Materiały źródłowe

• #1 Benign adrenal tumors – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-adrenal-tumors/symptoms-causes/syc-20356190

  Benign adrenal tumors are masses that aren’t cancer. They form in the adrenal glands. The adrenal glands are part of the endocrine system. These glands make hormones that send messages to nearly every organ and tissue in the body. […] Most benign adrenal tumors cause no symptoms and don’t need treatment. But sometimes these tumors make high levels of some hormones that can cause problems. […] Symptoms depend on whether the tumor makes hormones, what hormone it makes and how much it makes. But many benign adrenal gland tumors don’t cause symptoms because they don’t make hormones. […] The most common type of benign adrenal tumor, called adenoma, comes from the adrenal cortex. […] A type of benign adrenal tumor from the medulla is called pheochromocytoma. […] The cause of benign adrenal tumors often is not known. […] The following might raise the risk of developing a benign adrenal tumor: A family history of benign adrenal tumors. Certain syndromes passed through families, called genetic syndromes, that make benign adrenal tumors more likely. A history of having an adrenal tumor surgically removed.

• #1 Benign adrenal tumors | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/benign-adrenal-tumors

  Benign adrenal tumors often are found by chance on imaging that’s done for another reason. A healthcare professional then looks at how likely the tumor is to be cancer and whether it’s making too much hormone. […] Along with a physical exam, a healthcare professional runs blood and urine tests to see if the tumor is making too much hormone. The tests also show which hormone the tumor is making. […] Imaging tests can give more details about the tumor. They can show whether the tumor is at high risk of being a cancer, which is rare. […] Imaging tests might include: CT scan. This type of scan takes a series of X-ray images from different angles and makes them into cross-sectional images. MRI. This type of scan uses radio waves and a magnetic field to make detailed images. M-iodobenzylguanidine (MIBG) imaging. This type of scan uses a radioactive compound that’s injected into the body. Some adrenal gland tumors take up the compound. The image can show tiny amounts of the compound that are picked up by a tumor. Positron emission tomography (PET). This type of scan also can detect radioactive compounds taken up by a tumor. Ga-DOTATATE PET scanning. This newer imaging test isn’t widely offered. Ga-DOTATATE PET scanning is done along with either a CT scan or an MRI. This type of test is good at finding tumors of the endocrine system, such as benign adrenal tumors.

• #1 Benign adrenal tumors – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-adrenal-tumors/diagnosis-treatment/drc-20567035

  Benign adrenal tumors often are found by chance on imaging that’s done for another reason. A healthcare professional then looks at how likely the tumor is to be cancer and whether it’s making too much hormone. […] Along with a physical exam, a healthcare professional runs blood and urine tests to see if the tumor is making too much hormone. The tests also show which hormone the tumor is making. […] Imaging tests can give more details about the tumor. They can show whether the tumor is at high risk of being a cancer, which is rare. […] Imaging tests might include: CT scan. This type of scan takes a series of X-ray images from different angles and makes them into cross-sectional images. MRI. This type of scan uses radio waves and a magnetic field to make detailed images. M-iodobenzylguanidine (MIBG) imaging. This type of scan uses a radioactive compound that’s injected into the body. Some adrenal gland tumors take up the compound. The image can show tiny amounts of the compound that are picked up by a tumor. Positron emission tomography (PET). This type of scan also can detect radioactive compounds taken up by a tumor. Ga-DOTATATE PET scanning. This newer imaging test isn’t widely offered. Ga-DOTATATE PET scanning is done along with either a CT scan or an MRI. This type of test is good at finding tumors of the endocrine system, such as benign adrenal tumors.

• #1 Adenoma of the Adrenal Gland: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17769-adrenal-adenoma

  Adrenal adenomas are benign (noncancerous) tumors in your adrenal glands. Your healthcare provider will first determine whether a tumor is cancerous (for example, adrenocortical carcinoma) or benign (for example, adrenal adenoma). If its an adrenal adenoma, theyll perform tests to determine whether its secreting excess hormones. […] Your healthcare provider will perform a physical exam and ask you about your symptoms and medical history. They may perform any of the following tests to learn more about your tumor: […] A blood or urine test allows your healthcare provider to check for elevated hormone levels that may be a sign of a functioning tumor. You may need to collect your urine for 24 hours so they can test it for elevated cortisol. […] A CT scan is the most commonly used imaging procedure used to diagnose adrenal adenoma. In some instances, your healthcare provider may order an MRI instead. Imaging helps them determine whether a tumor is malignant or benign.

• #1 Incidental adrenal masses – A primary care approach

  https://www.racgp.org.au/afp/2017/june/incidental-adrenal-masses-a-primary-care-approach

  Overall, benign, non-functioning adrenal adenomas account for about 80% of adrenal incidentalomas. […] Evaluation of incidentalomas is to determine whether there are clinical (or subclinical) manifestations and malignant potential, which may be primary or secondary. […] Almost 20% of patients with adrenal incidentalomas have subclinical hormonal abnormalities, which have been associated with an increased risk of metabolic, cardiovascular and bone diseases. […] Although primary malignancy of the adrenal is rare, with an incidence of 0.52 per 1 million, it is highly aggressive and has a poor prognosis, highlighting the importance of thorough clinical evaluation. […] In the evaluation of adrenal lesions, the clinician must ask: Is the adrenal lesion functional or nonfunctional? Is the adrenal lesion benign or malignant?

