Adrenal Incidentaloma Clinical Presentation

Updated: Feb 24, 2017
  • Author: George T Griffing, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Presentation

History

Evidence of hormonal excess should be sought.

Pheochromocytomalike symptoms include episodic attacks, palpitations, sweats, headaches, and abdominal pain, as well as labile hypertension. Pheochromocytomas should be considered in all adrenal incidentaloma (AI) cases because they are more common than previously thought, the diagnosis is often overlooked, and a failure to recognize them may lead to patient death.

Primary hyperaldosteronism includes hypertension and unprovoked hypokalemia. However, more patients are being identified who have normal potassium levels.

Patients with adrenal carcinoma report weight loss. Virilization is reported in women (for androgen-secreting tumors), and feminization in men (for estrogen-secreting tumors).

Cushing syndrome (reflecting cortisol-secreting adenomas) includes weight gain, weakness, depression, and bruising.

Evidence of systemic disease, such as carcinoma, amyloidosis, or granulomatous disease, may be present. Often, no clinical clues can be found and other information is needed for diagnosis.

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Physical Examination

Vital signs may include findings of high blood pressure, postural hypotension, and tachycardia. A fundi feature is hypertensive retinopathy. Skin findings include hirsutism and striae. General signs include central obesity and gynecomastia.

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