Adrenal Adenoma Differential Diagnoses

  • Author: George T Griffing, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Sep 22, 2011
 
 

Diagnostic Considerations

The differential diagnosis of adrenal masses (AMs) includes many primary, metastatic, benign, and malignant entities, most of which are not discussed at length here. Problems to be considered include the following:

  • Adjacent structures masquerading as AMs (eg, kidneys, spleen, pancreas, lymph nodes)
  • Adrenal cortical hyperplasia
  • Adrenal cortical neoplasms
  • Infiltrative diseases
  • Hemorrhage
  • Lung cancer, adenocarcinoma
  • Medullary neoplasms
  • Metastatic disease
  • Teratoma, atypical

In addition, see the image below for further differential diagnoses of AMs.

Differential diagnosis of adrenal mass Differential diagnosis of adrenal mass

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Coauthor(s)

Perry J Horwich, MD  Staff Physician, Instructor of Radiology, Department of Radiology, Beth Israel - Deaconess Medical Center

Perry J Horwich, MD is a member of the following medical societies: American College of Radiology, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America

Disclosure: Nothing to disclose.

Stephen A Okon, MD  Consulting Staff, Assistant Professor of Radiology, Department of Radiology, Beth Israel Medical Center

Stephen A Okon, MD is a member of the following medical societies: American Medical Association and American Roentgen Ray Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stanley Wallach, MD  Executive Director, American College of Nutrition; Clinical Professor, Department of Medicine, New York University School of Medicine

Stanley Wallach, MD is a member of the following medical societies: American College of Nutrition, American Society for Bone and Mineral Research, American Society for Clinical Investigation, American Society for Clinical Nutrition, American Society for Nutritional Sciences, Association of American Physicians, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Don S Schalch, MD  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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Characteristics of adrenal masses and their malignant potential.
Differential diagnosis of adrenal mass
Pituitary-adrenal axis and cortisol-secreting adrenal mass.
Adrenal incidentaloma and disease type.
Left adrenal mass discovered incidentally.
Close-up of the left adrenal incidentaloma from the above image.
Homogeneous, well-defined, 7-HU ovoid mass is seen in the right adrenal gland; this finding is diagnostic of a benign adrenal adenoma.
Homogeneously enhancing ovoid mass is seen in the left adrenal gland.
Table 1. Prevalence of AMs
Author Method Sample Size Prevalence, %
Russl (1941)Autopsy (>1 cm)131/90001.5
Kokko (1967)[3] Autopsy (>5 mm)21/14951.5
Hedeland (1967)Autopsy (>2 mm)64/7398.7
Glazer (1982)[4] CT scan16/22000.7
Abecassis (1985)[5] CT scan19/14591.3
Belldegrun (1986)[6] CT scan88/120000.7
Herrera (1991)[7] CT scan259/610540.4
Table 2. Evaluation of AM Syndromes
Diagnosis Features Biochemical Tests
PheochromocytomaHigh blood pressure, catechol symptomsUrine-free and plasma-free metanephrines
Primary aldosteronismHigh blood pressure, low K+, low PRA*Plasma aldosterone-to-renin ratio
Adrenocortical carcinomaVirilization or feminizationUrine 17-ketosteroids
Cushing or "silent" Cushing syndromeCushing symptoms or normal examination resultsOvernight 1-mg dexamethasone test
*Plasma renin activity
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