• #1 X-Rays, CT Scans, MRI, and Other Tests for Adrenal Glands

  https://www.adrenal.com/adrenal-tumors/scans

  Scans and x-rays play a major role in the diagnosis and treatment of adrenal gland tumors and masses. The CT scan is the most useful scan but other x-rays and scans can sometimes be useful in diagnosing adrenal tumors and planning adrenal surgery. […] There are 4 primary radiological (x-ray) tests to examine the adrenal glands (and the rest of the abdomen) for the presence of a tumor (the word „tumor” simply means „mass”. These can be benign or malignant). […] The gold standard of adrenal imaging is a CT scan (CAT scan). An adrenal-protocol, contrast enhancement CT scan is best. Thus, a CT scan of the adrenal with and without contrast should always be the first scan ordered, and in more than 90% of cases, the ONLY scan a patient will need. […] The absolute percentage washout (APW) of contrast from the adrenal tumor can then be calculated using a formula. The relative percentage washout (RPW) is used when unenhanced CT value is not available. If the APW is 60% or RPW is 40% after 15-min from contrast administration, this is indicative of benign adenoma, with sensitivity and specificity of 88% and 96% at the APW and sensitivity and specificity of 83% and 93% at the RPW, respectively.

• #1 Distinguishing benign from malignant adrenal masses | Cancer Imaging | Full Text

  https://cancerimagingjournal.biomedcentral.com/articles/10.1102/1470-7330.2003.0006

  The approach to the radiological and clinical evaluation of adrenal masses in the oncologic and non-oncologic patient is discussed. […] The roles of magnetic resonance imaging and positron emission tomography in distinguishing benign from malignant adrenal masses will also be discussed. […] Most adrenal cancers do function, and can be diagnosed by elevated biochemical markers and therefore distinguished from incidental adenomas. […] If an adrenal mass measures 0 HU (Hounsfield units) or less on unenhanced CT, the likelihood of it being a benign mass is almost 100%. […] Specificities of more than 90% were achieved for the separation of adenomas from malignant lesions in these two studies, using a threshold washout percentage of greater than 50%. […] Chemical-shift MRI is now the most commonly used imaging technique to distinguish between adenomas and metastases.

• #1 Incidental adrenal masses – A primary care approach

  https://www.racgp.org.au/afp/2017/june/incidental-adrenal-masses-a-primary-care-approach

  The two primary predictors of malignancy within an adrenal incidentaloma are the size of the mass and imaging characteristics on computed tomography (CT) or magnetic resonance imaging (MRI). […] The risk of malignancy within an incidental adrenal mass increases with size: 25% of adrenal lesions 4 cm, 6-10% of tumours between 4 and 6 cm, and 25% of tumours 6 cm have been found to be malignant. […] Therefore, non-functioning adenomas 4 cm with benign imaging characteristics can be safely monitored. […] Imaging phenotypes other than size can suggest malignancy. […] Regardless of the imaging modality used, patients with suspicious imaging characteristics should be considered for urgent surgical referral. […] The two factors that affect management decisions for adrenal incidentalomas are the functional status of the lesion and malignant potential.

• #1 How to Differentiate Benign from Malignant Adrenocortical Tumors?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8431066/

  Adrenocortical carcinoma is a rare cancer with a poor prognosis. Discrimination between benign and malignant adrenal tumors is of great importance to determine the appropriate treatment and follow-up strategy. This review summarizes the current diagnostic strategies and challenges to distinguish benign from malignant adrenal lesions. […] Diagnosis of ACC starts with a thorough physical examination, biochemical evaluation, and imaging. Computed tomography is the first-level imaging modality in adrenal tumors, with tumor size and Hounsfield units being important features for determining malignancy. […] The Weiss score is used for diagnosis of ACC, consisting of nine histopathological criteria. […] The European Network for the Study of Adrenal Tumors (ENSAT) classification is the currently used staging system for ACC and has an accuracy of 83% in predicting 3-year cancer-specific mortality.

• #1 How to Differentiate Benign from Malignant Adrenocortical Tumors?

  https://www.mdpi.com/2072-6694/13/17/4383

  The Weiss score is currently the most widely used scoring system for ACC and represents the gold standard. […] In a revised and simplified Weiss score, only five instead of nine items are scored, with a maximum score of seven. […] The Helsinki score can be used not only for diagnosing conventional ACC, but also for oncocytic and myxoid variants. […] The diagnostic potential of the features and markers that are discussed in this review is shown in Table 4. Accurate diagnosis of malignancy is crucial in order to guide the decision on adrenalectomy, for prognosis stratification, and to determine the intensity and duration of follow-up.

• #1 Adrenal Mass Symptoms, Diagnosis, and Treatment | Saint John’s Cancer Institute – Santa Monica, CA

  https://www.saintjohnscancer.org/endocrine/conditions/adrenal-masses/

  Adrenal masses are present in 5-10% of all individuals and the gross majority are benign. […] The diagnostic workup of adrenal masses consists of blood tests, sometimes urine tests, and imaging which determine if the adrenal mass is producing hormones and if it has suspicious imaging features. […] There is no role for needle biopsy unless a tumor is strongly felt to be a metastatic lesion from another cancer, and this would be done after a hormone producing tumor is ruled out.

