Materiały źródłowe

• #1 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

• #2 Key Statistics for Adrenal Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/adrenal-cancer/about/key-statistics.html

  Adrenal tumors are found in about 1 in every 10 people who have an imaging test (like a CT or MRI) of the adrenal gland. Most are benign adenomas. […] Adrenocortical carcinomas are much less common than adenomas. In fact, they are very rare. The exact number diagnosed in the United States each year is not known. It is probably around 200 per year.

• #3 A case of adrenal cortical carcinoma arising from a regularly monitored sub-centimetre adrenal incidentaloma in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2024 Issue 1 (2024)

  https://edm.bioscientifica.com/view/journals/edm/2024/1/EDM23-0120.xml

  Approximately 80% of adrenal incidentalomas are benign, and development into adrenal cortical cancer is extremely rare. This is a major reason behind clinical guidelines recommending surveillance of incidentalomas for a relatively short duration of up to 5 years. Surveillance of lesions less than 1 cm is not routinely recommended. […] Clinical guidelines have moved towards a shortened duration of surveillance of incidentalomas. Even though malignant transformation is a rare event, it is possible that this will result in a delayed diagnosis of adrenal cortical cancer, a highly aggressive malignancy with a poor prognosis. […] The diagnosis of adrenal incidentaloma (defined as 1 cm) is increasingly common, related to the greater frequency of abdominal imaging and to radiological advances. Approximately 80% are benign adenomas, whilst less than 5% are adrenal cortical carcinomas (ACCs), rare malignant lesions that carry a poor prognosis.

• #4 Preoperative Assessment of Functioning Benign Adrenocortical Tumors: A Clinical Surgical Approach | IntechOpen

  https://www.intechopen.com/chapters/65619

  In terms of hormonal production, even though most tumors are nonfunctioning, in up to 15% of cases, there might be a slightly increased production of certain hormones, being cortisol the most common one, which may cause Cushings syndrome. […] Around 10-15% of all tumors found are bilateral. Bilateral functioning adrenocortical masses may be congenital adrenal hyperplasia due to a 21-hydroxylase deficiency, adrenal macronodular hyperplasia, or primary hyperaldosteronism. […] The most common causes of bilateral nonfunctioning adrenal masses are metastases, infections (mycosis, tuberculosis), lymphomas, bleedings, amyloidosis, and, rather rarely, carcinoma and myelolipomas. […] In a decreasing order of occurrence, the adrenocortical tumor categories are: Nonfunctioning adenomas (43-75%), Cortisol-producing adenomas (including subclinical Cushings syndrome) (10-15%), Myelolipomas (6-8%), Adrenal carcinomas (4-11%), Metastatic lesions (3-10%), Aldosteronomas (2-6%), Cyst (5%), Tuberculosis and lymphomas (3-8%).

• #5 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as adrenal incidentalomas and represent a public health challenge because they are increasingly recognized in current medical practice. The frequency of adrenal incidentalomas in computed tomography (CT) series assessed in the 1980s and 90s ranged from 0.35% to 1.9%, but more recent studies have reported a frequency of about 4.2% to 7.3% that may increase up to 10% in elderly population. […] Management of adrenal incidentalomas is currently matter of debate. There is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery, since there is no consensus on what type of follow-up, if any, is needed.

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

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

  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).

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

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

  Adrenal incidentalomas (AIs) are a common finding on cross-sectional abdominal images. In about 1-5% 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; most of these are AIs. The autopsy prevalence for AIs is 2-9%. […] Approximately 1-10% of CT scans and magnetic resonance images (MRIs) detect AIs that are 5 mm or larger. An Italian study of incidentally discovered AIs among subjects undergoing chest CT scan found that the prevalence of AIs was approximately 4%. […] Prevalence increases with age; the rate is less than 1% for patients younger than 30 years and is 7% for patients 70 years or older. Evidence suggests that the incidence in teenage girls is slightly higher than that of teenage boys, but no sex-related predilection is found in adults. AI prevalence is higher in white than in black people and in obese, diabetic, and hypertensive patients. […] Approximately 85% of AIs are nonfunctional (hormonally silent) and benign. The other 15% of AIs are either functional (hormonally active) or malignant and require further evaluation and treatment to avoid medical complications.

• #8 Adrenal Mass

  https://fpnotebook.com/Endo/Rad/AdrnlMs.htm

  Incidental Adrenal Mass found on up to 3-4% of Abdominal CTs or MRIs. […] Incidental Adrenal Masses found in 20% of autopsies.

• #9 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

• #10 Science Saturday: All adrenal tumors should be investigated – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/science-saturday-all-adrenal-tumors-should-be-investigated/

  In a recent publication in The Lancet Diabetes & Endocrinology, a team of international researchers describes the epidemiology of adrenal tumors in Olmsted County, Minnesota. […] Irina Bancos, M.D., a Mayo Clinic endocrinologist, is the senior author of the study. She has clinical and research expertise in adrenal tumors and was concerned about the lack of epidemiology studies in adrenal tumors. […] The study examined medical records collected as part of the Rochester Epidemiology Project. Using information collected by the project, researchers can identify what causes diseases; how diseases may progress over time; and how patients with certain conditions respond to surgery, medication or other interventions. […] Medical record review yielded 1,287 people diagnosed with adrenal tumors from 1995 to 2017. Due to increased use of medical imaging, the researchers found that diagnoses of any kind of adrenal tumor became 10 times more common by the end of the 23-year period.

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

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

  Adrenal incidentalomas (AIs) are a common finding on cross-sectional abdominal images. In about 1-5% 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; most of these are AIs. The autopsy prevalence for AIs is 2-9%. […] Approximately 1-10% of CT scans and magnetic resonance images (MRIs) detect AIs that are 5 mm or larger. An Italian study of incidentally discovered AIs among subjects undergoing chest CT scan found that the prevalence of AIs was approximately 4%. […] Prevalence increases with age; the rate is less than 1% for patients younger than 30 years and is 7% for patients 70 years or older. Evidence suggests that the incidence in teenage girls is slightly higher than that of teenage boys, but no sex-related predilection is found in adults. AI prevalence is higher in white than in black people and in obese, diabetic, and hypertensive patients. […] Approximately 85% of AIs are nonfunctional (hormonally silent) and benign. The other 15% of AIs are either functional (hormonally active) or malignant and require further evaluation and treatment to avoid medical complications.

