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Review
. 2021 Nov;105(6):1047-1063.
doi: 10.1016/j.mcna.2021.06.009. Epub 2021 Sep 9.

Approach to the Patient with an Incidental Adrenal Mass

Xin He  1 , Patricia R Peter  2 , Richard J Auchus  3
Affiliations
Review

Approach to the Patient with an Incidental Adrenal Mass

Xin He et al. Med Clin North Am. 2021 Nov.

Abstract

Adrenal masses are frequently incidentally identified from cross-sectional imaging studies, which are performed for other reasons. The intensity of the approach to the patient with such a mass is tailored to the clinical situation, ranging from a quick evaluation to a detailed work-up. In all cases, the three components of the evaluation are clinical assessment, review of the images, and biochemical testing with the goal of ruling out malignancy and identifying hormonally active lesions. This article incorporates recent information to produce a logical, systematic assessment of these patients with risk stratification and proportionate follow-up.

Keywords: Adenoma; Adrenal; Aldosterone; Cortisol; Hypertension; Pheochromocytoma.

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Conflict of interest statement

Disclosure The authors have nothing to disclose.

Figures

Figure 1.
Figure 1.. Biochemical Screening for Hypercortisolemia
*Based on patient’s clinical features and/or if adrenal lesion >2.5cm ACTH = adrenocorticotropic hormone; DHEAS = dehydroepiandrosterone sulfate; DST = dexamethasone suppression test; LNSC = late-night salivary cortisol; UFC = 24h urine free cortisol
Figure 2.
Figure 2.. Biochemical Screening for Primary Aldosteronism
AVS = adrenal vein sampling; PRA = plasma renin activity, or direct renin – PRA of 1 ng/mL/h ~ direct renin of 10 pg/mL; MRA, mineralocorticoid receptor antagonist
Figure 3.
Figure 3.. Biochemical Screening for Pheochromocytoma*
*Recommend screening all adrenal nodules for pheochromocytoma, although future guidelines might only recommend screening if the nodule density is >10 Hounsfield units
See this image and copyright information in PMC

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