• #1 Adrenal Incidentaloma: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/116587-overview

  Because adrenal metastases may be found in as many as 25% of patients with known primary lesions, radiologists frequently face the task of determining whether an adrenal mass is benign or malignant. The question can directly affect the clinical management of the case. […] The treatment for a hormonally active (functional) adrenal tumor is surgery. The treatment for a malignancy depends on the cell type, spread, and location of the primary tumor. […] Nonfunctional adrenal cortical adenomas are not premalignant, and surgical excision is not indicated. […] Adrenal fine-needle aspiration (FNA) helps to identify metastatic, systemic, and hemorrhagic disease of the adrenal glands. It cannot distinguish between benign and malignant primary adrenal tumors and should be used only when an AI cannot be diagnosed clinically or hormonally.

• #1 Urinary Steroid Profile Assay

  https://news.mayocliniclabs.com/2019/11/26/a-breakthrough-in-distinguishing-benign-adrenal-tumors-from-cancerous-ones/

  Mayo Clinic’s Clinical Mass Spectrometry Laboratory (CMSL) has added a new, noninvasive, and more accurate test to diagnose malignant adrenal tumors, via urinary steroid profiling. […] “Our new test for adrenal cortical carcinoma will differentiate this rare and lethal tumor from benign adrenocortical adenomas (ACAs), including those that overproduce corticosteroids, or mineral steroids, or sex steroids, or those that are hormonally inactive. […] The test will utilize both clinical and laboratory data. The clinical parameters are age at diagnosis and sex of the patient, the size of the tumor by CT scanning and its density in Hounsfield units, whether it was detected incidentally or not, and whether there is evidence of hormone overproduction. […] Clinical assessment of probability for malignancy works relatively well when expert physicians are involved and the tumors are relatively large.

• #1 How to Differentiate Benign from Malignant Adrenocortical Tumors?

  https://www.mdpi.com/2072-6694/13/17/4383

  Adrenocortical carcinoma is a rare cancer with a poor prognosis. Adrenal tumors are, however, commonly identified in clinical practice. Discrimination between benign and malignant adrenal tumors is of great importance to determine the appropriate treatment and follow-up strategy. This review summarizes the current diagnostic strategies and challenges to distinguish benign from malignant adrenal lesions. […] Diagnosis of ACC starts with a thorough physical examination, biochemical evaluation, and imaging. Computed tomography is the first-level imaging modality in adrenal tumors, with tumor size and Hounsfield units being important features for determining malignancy. […] The Weiss score is used for diagnosis of ACC, consisting of nine histopathological criteria. […] Several molecular targets of interest have been identified by genome wide sequencing studies providing alternative ways to diagnose adrenocortical carcinoma.

• #1 How to Differentiate Benign from Malignant Adrenocortical Tumors?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8431066/

  The Weiss score is currently the most widely used scoring system for ACC and represents the gold standard. […] The revised Weiss score correlates well with the original score and it has proven to be easier for use in clinical practice and more reproducible than the original Weiss score. […] Molecular studies have provided insights into the most promising and most frequent alterations in ACC. […] Liquid biopsies are a potential novel diagnostic, prognostic and therapeutic monitoring strategy that enables minimal invasive assessment of biomarkers in a blood sample.

• #1 Benign adrenal tumors | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20301710/

  Benign adrenal tumors often are found by chance on imaging thats done for another reason. A healthcare professional then looks at how likely the tumor is to be cancer and whether its making too much hormone. […] Along with a physical exam, a healthcare professional runs blood and urine tests to see if the tumor is making too much hormone. The tests also show which hormone the tumor is making. […] Imaging tests can give more details about the tumor. They can show whether the tumor is at high risk of being a cancer, which is rare. […] Treatment for small benign adrenal tumors that arent making hormones might involve watching the tumor. There might be repeat imaging tests 3 to 6 months after diagnosis, and then every one or two years. Watching also might involve testing hormones every year for five years. […] Surgery to remove the adrenal gland, called adrenalectomy, might be used to treat a benign adrenal tumor. The surgery may be done laparoscopically if the tumor is small and not likely to be cancer.

• #1 Benign adrenal tumors – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/benign-adrenal-tumors/diagnosis-treatment/drc-20567035

  Treatment depends on how likely the tumor is to become cancer. Treatment also might depend on whether the tumor is making hormones, the type of hormone it makes and how much it’s making. […] If the tumor is getting bigger or causing symptoms, the symptoms might be treated with medicines. Medicines also might be used to treat symptoms such as high blood pressure before surgery. […] Surgery to remove the adrenal gland, called adrenalectomy, might be used to treat a benign adrenal tumor. The surgery may be done laparoscopically if the tumor is small and not likely to be cancer.

• #1 Adrenal Adenoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/adrenal-adenoma

  Treatment depends on the type of adrenal adenoma. […] Non-functional adrenal adenoma: Treatment for non-functional adrenal adenoma is usually not necessary. […] Functional adrenal adenoma is usually treated with surgery. After these benign tumors are removed, symptoms usually disappear; the procedure is curative for most people, however in cases of long-standing hypertension, some patients will still require medication to normalize their blood pressure. […] The majority of people who have an adrenal adenoma will never learn that they have the condition, and it wont cause unwanted effects on their health. […] When a non-functional adrenal adenoma is diagnosed, doctors may track its progress two or more times during the first year, then annually for a year or two, then every five years. If the tumor grows in size or begins to exhibit symptoms, it can be treated with surgery or medication. When a functional adrenal adenoma is diagnosed and treated, it shouldnt have long-term effects on a persons health.