• #12 Hormonal Evaluation of Adrenal Tumors: What the Common General Practitioner Should Know

  https://clinmedjournals.org/articles/iauc/international-archives-of-urology-and-complications-iauc-5-063.php?jid=iauc

  Most adrenocortical tumors are benign, unilateral and non-functioning adenomas, presenting less than 4 cm in diameter, perceived during abdominal imaging studies. […] In a combined study with a different selection and diagnosis criteria, we had the main etiologies of adrenal tumors: Adenomas 41%, Metastases 19%, Carcinomas 10%, Myelolipomas 9% and Pheochromocytomas 8%. Most of the remaining cases (13%) were benign lesions, such as adrenal cysts. […] In clinical reports, adrenal incidentalomas show peak incidence in the fifth to seventh decades. The mean age of patients at diagnosis is 55 years, with no significant differences in age between female and male. […] The prevalence increases with age; the rate is less than 1% for patients under 30 and 7% for patients aged 70 and over. […] Attributed to hormonal production, although most tumors are not functioning, a slightly increased production of certain hormones can be verified in at least 15% of the cases.

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

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

  Adrenal incidentalomas (AIs) are a common finding on cross-sectional abdominal images. In about 1-5% 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; most of these are AIs. The autopsy prevalence for AIs is 2-9%. […] Approximately 1-10% of CT scans and magnetic resonance images (MRIs) detect AIs that are 5 mm or larger. An Italian study of incidentally discovered AIs among subjects undergoing chest CT scan found that the prevalence of AIs was approximately 4%. […] Prevalence increases with age; the rate is less than 1% for patients younger than 30 years and is 7% for patients 70 years or older. Evidence suggests that the incidence in teenage girls is slightly higher than that of teenage boys, but no sex-related predilection is found in adults. AI prevalence is higher in white than in black people and in obese, diabetic, and hypertensive patients. […] Approximately 85% of AIs are nonfunctional (hormonally silent) and benign. The other 15% of AIs are either functional (hormonally active) or malignant and require further evaluation and treatment to avoid medical complications.

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

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

  Adrenal incidentalomas (AIs) are a common finding on cross-sectional abdominal images. In about 1-5% 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; most of these are AIs. The autopsy prevalence for AIs is 2-9%. […] Approximately 1-10% of CT scans and magnetic resonance images (MRIs) detect AIs that are 5 mm or larger. An Italian study of incidentally discovered AIs among subjects undergoing chest CT scan found that the prevalence of AIs was approximately 4%. […] Prevalence increases with age; the rate is less than 1% for patients younger than 30 years and is 7% for patients 70 years or older. Evidence suggests that the incidence in teenage girls is slightly higher than that of teenage boys, but no sex-related predilection is found in adults. AI prevalence is higher in white than in black people and in obese, diabetic, and hypertensive patients. […] Approximately 85% of AIs are nonfunctional (hormonally silent) and benign. The other 15% of AIs are either functional (hormonally active) or malignant and require further evaluation and treatment to avoid medical complications.

• #15 Preoperative Assessment of Functioning Benign Adrenocortical Tumors: A Clinical Surgical Approach | IntechOpen

  https://www.intechopen.com/chapters/65619

  The frequency of adrenocortical tumor diagnosis has increased nowadays due to larger availability of image examination techniques, which makes it a relatively common clinical problem currently. Some studies claim a detection rate of 4% in all abdominal computer tomography. Studies in series of autopsies identified that adrenal masses count less than 1% in individuals younger than 30 years of age and that the rate increases to 7% in those who were 70 or older. […] Adrenocortical tumors are more common in white, obese, diabetic, and hypertensive individuals. These data might be biased, as elderly, white individuals constitute the groups that most frequently undergo image examinations. It is known that such tumors are rather uncommon in individuals under 50 years of age and are especially uncommon in children. They are more common on the right side.

• #16 Preoperative Assessment of Functioning Benign Adrenocortical Tumors: A Clinical Surgical Approach | IntechOpen

  https://www.intechopen.com/chapters/65619

  The frequency of adrenocortical tumor diagnosis has increased nowadays due to larger availability of image examination techniques, which makes it a relatively common clinical problem currently. Some studies claim a detection rate of 4% in all abdominal computer tomography. Studies in series of autopsies identified that adrenal masses count less than 1% in individuals younger than 30 years of age and that the rate increases to 7% in those who were 70 or older. […] Adrenocortical tumors are more common in white, obese, diabetic, and hypertensive individuals. These data might be biased, as elderly, white individuals constitute the groups that most frequently undergo image examinations. It is known that such tumors are rather uncommon in individuals under 50 years of age and are especially uncommon in children. They are more common on the right side.

• #17 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

• #18

  https://link.springer.com/article/10.1007/s12672-015-0245-y

  Adrenocortical carcinoma (ACC) is often diagnosed incidentally. However, significant difficulties persist in diagnosing the rare ACC among the very common benign adrenal tumors, which are present in up to 5 % of the population. […] The management of adrenal tumors is a public health challenge of growing importance, as these tumors are detected with increasing frequency in a population that has widespread access to advanced imaging technology. The prevalence of incidentally discovered adrenal masses on CT examinations has been reported to be 0.355.0 %. […] In non-oncological patients, adrenocortical carcinoma (ACC) is thought to be the most frequently observed adrenal malignancy with a prevalence of up to 46 % depending on size and appearance. However, this is likely a significant overestimate as more recent unbiased imaging approaches found a prevalence of 01 %.

• #19 The Radiology Assistant : Characterization of Adrenal lesions

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

  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. […] 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. […] More than half of ACC patients have stage III or IV disease at the time of diagnosis, which explains the dismal prognosis of this diagnosis, with 5-year survival of 50% for stage III, and 15% for stage IV. […] Up to 15% of all adrenal tumors are functional.

• #20 Top 4 Things to Know About Adrenal Nodule Size

  https://www.adrenal.com/blog/adrenal-nodule-size-chart

  Adrenal nodules are common in older people (occurring in 7-10%), but less common (but often even more important) in younger people. The overall prevalence of adrenal nodules in the general population has been estimated to be as high as 10% based on autopsy studies. Most adrenal nodules are benign, but some are cancerous (3-5%). […] As adrenal nodule size increases, the need for surgery does as well. […] Importantly, adrenal nodule size, however, does not directly correlate with the nodules being malignant. […] As a rule of thumb, any nodule over 4 cm (3 cm for younger people) should be removed by surgery. The risk of CANCER dramatically increases above this size (3-4 cm). […] Any nodule that is 4 cm or larger should be removed with adrenal surgery. The risk of CANCER dramatically increases above this size (3-4 cm).

