Adrenal Incidentaloma Questions & Answers

Updated: Mar 06, 2020
  • Author: George T Griffing, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Questions & Answers

Overview

How are adrenal incidentalomas discovered?

What does the differential diagnosis of adrenal incidentaloma include?

What is an adrenal cortical adenoma (adrenal incidentaloma)?

What is the importance of distinguishing whether an adrenal incidentaloma is benign or malignant?

What is the treatment for a hormonally active (functional) adrenal incidentaloma?

What is the anatomy of the adrenal glands relative to adrenal incidentaloma?

What is the pathophysiology of adrenal incidentaloma?

What causes adrenal incidentaloma?

How common are adrenal incidentalomas?

How common is pheochromocytoma in adrenal incidentaloma?

What is the demographic distribution of adrenal incidentaloma?

What is the prognosis of adrenal incidentaloma?

What percentage of adrenal incidentaloma are benign?

What is the prognosis of adrenal incidentaloma in patients with a previous history of cancer?

What is the prognosis of pheochromocytoma in adrenal incidentaloma?

What is the patient education on adrenal incidentaloma?

Presentation

What is the role of hormonal symptoms in the patient history in adrenal incidentaloma?

What are the symptoms of pheochromocytoma in adrenal incidentaloma?

What are the signs and symptoms of primary hyperaldosteronism in adrenal incidentaloma?

What are the signs and symptoms of adrenal carcinoma in adrenal incidentaloma?

What are the symptoms of Cushing syndrome associated with adrenal incidentaloma?

What clinical signs are associated with adrenal incidentaloma?

What are the physical exam findings of adrenal incidentaloma?

DDX

What are the diagnostic considerations of adrenal incidentaloma?

What are the differential diagnoses for Adrenal Incidentaloma?

Workup

What is the first consideration in the workup of adrenal incidentaloma?

How is a diagnosis of adrenal incidentaloma confirmed?

When is fine-needle aspiration indicated in the workup of adrenal incidentaloma?

How are adrenal cortical adenomas diagnosed in the workup of adrenal incidentaloma?

How accurate is liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the workup of adrenal incidentaloma?

What is the importance of distinguishing whether an adrenal mass is benign or malignant in adrenal incidentaloma?

How is real-time polymerase chain reaction (PCR) used in the diagnosis of adrenal incidentaloma?

When is biochemical testing indicated in the workup of adrenal incidentaloma?

What are the biochemical indications of Cushing syndrome in adrenal incidentaloma?

What are the signs and symptoms of Cushing syndrome associated with adrenal incidentaloma?

Why should pheochromocytoma be considered in all adrenal incidentaloma cases?

What are the considerations of pheochromocytoma prior to performing a fine-needle aspiration (FNA) biopsy on an adrenal incidentaloma?

Which tests for primary aldosteronism are indicated in the workup of adrenal incidentaloma?

What are the relevant secreted hormones in the workup of adrenal incidentaloma?

What are the diagnostic considerations of bilateral adrenal incidentaloma?

What are the diagnostic considerations of bilateral adrenal incidentaloma in a patient with primary hyperaldosteronism?

How common is Cushing syndrome in patients with adrenal incidentaloma?

What is the role of 21-hydroxylase deficiency in adrenal incidentaloma?

What are the indications of an adrenal myelolipoma in the workup of adrenal incidentaloma?

What does the presence of intracytoplasmic lipid indicate in the workup of adrenal incidentaloma?

Which imaging studies are used in the workup of adrenal incidentaloma?

How is MRI used in the workup of adrenal incidentaloma?

How is PET scanning used in the workup of adrenal incidentaloma?

What is the importance of mass size in the workup of adrenal incidentaloma?

What is the cutoff criterion for suspicion of malignancy in the workup of adrenal incidentaloma?

What is the role of plain radiography, tomography, and ultrasonography in the workup of adrenal incidentaloma?

What other scanning techniques are used in the workup of adrenal incidentaloma?

How are pheochromocytomas characterized on imaging in the workup of adrenal incidentaloma?

How are adrenal carcinomas characterized on imaging in the workup of adrenal incidentaloma?

What is the role of fine-needle aspiration (FNA) in the workup of adrenal incidentaloma?

How is CT scanning used in conjunction with fine-needle aspiration (FNA) in the workup of adrenal incidentaloma?

What is the role of percutaneous adrenal biopsy in the detection of malignant adrenal neoplasms?

Treatment

What are the approach considerations in the treatment of an adrenal incidentaloma?

When is surgery not indicated in the treatment of adrenal incidentaloma?

What is the treatment for a hormonally active adrenal tumor?

Which surgical approach is preferred in the treatment of bilateral adrenal incidentaloma?

What novel approaches have been used in the surgical treatment of adrenal incidentaloma?

What is the treatment for adrenal incidentaloma in the setting of metastatic disease?

What are the potential complications of adrenal incidentaloma treatment?

Which specialist consultation is indicated in the treatment of adrenal incidentaloma?

What is the role of follow-up care in patients with adrenal incidentaloma who have not undergone adrenalectomy?

Which lab studies are indicated in the follow-up of adrenal incidentalomas?

Which hormonal disorders are most common in the follow-up period of patients with adrenal incidentaloma?

What are the AACE/AAES 2009 guidelines on follow-up in patients with adrenal incidentaloma?

What does FDG update indicate in the follow-up of adrenal incidentaloma?

How common is primary hyperaldosteronism or catecholamine excess in the long-term care of adrenal incidentaloma?

When can adrenal insufficiency occur in the follow-up of adrenal incidentaloma?

What is the treatment for hypocortisolism in the long-term care of patients with adrenal incidentaloma?

Guidelines

What are the AACE guidelines for the evaluation of adrenal incidentaloma?

What is the simplest screening test for autonomous cortisol secretion in patients with an adrenal incidentaloma?

How is primary aldosteronism confirmed in adrenal incidentaloma?

How is the adrenal incidentaloma subtype determined?

What are the diagnostic recommendations of the adrenal incidentaloma guidelines?

Which lab studies are indicated in the hormonal workup of adrenal incidentaloma?

Which lab studies are indicated for the evaluation of sexual steroids and precursors in the workup of adrenal incidentaloma?

Which lab studies are indicated for the evaluation of mineralocorticoid excess in the workup of adrenal incidentaloma?

Which lab studies are indicated for the evaluation of catecholamine excess in the workup of adrenal incidentaloma?

Which imaging studies are indicated in the workup of adrenal incidentaloma?

What are the NCCN guidelines for the staging of adrenal incidentaloma?

What are the AACE/AAES guidelines on the treatment of adrenal incidentaloma?

What are the guidelines for patients with adrenal incidentalomas who do not meet the criteria for surgical resection?

What are the NCCN treatment guidelines for localized disease in adrenal incidentaloma?

What are the NCCN treatment guidelines for metastatic disease in adrenal incidentaloma?

What are the ESMO guidelines on the workup of adrenal incidentaloma?

What are the ESE/ENSAT recommendations for the surgical treatment of adrenal incidentaloma management?