• #1 Adrenal Incidentaloma | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/adrenal-incidentaloma

  Size is the best indication of cancer in an adrenal incidentaloma. The larger the tumor the higher the risk of adrenocortical cancer. […] For patients with non-functional tumors, the risk of adrenocortical cancer based on size and imaging characteristics will determine if they should be removed. […] Tumors that appear suspicious for cancer on imaging should be removed. […] The guidelines for removing adrenal incidentaloma based on size are as follows: Size: Smaller than 4 cm Risk of Adrencortical Cancer: 3% Recommendation: Observation; Size: 4 to 6 cm Risk of Adrencortical Cancer: 7% Recommendation: Adrenalectomy if the patient is healthy enough; Size: Bigger than 6 cm Risk of Adrencortical Cancer: 25% Recommendation: Adrenalectomy. […] Most adrenal incidentalomas can be removed using minimally invasive techniques such as laparoscopy. […] Studies have shown that 25% of adrenal incidentaloma will grow and up to 20% will become functional over time.

• #1 Adrenal Adenoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/adrenal-adenoma

  The Yale Smilow Cancer Center is a center of excellence for the management of adrenal adenomas, says Smilow Cancer Hospital endocrine surgeon Courtney Gibson, MD. Our multidisciplinary endocrine neoplasia team, consisting of expert endocrinologists, endocrine surgeons, radiologists, and pathologists, provide world-class expertise in the work-up, diagnosis, and treatment of these tumors.

• #1 Recent Updates on the Management of Adrenal Incidentalomas

  https://www.e-enm.org/journal/view.php?number=2413

  The guideline advocates for more proactive surgical treatment for indeterminate adrenal masses in young patients (40 years) and pregnant women. […] The 2023 ESE guideline defines MACS as cases where serum cortisol levels after the 1-mg DST exceed 1.8 g/dL without any further stratification by degree of post-dexamethasone cortisol level. […] The 2023 ESE guideline recommends a multidisciplinary team approach to determine the necessity of surgical intervention in MACS patients. […] The 2023 ESE guideline recommends adopting a minimally invasive surgical approach for benign adrenal tumors requiring surgery due to hormone excess. […] The guidelines also stress the importance of a multidisciplinary team approach in managing these cases.

• #2 Adrenal Adenoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/adrenal-adenoma

  An adrenal adenoma is a benign (non-cancerous) tumor that forms within an adrenal glandthe hormone-producing gland located on top of each kidney. […] How is adrenal adenoma diagnosed? […] Many adrenal adenomas are discovered incidentally when doctors are trying to diagnose another condition. An imaging study (CT scan or MRI) of the abdomen, for example, may show the presence of a non-functional adrenal adenoma. […] Blood tests or urine tests may be used to check your hormone levels. High levels of cortisol or aldosterone, as well as estrogen and testosterone, may suggest an adrenal adenoma. […] Imaging tests, such as CT scans or MRIs, may be used to diagnose an adrenal adenoma. It is often possible to use an imaging study to confirm that the tumor is noncancerous. […] In some instances when results are unclear, a fine-needle biopsy may be needed to confirm that the tumor is a benign adrenal adenoma and not cancer; this procedure should only be performed after a functional work-up of the gland has been completed and has confirmed it is a non-functional tumor.

• #2 Evaluation and management of the adrenal incidentaloma – UpToDate

  https://www.uptodate.com/contents/evaluation-and-management-of-the-adrenal-incidentaloma

  An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination. 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. Discovery of an adrenal mass raises two questions that determine the degree of evaluation and the need for therapy, and both questions should be addressed simultaneously: Is it malignant? […] The approach to the evaluation and management of adrenal incidentalomas is reviewed here. […] Unilateral masses—Adrenal masses may be found incidentally when CT scans or MRI is done for other reasons. In a study of 61,054 abdominal CT scans performed from 1985 to 1990, an incidental adrenal tumor (incidentaloma >1 cm) was detected in 259 patients (0.4 percent of all CT scans). Subsequent studies, utilizing higher-resolution scanners, have reported a prevalence of adrenal incidentaloma on abdominal CT from 1.4 to 7.3 percent. The prevalence of adrenal incidentaloma is higher in older patients (10 percent).

• #2 Incidental adrenal masses – A primary care approach

  https://www.racgp.org.au/afp/2017/june/incidental-adrenal-masses-a-primary-care-approach

  Overall, benign, non-functioning adrenal adenomas account for about 80% of adrenal incidentalomas. […] Evaluation of incidentalomas is to determine whether there are clinical (or subclinical) manifestations and malignant potential, which may be primary or secondary. […] Almost 20% of patients with adrenal incidentalomas have subclinical hormonal abnormalities, which have been associated with an increased risk of metabolic, cardiovascular and bone diseases. […] Although primary malignancy of the adrenal is rare, with an incidence of 0.52 per 1 million, it is highly aggressive and has a poor prognosis, highlighting the importance of thorough clinical evaluation. […] In the evaluation of adrenal lesions, the clinician must ask: Is the adrenal lesion functional or nonfunctional? Is the adrenal lesion benign or malignant?