• #21 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. […] When an adrenal incidentaloma is detected, use the following steps: If the lesion has typically benign imaging features no follow up is needed. This includes lesions that show long-term stability in comparison to prior imaging. […] 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. […] 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.

• #22 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

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

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

  INTRODUCTION […] 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? […] Is it functioning? […] The approach to the evaluation and management of adrenal incidentalomas is reviewed here. Detailed discussions of adrenal carcinoma and functioning adrenal tumors such as pheochromocytomas and aldosteronomas are found elsewhere. […] PREVALENCE

• #24 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as adrenal incidentalomas and represent a public health challenge because they are increasingly recognized in current medical practice. The frequency of adrenal incidentalomas in computed tomography (CT) series assessed in the 1980s and 90s ranged from 0.35% to 1.9%, but more recent studies have reported a frequency of about 4.2% to 7.3% that may increase up to 10% in elderly population. […] Management of adrenal incidentalomas is currently matter of debate. There is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery, since there is no consensus on what type of follow-up, if any, is needed.

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

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

  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).

• #26 Current Management of Adrenal Incidentalomas | IntechOpen

  https://www.intechopen.com/chapters/55357

  Adrenal incidentalomas refer to a group of adrenal masses initially discovered during cross-sectional imaging obtained for other clinical reasons. The majority of incidentalomas are benign nonfunctional adrenal adenomas and can be safely managed expectantly. A subset of adrenal incidentalomas, however, are functional and/or malignant, and these lesions most often require adrenalectomy. […] The frequency of adrenal incidentalomas varies in the literature. Autopsy studies report an incidence of adrenal incidentalomas ranging from 1 to 9%. Frequency of adrenal incidentalomas reported in the radiology literature varies according to imaging modality. With computed tomography (CT) scans and magnetic resonance imaging (MRI), incidence of these adrenal tumors ranges from 0.3 to 7%, whereas prevalence of adrenal incidentalomas from ultrasound studies reaches 0.42%.

• #27 Science Saturday: All adrenal tumors should be investigated – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/science-saturday-all-adrenal-tumors-should-be-investigated/

  Of the incidentaloma group — which accounted for about 81.5% of the tumors found — some had malignant adrenal masses (3.3%) and a smaller group had obvious signs of elevated hormones (1.9%). […] „We also found that the clinical presentation and tumor characteristics tells us a lot about the tumor and whether it is likely to be malignant or not. For example, adrenal tumors in children, or any patients with another type of cancer, should be considered malignant until proven otherwise.” […] „In this study, we show that any adrenal mass should be properly evaluated for both malignancy and hormonal excess before dismissing this problem.” […] „Our message is, again, to recognize the adrenal mass as a problem that needs full investigation at the time of discovery,” reiterates Dr. Bancos. […] This study is an example of descriptive epidemiology, examining incidence, prevalence, morbidity and mortality. It describes the scope of adrenal tumors, which helps shared decision-making with patients. […] „Clear understanding of the risk is very helpful in shared decision-making on the next steps in management.” […] „Outside the clinic, I agree with Andreas that epidemiology data is extremely important for development of guidelines and proposing intervention.”

• #28 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

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

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

  Adrenal incidentalomas (AIs) are a common finding on cross-sectional abdominal images. In about 1-5% 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; most of these are AIs. The autopsy prevalence for AIs is 2-9%. […] Approximately 1-10% of CT scans and magnetic resonance images (MRIs) detect AIs that are 5 mm or larger. An Italian study of incidentally discovered AIs among subjects undergoing chest CT scan found that the prevalence of AIs was approximately 4%. […] Prevalence increases with age; the rate is less than 1% for patients younger than 30 years and is 7% for patients 70 years or older. Evidence suggests that the incidence in teenage girls is slightly higher than that of teenage boys, but no sex-related predilection is found in adults. AI prevalence is higher in white than in black people and in obese, diabetic, and hypertensive patients. […] Approximately 85% of AIs are nonfunctional (hormonally silent) and benign. The other 15% of AIs are either functional (hormonally active) or malignant and require further evaluation and treatment to avoid medical complications.

• #30 Clinical presentation and evaluation of adrenocortical tumors – UpToDate

  https://www.uptodate.com/contents/clinical-presentation-and-evaluation-of-adrenocortical-tumors

  Unilateral tumors or masses of the adrenal gland are common. They are categorized as either functional (hormone-secreting) or silent and as either benign or malignant. […] The majority of adrenocortical tumors are benign, nonfunctioning adenomas that are discovered incidentally on abdominal imaging studies (adrenal incidentalomas). […] Others are benign, hormone-secreting adenomas that cause Cushing’s syndrome, primary aldosteronism, or, much less commonly, virilization. […] Adrenocortical carcinomas (ACCs) are rare, often aggressive tumors that may be functional and cause Cushing’s syndrome and/or virilization, or nonfunctional and present as an abdominal mass or an incidental finding.

• #31 Preoperative Assessment of Functioning Benign Adrenocortical Tumors: A Clinical Surgical Approach | IntechOpen

  https://www.intechopen.com/chapters/65619

  In terms of hormonal production, even though most tumors are nonfunctioning, in up to 15% of cases, there might be a slightly increased production of certain hormones, being cortisol the most common one, which may cause Cushings syndrome. […] Around 10-15% of all tumors found are bilateral. Bilateral functioning adrenocortical masses may be congenital adrenal hyperplasia due to a 21-hydroxylase deficiency, adrenal macronodular hyperplasia, or primary hyperaldosteronism. […] The most common causes of bilateral nonfunctioning adrenal masses are metastases, infections (mycosis, tuberculosis), lymphomas, bleedings, amyloidosis, and, rather rarely, carcinoma and myelolipomas. […] In a decreasing order of occurrence, the adrenocortical tumor categories are: Nonfunctioning adenomas (43-75%), Cortisol-producing adenomas (including subclinical Cushings syndrome) (10-15%), Myelolipomas (6-8%), Adrenal carcinomas (4-11%), Metastatic lesions (3-10%), Aldosteronomas (2-6%), Cyst (5%), Tuberculosis and lymphomas (3-8%).

