should be observed for several years, mainly with hormonal studies, until their secretory and benign nature is confirmed. 2. All patients with adrenalomas and evidence of subclinical function, suspicion for malignancy (using size, imaging, .NA and molecular biology criteria) and symptoms, such as hypertension, obesity, impaired glucose tolerance, central fat deposition and reduced bone mineral density, should undergo laparoscopic adrenalectomy. The age, the overall medical condition and the anxiety of the patient should also be considered in the decision to operate on a patient with an adrenaloma.

Clinical Characteristics for 132 Patients with Adrenal Incidentaloma

“…Similarly, they are found in 4% of patients undergoing imaging with CT [2,15]. The prevalence of adrenal incidentalomas increases with age; the prevalence among people in their 20s and 30s is 0.2%, whereas it is about 7% in those over the age of 70 [16].…”

Adrenal incidentaloma: a diagnostic challenge

“…Excision is strongly supported for masses greater than 6cm in diameter (risk of malignancy up to 25% vs 2% for lesions smaller than 4cm), those demonstrating suspicious imaging features (rapid growth rate, heterogeneity, irregular shape, calcifications, necrosis, invasion of adjacent structures) and hormonal hypersecretion. [1][2][3]21,139 Others recommend a threshold of 5cm in diameter for surgery. 13,36,71,140 However, it must be stated that the parameter "size" determined by CT should be assessed with care because it is often underestimated.…”

“…13,36,71,140 However, it must be stated that the parameter "size" determined by CT should be assessed with care because it is often underestimated. 80,139,141 When a mass displays attenuation values >10HU on unenhanced CT, a delayed contrast-enhanced CT should be performed. If the percentage of washout at 10min is less than 50%, adrenalectomy should be seriously considered.…”

“…Most researchers have reported favourable outcomes after LA in terms of intra-and postoperative complications and local or port site recurrences at variable follow-up times. 1,3,21,71,139,[147][148][149][150][151][152] …”

Radiology of the adrenal incidentalomas. Review of the literature

“…On contrast-enhanced studies, carcinomas enhance avidly due to their vascularity. Th e pattern of enhancement can be homogeneous, unless there is central necrosis (Dunnick and Korobkin 2002;Lockhart et al 2002;Ilias et al 2007;Young Jr 2007). Th e relative percentage washout of carcinomas is <40% (Slattery et al 2006).…”