• #2 Lab Tests, Blood Tests and Hormone Tests for Adrenal Tumors

  https://www.adrenal.com/adrenal-tumors/lab-testing

  Adrenal tumors and adrenal masses require a thorough investigation by an endocrinologist to determine if the tumor is producing any hormone, and which adrenal hormone is being produced. How much adrenal hormone being produced by the tumor (if any) will play a big role in deciding if adrenal surgery is necessary. […] After performing a very careful interview of the patient to see if they have any signs and symptoms of adrenal hormone excess, the next step is to perform laboratory testing to see if the adrenal tumor is overproducing any hormones. Knowing what hormone is being produced (if any), and how much is critically important. […] The correct laboratory evaluation includes both urinary tests as well as blood tests because some of the adrenal hormones can build up in the blood while others build up in the urine.

• #2 Adrenal Tumor Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/adrenal-tumors/adrenal-tumor-diagnosis.html

  Adrenal gland tumors are diverse and can be challenging to diagnose. It is essential that an endocrinologist familiar with adrenal gland tumor recommends which tests you should have and analyzes your test results. […] The experts at MD Anderson have a high level of expertise in diagnosing adrenal gland tumors. They use the latest techniques and technology to give you the most accurate and concise diagnosis possible, including radiographic scanning, adreno-venous sampling and biochemical testing. […] If you have symptoms that might signal an adrenal gland tumor, your doctor will examine you and ask you questions about your health and your medical history. […] One or more of the following tests may be used to find out if you have an adrenal gland tumor or if treatment is working. […] Blood tests to evaluate levels of certain hormones, including cortisol, aldosterone, plasma metanephrines and dehydroepiandrosterone (DHEA), or chemicals such as sodium and potassium. […] Urine tests, which may include 24-hour urine collection tests. […] Diagnostic imaging tests, which may include: CT or CAT (computed axial tomography) scans, MRI (magnetic resonance imaging) scans, PET scan (positron emission tomography), MIBG (meta-iodobenzylguanidine) scans.

• #2 X-Rays, CT Scans, MRI, and Other Tests for Adrenal Glands

  https://www.adrenal.com/adrenal-tumors/scans

  Scans and x-rays play a major role in the diagnosis and treatment of adrenal gland tumors and masses. The CT scan is the most useful scan but other x-rays and scans can sometimes be useful in diagnosing adrenal tumors and planning adrenal surgery. […] There are 4 primary radiological (x-ray) tests to examine the adrenal glands (and the rest of the abdomen) for the presence of a tumor (the word „tumor” simply means „mass”. These can be benign or malignant). […] The gold standard of adrenal imaging is a CT scan (CAT scan). An adrenal-protocol, contrast enhancement CT scan is best. Thus, a CT scan of the adrenal with and without contrast should always be the first scan ordered, and in more than 90% of cases, the ONLY scan a patient will need. […] The absolute percentage washout (APW) of contrast from the adrenal tumor can then be calculated using a formula. The relative percentage washout (RPW) is used when unenhanced CT value is not available. If the APW is 60% or RPW is 40% after 15-min from contrast administration, this is indicative of benign adenoma, with sensitivity and specificity of 88% and 96% at the APW and sensitivity and specificity of 83% and 93% at the RPW, respectively.

• #2 How to Differentiate Benign from Malignant Adrenocortical Tumors?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8431066/

  Adrenocortical carcinoma is a rare cancer with a poor prognosis. Discrimination between benign and malignant adrenal tumors is of great importance to determine the appropriate treatment and follow-up strategy. This review summarizes the current diagnostic strategies and challenges to distinguish benign from malignant adrenal lesions. […] Diagnosis of ACC starts with a thorough physical examination, biochemical evaluation, and imaging. Computed tomography is the first-level imaging modality in adrenal tumors, with tumor size and Hounsfield units being important features for determining malignancy. […] The Weiss score is used for diagnosis of ACC, consisting of nine histopathological criteria. […] The European Network for the Study of Adrenal Tumors (ENSAT) classification is the currently used staging system for ACC and has an accuracy of 83% in predicting 3-year cancer-specific mortality.

• #2 Radiologic Evaluation of Incidentally Discovered Adrenal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0601/p1361.html

  The increasing use of cross-sectional imaging has led to an increase in the incidental discovery of adrenal masses (adrenal incidentalomas). Although most of these lesions are benign, they often present a diagnostic dilemma. Before creating a management plan, the physician should determine if the lesion is benign or malignant and if the lesion is functioning or nonfunctioning. […] The most common incidentally discovered adrenal masses are adenomas, which are benign lesions. […] A lesion measuring at least 1 cm is normally considered large enough for further imaging investigation. […] The purpose of further imaging and clinical workup is to answer two questions: Is the lesion benign or malignant? Is the lesion functioning or nonfunctioning? […] A CT or MRI can usually determine whether an adrenal incidentaloma is benign by detecting lipid in the mass. Adenomas usually contain lipid (lipid-rich adenomas); however, most lipid-poor lesions are also adenomas.