• #32 Preoperative Assessment of Functioning Benign Adrenocortical Tumors: A Clinical Surgical Approach | IntechOpen

  https://www.intechopen.com/chapters/65619

  In terms of hormonal production, even though most tumors are nonfunctioning, in up to 15% of cases, there might be a slightly increased production of certain hormones, being cortisol the most common one, which may cause Cushings syndrome. […] Around 10-15% of all tumors found are bilateral. Bilateral functioning adrenocortical masses may be congenital adrenal hyperplasia due to a 21-hydroxylase deficiency, adrenal macronodular hyperplasia, or primary hyperaldosteronism. […] The most common causes of bilateral nonfunctioning adrenal masses are metastases, infections (mycosis, tuberculosis), lymphomas, bleedings, amyloidosis, and, rather rarely, carcinoma and myelolipomas. […] In a decreasing order of occurrence, the adrenocortical tumor categories are: Nonfunctioning adenomas (43-75%), Cortisol-producing adenomas (including subclinical Cushings syndrome) (10-15%), Myelolipomas (6-8%), Adrenal carcinomas (4-11%), Metastatic lesions (3-10%), Aldosteronomas (2-6%), Cyst (5%), Tuberculosis and lymphomas (3-8%).

• #33 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

• #34 Epidemiology of Adrenal Tumors – a Population-based Study in Olmsted County, Minnesota

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7601441/

  Adrenal tumors are commonly encountered in clinical practice, but current epidemiological data mainly originate from referral centers. We aimed to determine incidence rates (SIR), prevalence, and rates of malignancy and hormone excess in a standardized setting. […] An adrenal tumor was diagnosed in 1,287 patients (median age 62 years; 713 (554%) were women, and 13 (10%) were children). SIR increased from 44 (95%CI 0386) per 100,000 person-years in 1995 to 478 (95%CI 369587) in 2017, mainly due to incidental discovery of adenomas 40mm in 40-year-olds. Prevalence of adrenal tumors in 2017 was 532/100,000 inhabitants, ranging from 13/100,000 in children to 1,900/100,000 among 65-year-olds. Of 1,287 patients, 111 (86%) were diagnosed with malignancy (96 (75%) metastases), 14 (11%) with pheochromocytoma, and 53 (41%) with overt steroid hormone excess. Malignancy was more common in children (62% vs 8% in 18-year-olds, P0001), tumors discovered non-incidentally (32% vs 3% in incidentalomas, P0001), tumors 4 cm (34% vs 7% in 4 cm, P0001), tumors with unenhanced CT attenuation 20 Hounsfield units (15% vs 1% for 20 Hounsfield units, P0001), and bilateral masses (16% vs 7% for unilateral, P=0004). […] Adrenal tumor SIR increased 10 times from 1995 to 2017. Population-based data revealed lower rates of malignancy, pheochromocytoma, and overt steroid hormone excess than previously reported.

• #35 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as adrenal incidentalomas and represent a public health challenge because they are increasingly recognized in current medical practice. The frequency of adrenal incidentalomas in computed tomography (CT) series assessed in the 1980s and 90s ranged from 0.35% to 1.9%, but more recent studies have reported a frequency of about 4.2% to 7.3% that may increase up to 10% in elderly population. […] Management of adrenal incidentalomas is currently matter of debate. There is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery, since there is no consensus on what type of follow-up, if any, is needed.

• #36 71.02 Surveillance Strategies for Benign Non-functional Adrenal Incidentaloma:A Cost Effectiveness Study. – Academic Surgical Congress Abstracts Archive

  https://www.asc-abstracts.org/abs2019/71-02-surveillance-strategies-for-benign-non-functional-adrenal-incidentalomaa-cost-effectiveness-study/

  There is significant global variation in both society guidelines and clinical practice regarding the surveillance of an initially diagnosed non-functional, radiologically-benign adrenal incidentaloma. […] We hypothesized that the FLTS strategy would not be a cost effective approach to managing this group of patients. […] The FLTS strategy was not cost effective and this result was confirmed on multi-way sensitivity analysis using Monte Carlo simulation. […] Frequent long term surveillance (as described in the current US adrenal incidentaloma guideline) is not a cost effective strategy for the management of non-functional, radiologically-benign adrenal incidentaloma.

• #37 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  The ESE/European Network for the Study of Adrenal Tumors (ENSAT) guidelines recommend first to establish the risk of malignancy of an adrenal mass at the time of initial detection. An adrenal mass is considered benign if appears homogeneous and lipid-rich, with a density 10 Hounsfield units (HU) at an unenhanced CT scan. For adrenal masses smaller than 4 cm with benign features, the ESE/ENSAT guidelines and Korean guidelines suggest that no further imaging is required. […] The most recent recommendations extend the idea to limit follow-up introduced by the Italian Associazione Medici Endocrinologi (AME) position statement, that suggested to not perform any further imaging test in very small (1 to 2 cm) benign masses or in masses with clear benign features. […] A recent systematic review and meta-analysis of the literature by Elhassan et al. confirmed that most of the non-functioning adrenal adenomas and adenomas causing mild autonomous cortisol excess do not show significant growth in size during their follow-up. Only 2.5% of adrenal adenomas grew by 10 mm or more over an average follow-up of 41.5 months and, again, malignant transformation was never observed.

• #38 Recent Updates on the Management of Adrenal Incidentalomas

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

  Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. […] The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. […] 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.

• #39 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  The ESE/European Network for the Study of Adrenal Tumors (ENSAT) guidelines recommend first to establish the risk of malignancy of an adrenal mass at the time of initial detection. An adrenal mass is considered benign if appears homogeneous and lipid-rich, with a density 10 Hounsfield units (HU) at an unenhanced CT scan. For adrenal masses smaller than 4 cm with benign features, the ESE/ENSAT guidelines and Korean guidelines suggest that no further imaging is required. […] The most recent recommendations extend the idea to limit follow-up introduced by the Italian Associazione Medici Endocrinologi (AME) position statement, that suggested to not perform any further imaging test in very small (1 to 2 cm) benign masses or in masses with clear benign features. […] A recent systematic review and meta-analysis of the literature by Elhassan et al. confirmed that most of the non-functioning adrenal adenomas and adenomas causing mild autonomous cortisol excess do not show significant growth in size during their follow-up. Only 2.5% of adrenal adenomas grew by 10 mm or more over an average follow-up of 41.5 months and, again, malignant transformation was never observed.

