A multidisciplinary approach to the management of adrenal incidentaloma

Expert Rev Endocrinol Metab. 2021 Jul;16(4):201-212. doi: 10.1080/17446651.2021.1948327. Epub 2021 Jul 9.

Abstract

An adrenal incidentaloma (AI) is an adrenal neoplasm incidentally discovered during an imaging unrelated to suspected adrenal disease. The aim of the present review is to offer practical guidance on the multidisciplinary approach of AIs.Areas covered:The prevalence of AI is high in the aging population (up to 5-8%); however, hormonally active or malignant conditions are rare. After the discovery of an AI, it is suggested to assess in parallel if the mass is potentially malignant and functionally active. The answer to the former question is mainly based on medical history (extra-adrenal malignancies, new-onset of signs or symptoms) and imaging (conventional radiology and/or nuclear medicine). The answer to the latter question is a complete endocrine evaluation of both cortical (glucocorticoids, mineralocorticoids) and medullary (catecholamines) secretion.Expert opinion:A multidisciplinary discussion is suggested for patients with adrenal disease, after the exclusion of nonfunctioning benign cortical adenoma, in order to plan a close and tailored follow-up for the suspected malignant or functioning forms. Surgery is advised for patients with malignant disease (adrenocortical cancer) or with clinically relevant secreting neoplasm (primary aldosteronism, Cushing's syndrome, and pheochromocytoma).

Keywords: Multidisciplinary approach; adrenal incidentaloma; adrenocortical cancer; pheochromocytoma; primary aldosteronism; surgery.

Publication types

  • Review

MeSH terms

  • Adrenal Gland Neoplasms* / diagnosis
  • Adrenal Gland Neoplasms* / epidemiology
  • Adrenal Gland Neoplasms* / therapy
  • Aged
  • Cushing Syndrome*
  • Humans
  • Incidental Findings
  • Pheochromocytoma* / diagnosis
  • Pheochromocytoma* / epidemiology
  • Pheochromocytoma* / therapy

Supplementary concepts

  • Adrenal incidentaloma