• #2 X-Rays, CT Scans, MRI, and Other Tests for Adrenal Glands

  https://www.adrenal.com/adrenal-tumors/scans

  MRI has similar diagnostic accuracy to CT, allowing characterizing adenomas regardless of their CT enhancement. […] A nuclear medicine scan is only needed for certain cases of adrenal tumors, when CT and MRI scans are not sufficient. […] Regular PET (18-FDG-PET/CT) is mainly used to image malignant (cancerous lesions). It is an imaging modality which is very useful in adrenocortical carcinoma and metastasis to the adrenal gland (most commonly carcinomas of the lung, breast, kidney, and melanoma).

• #2 The Radiology Assistant : Characterization of Adrenal lesions

  https://radiologyassistant.nl/abdomen/adrenals/lesion-characterization

  Adrenal incidentalomas are common and seen in about 3% of abdominal CT’s, increasing up to 10% in elderly patients. […] The issue is to differentiate benign adrenal tumors from metastases or primary malignant masses without unnecessarily exposing the majority of patients to the burden of clinical workup, interventions and imaging follow-up. […] First, determine whether a lesion has typically benign or indeterminate imaging features. If it is indeterminate, do a washout-CT or an MRI to see whether it is a lipid-poor adenoma. If it is not an adenoma, then you have to choose between follow up, PET-CT, biopsy or resection. […] If the lesion is indeterminate and 4 cm in diameter: No cancer history, consider resection because of the possibility of an adrenocortical carcinoma. No biopsy. […] The maximum diameter of the adrenal mass is predictive of malignancy. In particular, lesions 4 cm are more likely to be either metastases or adrenocortical carcinomas.

• #2 Adrenal Incidentaloma | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/adrenal-incidentaloma

  Size is the best indication of cancer in an adrenal incidentaloma. The larger the tumor the higher the risk of adrenocortical cancer. […] For patients with non-functional tumors, the risk of adrenocortical cancer based on size and imaging characteristics will determine if they should be removed. […] Tumors that appear suspicious for cancer on imaging should be removed. […] The guidelines for removing adrenal incidentaloma based on size are as follows: Size: Smaller than 4 cm Risk of Adrencortical Cancer: 3% Recommendation: Observation; Size: 4 to 6 cm Risk of Adrencortical Cancer: 7% Recommendation: Adrenalectomy if the patient is healthy enough; Size: Bigger than 6 cm Risk of Adrencortical Cancer: 25% Recommendation: Adrenalectomy. […] Most adrenal incidentalomas can be removed using minimally invasive techniques such as laparoscopy. […] Studies have shown that 25% of adrenal incidentaloma will grow and up to 20% will become functional over time.

• #2 The Radiology Assistant : Characterization of Adrenal lesions

  https://radiologyassistant.nl/abdomen/adrenals/lesion-characterization

  Therefore, the recommendation for an indeterminate adrenal mass 4 cm in size and no history of cancer is surgical resection -in most cases without biopsy – in order to timely treat a possible primary adrenal cortical carcinoma. […] Pheochromocytomas are rare tumors that originate in the adrenal medulla. Usually, tumors are larger than 3 cm when found. Nonfunctioning tumors are typically larger than functioning tumors. […] A typical pheochromocytoma will have an unenhanced density 10 HU, or higher in case of hemorrhage. They are highly vascular, resulting in strong enhancement, but in contrast to adenomas they usually have delayed washout. […] Adrenal myelolipomas are benign, relatively rare (0,08-0,2%) tumors that contain variable amounts of bone marrow elements and mature fat. […] Adrenocortical carcinomas (ACCs) are rare aggressive tumors with an incidence of approximately 1-2 per million per year.

• #2 How to Differentiate Benign from Malignant Adrenocortical Tumors?

  https://www.mdpi.com/2072-6694/13/17/4383

  The Weiss score is currently the most widely used scoring system for ACC and represents the gold standard. […] In a revised and simplified Weiss score, only five instead of nine items are scored, with a maximum score of seven. […] The Helsinki score can be used not only for diagnosing conventional ACC, but also for oncocytic and myxoid variants. […] The diagnostic potential of the features and markers that are discussed in this review is shown in Table 4. Accurate diagnosis of malignancy is crucial in order to guide the decision on adrenalectomy, for prognosis stratification, and to determine the intensity and duration of follow-up.

• #2 Hypercortisolism Diagnosis & Treatment | OSUCCC – James

  https://cancer.osu.edu/for-patients-and-caregivers/learn-about-cancers-and-treatments/cancers-conditions-and-treatment/cancer-types/endocrine-cancers/adrenal-cancers/other-adrenal-disorders/hypercortisolism

  We almost never recommend a biopsy of the adrenal gland because this rarely provides useful information and often cannot distinguish between benign and malignant tumors of adrenal origin. […] Depending on the severity of excess cortisol, patients may simply be observed over time, be prescribed medication to control the amount of cortisol or the effects of excess cortisol, or undergo surgery. The type of treatment depends on the origin of the excess cortisol. […] Treatment options include: An attempt to stop or at least minimize the quantity of steroids is tried. […] Patients are most often offered surgery. Depending on the degree of excess cortisol, some patients may be observed over time. […] After surgery for hypercortisolism, most patients will need to take steroids for a period of time. […] For patients who are taking steroids to provide adequate amounts of cortisol for the body, it’s important they take their medication every day.