• #40 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  The ESE/ENSAT guidelines suggest annual clinical reassessment of comorbidities related to cortisol excess in patients with autonomous cortisol secretion without signs of overt Cushing syndrome and in patients with both possible autonomous cortisol secretion and potentially associated comorbidities. […] The possibility that an adrenal adenoma progresses to carcinoma is unlikely. However, it would be important to better understand this mechanism to define how and in which patients there is more risk to malignancy, and to develop an appropriate follow-up algorithm.

• #41 Recent Updates on the Management of Adrenal Incidentalomas

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

  Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. […] The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. […] 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.

• #42 Science Saturday: All adrenal tumors should be investigated – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/science-saturday-all-adrenal-tumors-should-be-investigated/

  Of the incidentaloma group — which accounted for about 81.5% of the tumors found — some had malignant adrenal masses (3.3%) and a smaller group had obvious signs of elevated hormones (1.9%). […] „We also found that the clinical presentation and tumor characteristics tells us a lot about the tumor and whether it is likely to be malignant or not. For example, adrenal tumors in children, or any patients with another type of cancer, should be considered malignant until proven otherwise.” […] „In this study, we show that any adrenal mass should be properly evaluated for both malignancy and hormonal excess before dismissing this problem.” […] „Our message is, again, to recognize the adrenal mass as a problem that needs full investigation at the time of discovery,” reiterates Dr. Bancos. […] This study is an example of descriptive epidemiology, examining incidence, prevalence, morbidity and mortality. It describes the scope of adrenal tumors, which helps shared decision-making with patients. […] „Clear understanding of the risk is very helpful in shared decision-making on the next steps in management.” […] „Outside the clinic, I agree with Andreas that epidemiology data is extremely important for development of guidelines and proposing intervention.”

• #43 71.02 Surveillance Strategies for Benign Non-functional Adrenal Incidentaloma:A Cost Effectiveness Study. – Academic Surgical Congress Abstracts Archive

  https://www.asc-abstracts.org/abs2019/71-02-surveillance-strategies-for-benign-non-functional-adrenal-incidentalomaa-cost-effectiveness-study/

  There is significant global variation in both society guidelines and clinical practice regarding the surveillance of an initially diagnosed non-functional, radiologically-benign adrenal incidentaloma. […] We hypothesized that the FLTS strategy would not be a cost effective approach to managing this group of patients. […] The FLTS strategy was not cost effective and this result was confirmed on multi-way sensitivity analysis using Monte Carlo simulation. […] Frequent long term surveillance (as described in the current US adrenal incidentaloma guideline) is not a cost effective strategy for the management of non-functional, radiologically-benign adrenal incidentaloma.

• #44 A case of adrenal cortical carcinoma arising from a regularly monitored sub-centimetre adrenal incidentaloma in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2024 Issue 1 (2024)

  https://edm.bioscientifica.com/view/journals/edm/2024/1/EDM23-0120.xml

  Current guidelines aim to distinguish between adrenal lesions that can be safely monitored versus those that need surgical intervention. However, there is little consensus between guidelines, which are generally based on low-level evidence and relatively short follow-up periods of up to 5 years. […] The importance of avoiding repetitive radiological evaluation, as proposed by the ESE guidelines, is supported by the high financial costs of imaging, high false-positive rates and significant radiation exposure. […] A recent large series of 512 patients with ACC reported that ACC first detected as an incidentaloma accounted for almost 40% of cases, with a frequency that increased with age.

• #45 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  The ESE/European Network for the Study of Adrenal Tumors (ENSAT) guidelines recommend first to establish the risk of malignancy of an adrenal mass at the time of initial detection. An adrenal mass is considered benign if appears homogeneous and lipid-rich, with a density 10 Hounsfield units (HU) at an unenhanced CT scan. For adrenal masses smaller than 4 cm with benign features, the ESE/ENSAT guidelines and Korean guidelines suggest that no further imaging is required. […] The most recent recommendations extend the idea to limit follow-up introduced by the Italian Associazione Medici Endocrinologi (AME) position statement, that suggested to not perform any further imaging test in very small (1 to 2 cm) benign masses or in masses with clear benign features. […] A recent systematic review and meta-analysis of the literature by Elhassan et al. confirmed that most of the non-functioning adrenal adenomas and adenomas causing mild autonomous cortisol excess do not show significant growth in size during their follow-up. Only 2.5% of adrenal adenomas grew by 10 mm or more over an average follow-up of 41.5 months and, again, malignant transformation was never observed.

• #46 Is Follow-up of Adrenal Incidentalomas Always Mandatory?

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2020.35.1.26

  The ESE/ENSAT guidelines suggest annual clinical reassessment of comorbidities related to cortisol excess in patients with autonomous cortisol secretion without signs of overt Cushing syndrome and in patients with both possible autonomous cortisol secretion and potentially associated comorbidities. […] The possibility that an adrenal adenoma progresses to carcinoma is unlikely. However, it would be important to better understand this mechanism to define how and in which patients there is more risk to malignancy, and to develop an appropriate follow-up algorithm.

• #47 A case of adrenal cortical carcinoma arising from a regularly monitored sub-centimetre adrenal incidentaloma in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2024 Issue 1 (2024)

  https://edm.bioscientifica.com/view/journals/edm/2024/1/EDM23-0120.xml

  Current guidelines aim to distinguish between adrenal lesions that can be safely monitored versus those that need surgical intervention. However, there is little consensus between guidelines, which are generally based on low-level evidence and relatively short follow-up periods of up to 5 years. […] The importance of avoiding repetitive radiological evaluation, as proposed by the ESE guidelines, is supported by the high financial costs of imaging, high false-positive rates and significant radiation exposure. […] A recent large series of 512 patients with ACC reported that ACC first detected as an incidentaloma accounted for almost 40% of cases, with a frequency that increased with age.

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

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

  INTRODUCTION […] 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? […] Is it functioning? […] The approach to the evaluation and management of adrenal incidentalomas is reviewed here. Detailed discussions of adrenal carcinoma and functioning adrenal tumors such as pheochromocytomas and aldosteronomas are found elsewhere. […] PREVALENCE

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

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

  A benign cortical adenoma is the most common adrenal tumor and it is almost always round. A cortical adenoma is an adrenal tumor that grows from the adrenal cortex — the outermost layer of the adrenal gland. […] 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. […] MRI has similar diagnostic accuracy to CT, allowing characterizing adenomas regardless of their CT enhancement. On T2-weighted MR images (fluid-filled tissues appear bright), adrenal adenomas are homogeneous and present intermediate-low signal intensity compared to skeletal muscle or liver.

• #50 A Clinical Challenge: Endocrine and Imaging Investigations of Adrenal Masses | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/62/Supplement_2/26S

  Incidentalomas are reported in 3%4% of patients who undergo abdominal anatomic imaging, making adrenal mass evaluation a common occurrence. An adrenal mass can be caused by a variety of pathologies, such as benign cortical and medullary tumors, malignant tumors (primary or secondary), cysts, hyperplasia, hemorrhage, or more rarely infection/inflammation processes. […] Understanding the epidemiology of incidentalomas, which are benign lesions in most cases (2), has resulted in simplifying and streamlining of the imaging procedures and follow-up routines for adrenal incidentalomas. […] Dedicated imaging is required to differentiate benign and malignant adrenal lesions. […] Most (70%) benign adrenocortical adenomas show low attenuation on precontrast CT (10 Hounsfield units [HU]) (3) and chemical shift on MRI (4) due to their high content of cytoplasmatic fat (5).

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

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

  A benign cortical adenoma is the most common adrenal tumor and it is almost always round. A cortical adenoma is an adrenal tumor that grows from the adrenal cortex — the outermost layer of the adrenal gland. […] 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. […] MRI has similar diagnostic accuracy to CT, allowing characterizing adenomas regardless of their CT enhancement. On T2-weighted MR images (fluid-filled tissues appear bright), adrenal adenomas are homogeneous and present intermediate-low signal intensity compared to skeletal muscle or liver.

• #52 A Clinical Challenge: Endocrine and Imaging Investigations of Adrenal Masses | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/62/Supplement_2/26S

  Adrenocortical carcinomas (ACC) are rare and usually appear on CT/MRI as a large, irregular, and heterogeneous tumor with predominantly peripheral contrast-enhancement due to central necrosis. […] Approximately 30% of adrenocortical adenomas do not have enough cytoplasmic fat for proper characterization on CT/MRI and are thus categorized as lipid-poor adrenal adenomas. […] The most common hormones that can be oversecreted are aldosterone and cortisol from the cortex and epinephrine and norepinephrine from the medulla. […] Primary hyperaldosteronism (PHA) represents the most common form of secondary hypertension, with a prevalence of up to 12% of hypertensive patients. […] The use of123I-iodometomidate for SPECT is limited by the reduced spatial resolution and the need to premedicate patients with dexamethasone (23). […] In a prospective study that included 36 patients with PHA, 68Ga-pentixafor was effective in distinguishing aldosterone-producing adenoma from nonfunctioning adenoma and hyperplasia (25).

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

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

  Cushings syndrome (hypercortisolism): This condition occurs when your adenoma secretes too much cortisol. Tumors in your pituitary gland most often cause Cushings syndrome, but adrenal tumors can also lead to Cushing’s syndrome. Symptoms include high blood pressure, weight gain (especially around your middle) and sexual dysfunction. It can increase your likelihood of diabetes. […] Primary aldosteronism (Conns syndrome): This condition occurs when your adenoma secretes too much aldosterone. Signs and symptoms include low potassium levels, high blood pressure, headache, fatigue and muscle weakness. […] In rare instances, an adrenal adenoma may secrete excess sex hormones. Too many androgens (for example, testosterone) in females may lead to irregular periods, increased body hair (hirsutism), a deeper voice, etc. Too much estrogen in males may cause decreased sex drive and erectile dysfunction.

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

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

  Functioning adrenal adenomas may produce symptoms related to having excess hormones in your body, especially excess cortisol (Cushings syndrome) or excess aldosterone (Primary aldosteronism). […] Researchers dont know what causes an adrenal adenoma or other benign adrenal gland tumors to form. Still, certain genetic conditions may increase your risk, including: […] Multiple endocrine neoplasia, type 1 (MEN1). […] Familial adenomatous polyposis (FAP). […] Carney complex. […] Li-Fraumeni syndrome. […] Multiple endocrine neoplasia type 2 (MEN2). […] Neurofibromatosis Type 1. […] Obesity and tobacco use may also increase your chances of having an adrenal adenoma. […] Many people dont realize they have an adrenal adenoma until their healthcare provider discovers an adrenal gland tumor during an imaging procedure for an unrelated medical condition. These tumors are sometimes called incidentalomas because theyre found incidentally, or by chance.

• #55 Genetic Alterations in Benign Adrenal Tumors

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

  The genetic background of primary adrenal lesions has been unraveled through advances in the field of genomics over the past decade. […] The incidence of CS is estimated to be 39–79 per million people per year in various populations with male to female ratio of 1:3. […] The cAMP/protein kinase A (PKA) pathway plays a vital role in adrenocortical cell development, proliferation, and function. […] The PKA holoenzyme consists of four regulatory subunits RIα, RIβ, RIIα, RIIβ and three catalytic subunits Cα, Cβ, and Cγ and those form the type I and type II isoforms of PKA. […] In the majority of PBMAH cases (ranging between 77 and 87% among studies), adrenocortical cells express aberrant hormone receptors, either excessive or ectopic. […] In the recent years, genetic alterations in the catalytic subunits of the PKA enzyme have been found to play a role in micronodular BAH. […] The dysregulation of the cAMP-PKA signaling pathway is vital in the development of those tumors.

• #56 Recent Updates on the Management of Adrenal Incidentalomas

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

  Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. […] The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. […] 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.

• #57 Urinary Steroid Profile Assay

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

  Approximately 80 million CT scans are performed in the United States every year. Adrenal tumors are found incidentally in about 5% of these scans. Most of these tumors will turn out to be benign, but a small fraction will be adrenal cortical carcinoma (ACC), a type of cancer with high mortality and frequent recurrence; even for localized disease the 5-year survival rates do not exceed 65%, and distant spread is associated with a >90% death rate within that time period. Early diagnosis of a malignant adrenal mass is therefore imperative to assure timely and appropriate therapy. […] The timing for this new biomarker comes none too soon, since, as aforementioned, adrenal masses are found in 5% of the population. The prevalence increases with age, ranging between less than 0.5% in children and around 10% in 70-year-old patients. […] Although the majority of these tumors are benign, around 30% of adrenal tumors (>4cm) are malignant (most represented by ACCs), and the survival rate for these patients is very poor unless detected early.