• #2 Diagnosis of adrenal gland cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/adrenal-gland/diagnosis

  A CT scan is used to: find a tumour in the adrenal gland, find out if the cancer has spread and where it has spread, help find out if a tumour is cancerous or non-cancerous based on its features, such as the size, the density and whether the edges are smooth or uneven. […] A PET scan may be used to: help find out if a tumour is cancerous or non-cancerous, check for small groups of cancer cells, find out if cancer has spread to other parts of the body. […] A biopsy is not usually done for adrenal gland tumours because it’s hard to see a difference between non-cancerous and cancerous adrenal gland tumour cells under a microscope. Also, a biopsy of an adrenal gland can cause serious problems such as excessive blood loss (hemorrhage), a collapsed lung (pneumothorax) and sudden increases in hormone levels (catecholamines). A biopsy is done only if cancer is found but it isn’t clear whether it started in the adrenal gland or spread to the adrenal gland from a different place (called secondary adrenal gland cancer).

• #2 ACC – Overview: Adrenal Mass Panel, 24 Hour, Urine

  https://www.mayocliniclabs.com/test-catalog/Overview/604986

  Aiding in assessing malignancy in adrenal masses. […] May aid in improving diagnostic and prognostic prediction and dissect disease mechanisms for the following applications: -Diagnostic assessment and follow up of adrenal cortical carcinoma. […] Differential diagnostic assessment of adrenal tumors. […] This test offers an accurate, rapid, cost-effective, noninvasive tool to better assess malignant adrenal tumors and assist clinicians in determining whether an adrenal mass is benign or malignant. […] Testing begins with a clinical risk assessment based on clinical data before integration with biochemical steroid data to assess the probability of a malignant adrenal cortical carcinoma (ACC) or other malignancy (sarcoma, lymphoma, other) as well as the probability of a benign mass (adenoma, myelolipoma, cyst, other).

• #2 Genetic Alterations in Benign Adrenal Tumors

  https://www.mdpi.com/2227-9059/10/5/1041

  The genetic basis of most types of adrenal adenomas has been elucidated over the past decade, leading to the association of adrenal gland pathologies with specific molecular defects. […] Various genetic studies have established links between variants affecting the protein kinase A (PKA) signaling pathway and benign cortisol-producing adrenal lesions. […] The genetic background of primary adrenal lesions has been unraveled through advances in the field of genomics over the past decade. […] The initial clues to our understanding came from a study of rare familial tumor syndromes and the identification of germline and somatic pathogenic variants in CS and primary aldosteronism (PA). […] These discoveries have facilitated the classification of adrenocortical lesions more accurately based on the causal gene while the genetic screening and counseling can be more individualized to each patient. […] In CS, aberrant cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA) signaling has been found to be implicated in the majority of the benign cortisol-secreting ATCs. […] This review aims to describe the causative molecular alternations in benign ATCs.

• #2 Incidental adrenal masses – A primary care approach

  https://www.racgp.org.au/afp/2017/june/incidental-adrenal-masses-a-primary-care-approach

  All patients with an adrenal lesion who have signs, symptoms and biochemical evidence of glucocorticoid, sex hormone or catecholamine excess should undergo surgical intervention. […] If a lesion of any size has radiological features that are suggestive of malignancy, surgical resection is indicated. […] In patients with non-functional tumours that are 4 cm, follow-up metabolic evaluation is recommended annually for five years because there is a risk of subsequent hyperfunction. […] An algorithm to approach incidental adrenal masses is included in Figure 1.

• #2 Adrenal Adenoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/adrenal-adenoma

  Treatment depends on the type of adrenal adenoma. […] Non-functional adrenal adenoma: Treatment for non-functional adrenal adenoma is usually not necessary. […] Functional adrenal adenoma is usually treated with surgery. After these benign tumors are removed, symptoms usually disappear; the procedure is curative for most people, however in cases of long-standing hypertension, some patients will still require medication to normalize their blood pressure. […] The majority of people who have an adrenal adenoma will never learn that they have the condition, and it wont cause unwanted effects on their health. […] When a non-functional adrenal adenoma is diagnosed, doctors may track its progress two or more times during the first year, then annually for a year or two, then every five years. If the tumor grows in size or begins to exhibit symptoms, it can be treated with surgery or medication. When a functional adrenal adenoma is diagnosed and treated, it shouldnt have long-term effects on a persons health.

• #2 Adenoma of the Adrenal Gland: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17769-adrenal-adenoma

  Your treatment depends on whether the tumor is nonfunctioning or functioning (secreting excess hormones). If a nonfunctioning tumor is small, your healthcare provider may recommend periodic CT scans to ensure it doesnt increase in size or become functional. […] If the tumor grows rapidly or gets bigger (usually nearing 5 centimeters), your healthcare provider may recommend surgery. […] Treatments for functioning tumors almost always involve surgery. […] Your healthcare provider may remove your adrenal gland via laparoscopy if the tumor is benign and small. […] If your tumor turns out to be an adrenal adenoma, your healthcare provider can run tests to see if its causing an overproduction of hormones. If it is, surgery can help. If your tumor is nonfunctioning, your healthcare provider can monitor it to ensure it doesnt negatively impact your hormones.

• #2 Cushing syndrome due to adrenal tumor: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000407.htm

  Cushing syndrome due to adrenal tumor is a form of Cushing syndrome. It occurs when a tumor of the adrenal gland releases excess amounts of the hormone cortisol. […] Adrenal tumors are rare. They can be noncancerous (benign) or cancerous (malignant). […] Tests to confirm Cushing syndrome: 24-hour urine sample to measure cortisol and creatinine levels, blood tests to check ACTH (adrenocorticotropic hormone), cortisol, and potassium levels, dexamethasone suppression test, blood cortisol levels, blood DHEA level, saliva cortisol level. […] In some cases, you need a special test called adrenal vein sampling to determine which adrenal gland is making too much cortisol and causing Cushing syndrome. […] Surgery is done to remove the adrenal tumor. Often, the entire adrenal gland is removed. […] People with an adrenal tumor who have surgery have an excellent outlook. […] Appropriate treatment of adrenal tumors may reduce the risk of complications in some people with adrenal tumor-related Cushing syndrome.

• #2 Recent Updates on the Management of Adrenal Incidentalomas

  https://www.e-enm.org/journal/view.php?number=2413

  The guideline advocates for more proactive surgical treatment for indeterminate adrenal masses in young patients (40 years) and pregnant women. […] The 2023 ESE guideline defines MACS as cases where serum cortisol levels after the 1-mg DST exceed 1.8 g/dL without any further stratification by degree of post-dexamethasone cortisol level. […] The 2023 ESE guideline recommends a multidisciplinary team approach to determine the necessity of surgical intervention in MACS patients. […] The 2023 ESE guideline recommends adopting a minimally invasive surgical approach for benign adrenal tumors requiring surgery due to hormone excess. […] The guidelines also stress the importance of a multidisciplinary team approach in managing these cases.

• #3 Incidental adrenal masses – A primary care approach

  https://www.racgp.org.au/afp/2017/june/incidental-adrenal-masses-a-primary-care-approach

  Adrenal incidentalomas are found in approximately 34% of abdominal computed tomography (CT) scans. […] It is important to evaluate these incidental adrenal lesions to determine what treatment, if any, is needed and when specialist referral may be necessary. […] In particular, incidentalomas must be evaluated in regard to their functional status and malignant potential, as lesions can range from being indolent, benign and non-functioning tumours that can simply be observed, to aggressive and hormonally active malignant lesions that require urgent surgical intervention. […] Although most lesions are benign, non-functional adrenal adenomas, further evaluation is necessary to determine whether a lesion may be hormonally active or malignant, as this would affect future management decisions.

• #3 Adrenal Adenoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/adrenal-adenoma

  An adrenal adenoma is a benign (non-cancerous) tumor that forms within an adrenal glandthe hormone-producing gland located on top of each kidney. […] How is adrenal adenoma diagnosed? […] Many adrenal adenomas are discovered incidentally when doctors are trying to diagnose another condition. An imaging study (CT scan or MRI) of the abdomen, for example, may show the presence of a non-functional adrenal adenoma. […] Blood tests or urine tests may be used to check your hormone levels. High levels of cortisol or aldosterone, as well as estrogen and testosterone, may suggest an adrenal adenoma. […] Imaging tests, such as CT scans or MRIs, may be used to diagnose an adrenal adenoma. It is often possible to use an imaging study to confirm that the tumor is noncancerous. […] In some instances when results are unclear, a fine-needle biopsy may be needed to confirm that the tumor is a benign adrenal adenoma and not cancer; this procedure should only be performed after a functional work-up of the gland has been completed and has confirmed it is a non-functional tumor.

• #3 Distinguishing benign from malignant adrenal masses | Cancer Imaging | Full Text

  https://cancerimagingjournal.biomedcentral.com/articles/10.1102/1470-7330.2003.0006

  Lipid-rich adenomas lose signal on the chemical-shift or out-of-phase (opposed-phase) images, while lipid-poor lesions will not lose signal. […] Although adrenal biopsy is a very valuable tool in the differentiation between metastases and adrenal adenoma, it is less frequently used than in days prior to the use of unenhanced CT densitometry and chemical-shift MRI.

• #3 Diagnosing Adrenal Gland Tumors | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancer/adrenal/diagnosis

  A small and safe amount of radioactive material (MIBG) is injected into a vein and travels through the bloodstream. Adrenal gland cells take up the radioactive material and are detected by a device that measures radiation. Overactive adrenal tissue present in some adrenal tumors (pheochromocytomas) may take up more radioactive material, allowing their location in the body to be confirmed. This scan is done to detect the presence of an adrenal pheochromocytoma that is making excess amounts of adrenaline-type hormones. […] Unfortunately, it is quite difficult to determine whether an adrenal nodule is benign or cancerous by this technique, and there is a risk to cause dangerously high levels of hormone to be released by the adrenal gland during biopsy. Needle core biopsies are therefore not routinely performed for adrenal masses.

• #3 Incidental adrenal masses – A primary care approach

  https://www.racgp.org.au/afp/2017/june/incidental-adrenal-masses-a-primary-care-approach

  All patients with an adrenal lesion who have signs, symptoms and biochemical evidence of glucocorticoid, sex hormone or catecholamine excess should undergo surgical intervention. […] If a lesion of any size has radiological features that are suggestive of malignancy, surgical resection is indicated. […] In patients with non-functional tumours that are 4 cm, follow-up metabolic evaluation is recommended annually for five years because there is a risk of subsequent hyperfunction. […] An algorithm to approach incidental adrenal masses is included in Figure 1.

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