• #58 Differentiation of multiple adrenal adenoma subtypes based on a radiomics and clinico-radiological model: a dual-center study | BMC Medical Imaging | Full Text

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-025-01556-w

  This study found that the combination models based on logistic regression can accurately predict the preoperative multi-classification of adrenal tumors, as evidenced by their performance in the external test set. […] The logistic regression classifier model, incorporating both clinico-radiological and radiomic features, proves to be effective in distinguishing adrenal adenoma subtypes.

• #59 Adrenal Gland Tumor | Temple Health

  https://www.templehealth.org/services/conditions/adrenal-gland-tumor

  Adrenal gland tumors affect the adrenal glands, located above your kidneys. Adrenal glands release hormones that help control your blood sugar and blood pressure and help you manage stress. Tumors or nodules of the adrenal glands are more common over age 45 and are common findings on CT or MRI scans of the abdomen. […] Benign adenomas generally do not cause symptoms. However, if they cause you to over-produce hormones, symptoms can include: […] Most small benign tumors or nodules that do not produce excess hormones can be monitored rather than immediately removed.

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

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

  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 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. Large tumors and rapid growth increase the likelihood of a tumor becoming cancerous. […] Treatments for functioning tumors almost always involve surgery.

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

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

  Adrenal gland tumors, including adrenal adenoma, cant be prevented. The risk factors for adrenal adenoma often depend on your genes. Still, you can develop an adrenal adenoma even if no one in your family has a history of adrenal gland tumors. […] Treatment outcomes associated with adrenalectomy are excellent. Removing the affected adrenal gland often relieves the symptoms related to functional adrenal adenomas. […] Follow your healthcare providers guidance about how often you should be tested if youve been diagnosed with a nonfunctioning adrenal adenoma. Depending on your tumor, your healthcare provider may recommend periodic CT scans or hormone testing. […] Dont be too alarmed if your healthcare provider finds an adrenal gland tumor during an imaging procedure. Most often, these tumors are harmless. 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. If theres a concern that it could become malignant, your healthcare provider can remove it.

• #62 Current Management of Adrenal Incidentalomas | IntechOpen

  https://www.intechopen.com/chapters/55357

  Adrenal size is one of the most important determinants of malignancy. Prior guidelines recommended adrenalectomy for patients with an adrenal mass 6 cm. However, in one of the largest multicenter retrospective studies, adrenal tumor size 4 cm provided the highest sensitivity (93%) in differentiating between benignity and malignancy. […] Current guidelines suggest adrenalectomy in all surgically fit patients with an adrenal mass 4 cm. […] Patients with adrenal incidentalomas who do not fulfill criteria for surgical resection should undergo repeat imaging at 36 months, and then annually, for 12 years. In addition, hormonal evaluation should be obtained annually for 5 years. The risk of enlargement during 1, 2, and 5 years is 6, 14, and 29%, respectively, and the risk of the mass becoming hormonally active during the same periods is 17, 29, and 47%, respectively.

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

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

  Adrenal gland tumors, including adrenal adenoma, cant be prevented. The risk factors for adrenal adenoma often depend on your genes. Still, you can develop an adrenal adenoma even if no one in your family has a history of adrenal gland tumors. […] Treatment outcomes associated with adrenalectomy are excellent. Removing the affected adrenal gland often relieves the symptoms related to functional adrenal adenomas. […] Follow your healthcare providers guidance about how often you should be tested if youve been diagnosed with a nonfunctioning adrenal adenoma. Depending on your tumor, your healthcare provider may recommend periodic CT scans or hormone testing. […] Dont be too alarmed if your healthcare provider finds an adrenal gland tumor during an imaging procedure. Most often, these tumors are harmless. 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. If theres a concern that it could become malignant, your healthcare provider can remove it.

• #64 Diagnosis and Treatment of Adrenal Tumors (Incidentaloma)

  https://www.urology-textbook.com/adrenal-incidentaloma.html

  An adrenal incidentaloma is an (incidentally discovered) tumor of the adrenal gland. The most common cause is an adenoma without hormone production and without clinical significance. In 20%, a need for therapy arises from either progressive growth or hormone production. […] A rational treatment for incidentaloma is shown in the flowchart above. Adrenal tumors 4 cm in size without hormone production: imaging once after one year if typical criteria for adrenal adenoma are present. If imaging becomes suspicious, additional imaging might be necessary. Annual check for hormone activity for four years. In case of size progression or hormone activity, adrenalectomy is indicated. Adrenal tumors 46 cm in size without hormone production: adrenalectomy or continue active surveillance (see tumors 4 cm size), depending on the patient’s wishes, imaging results, and clinical situation. Adrenal tumors with hormone activity: adrenalectomy. Adrenal tumors larger than 6 cm: adrenalectomy.

• #65 Diagnosis and Treatment of Adrenal Tumors (Incidentaloma)

  https://www.urology-textbook.com/adrenal-incidentaloma.html

  An adrenal incidentaloma is an (incidentally discovered) tumor of the adrenal gland. The most common cause is an adenoma without hormone production and without clinical significance. In 20%, a need for therapy arises from either progressive growth or hormone production. […] A rational treatment for incidentaloma is shown in the flowchart above. Adrenal tumors 4 cm in size without hormone production: imaging once after one year if typical criteria for adrenal adenoma are present. If imaging becomes suspicious, additional imaging might be necessary. Annual check for hormone activity for four years. In case of size progression or hormone activity, adrenalectomy is indicated. Adrenal tumors 46 cm in size without hormone production: adrenalectomy or continue active surveillance (see tumors 4 cm size), depending on the patient’s wishes, imaging results, and clinical situation. Adrenal tumors with hormone activity: adrenalectomy. Adrenal tumors larger than 6 cm: adrenalectomy.

• #66 Diagnosis and Treatment of Adrenal Tumors (Incidentaloma)

  https://www.urology-textbook.com/adrenal-incidentaloma.html

  An adrenal incidentaloma is an (incidentally discovered) tumor of the adrenal gland. The most common cause is an adenoma without hormone production and without clinical significance. In 20%, a need for therapy arises from either progressive growth or hormone production. […] A rational treatment for incidentaloma is shown in the flowchart above. Adrenal tumors 4 cm in size without hormone production: imaging once after one year if typical criteria for adrenal adenoma are present. If imaging becomes suspicious, additional imaging might be necessary. Annual check for hormone activity for four years. In case of size progression or hormone activity, adrenalectomy is indicated. Adrenal tumors 46 cm in size without hormone production: adrenalectomy or continue active surveillance (see tumors 4 cm size), depending on the patient’s wishes, imaging results, and clinical situation. Adrenal tumors with hormone activity: adrenalectomy. Adrenal tumors larger than 6 cm: adrenalectomy.

• #67 Diagnosis and Treatment of Adrenal Tumors (Incidentaloma)

  https://www.urology-textbook.com/adrenal-incidentaloma.html

  An adrenal incidentaloma is an (incidentally discovered) tumor of the adrenal gland. The most common cause is an adenoma without hormone production and without clinical significance. In 20%, a need for therapy arises from either progressive growth or hormone production. […] A rational treatment for incidentaloma is shown in the flowchart above. Adrenal tumors 4 cm in size without hormone production: imaging once after one year if typical criteria for adrenal adenoma are present. If imaging becomes suspicious, additional imaging might be necessary. Annual check for hormone activity for four years. In case of size progression or hormone activity, adrenalectomy is indicated. Adrenal tumors 46 cm in size without hormone production: adrenalectomy or continue active surveillance (see tumors 4 cm size), depending on the patient’s wishes, imaging results, and clinical situation. Adrenal tumors with hormone activity: adrenalectomy. Adrenal tumors larger than 6 cm: adrenalectomy.

• #68 Current Management of Adrenal Incidentalomas | IntechOpen

  https://www.intechopen.com/chapters/55357

  Adrenal size is one of the most important determinants of malignancy. Prior guidelines recommended adrenalectomy for patients with an adrenal mass 6 cm. However, in one of the largest multicenter retrospective studies, adrenal tumor size 4 cm provided the highest sensitivity (93%) in differentiating between benignity and malignancy. […] Current guidelines suggest adrenalectomy in all surgically fit patients with an adrenal mass 4 cm. […] Patients with adrenal incidentalomas who do not fulfill criteria for surgical resection should undergo repeat imaging at 36 months, and then annually, for 12 years. In addition, hormonal evaluation should be obtained annually for 5 years. The risk of enlargement during 1, 2, and 5 years is 6, 14, and 29%, respectively, and the risk of the mass becoming hormonally active during the same periods is 17, 29, and 47%, respectively.

• #69 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 majority of them are benign adrenocortical adenomas (ACAs) and a small portion of them adrenocortical carcinomas (ACCs). ACAs are usually non-secreting; the long-term follow-up still remains controversial. […] According to the guidelines from the National Institutes of Health (NIH) and the American Association of Clinical Endocrinologists (AACE/AASE) dexamethasone suppression test should be repeated once a year for five years while imaging testing should be performed for at least one year if the tumor is <4 cm or for at least two years if the tumor is ≥4 cm.

• #70 Adrenocortical adenoma – Wikipedia

  https://en.wikipedia.org/wiki/Adrenocortical_adenoma

  Adrenocortical adenomas are classified as ACTH-independent disorders, and are commonly associated with conditions linked to hyperadrenalism such as Cushing’s syndrome (hypercortisolism) or Conn’s syndrome (hyperaldosteronism), which is also known as primary aldosteronism. […] Adrenal adenomas are often categorized as endocrine-inactive tumors considering that majority of them are non-functioning and asymptomatic. […] Study of the reported cases indicate that most adrenocortical adenomas occur due to neoplastic proliferation of adrenal cortical cells within the three distinct layers of adrenal cortex. […] The long-term outlook for individuals diagnosed with non-functional adrenocortical adenoma is usually excellent. […] The long-term outlook for individuals diagnosed with functional adrenocortical adenoma is good with early diagnosis and treatment. […] Prevalence: Female Male […] More common in adults […] Relatively earlier onset in females (ages 20) than males (ages 30) […] Most common cause of ACTH-independent Cushing’s syndrome.

• #71

  https://journals.lww.com/indianjcancer/fulltext/2015/52030/adrenal_tumors__an_experience_of_10_years_in_a.75.aspx

  Most of the adrenal masses are discovered incidentally by imaging techniques for reasons unrelated to adrenal diseases. […] A total of 5 year survival was 100% in benign cases and 27% in malignant tumors. […] Adrenal tumors need to be assessed for their functional status and malignant potential prior to treatment. Surgical excision is usually curative for benign lesion. […] The incidence of malignancy increases with the increase in size of the tumor. […] The mean size of malignant tumors was 9.7 cm as compared to 5.9 cm in the benign group. […] A reasonable accepted cut-off value is 4 cm, beyond, which strong suspicion of malignancy should be entertained. […] The patients could be maximally followed-up for 7 years and the 5 year survival rate for benign tumors was 100% while it was only 27% for malignant tumors. […] Most of the patients being referred were of large size (4 cm). Malignancy and myelolipoma formed the majority of the patients. Functional abnormalities were detected in only 14.8% of patients.

• #72 Adrenal tumor: Outlook and more

  https://www.medicalnewstoday.com/articles/how-serious-is-a-tumor-on-the-adrenal-gland

  Adrenal gland tumors may be cancerous or benign. Most adrenal tumors are benign, but can produce excess levels of certain hormones. […] Most adrenal tumors are benign, but some can be cancerous. […] Noncancerous, or benign, adrenal tumors do not spread, and in most people, are not life threatening. Most tumors on the adrenal gland are not cancerous. […] Benign adrenal gland tumors may be functional or nonfunctional. Functional tumors make excess hormones, which can affect other systems in the body and cause symptoms. Nonfunctional tumors do not usually cause any symptoms. […] Benign adrenal tumors are usually not life threatening, but people may require treatment if the tumor causes symptoms. […] Most adrenal tumors are benign and adrenal cancer is rare. In total, less than 1% of adrenal gland tumors are cancerous. […] Adrenal gland tumors are usually benign, but some can be cancerous. People may require treatment for cancerous tumors or benign tumors that cause symptoms.

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