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INCIDENTAL ADRENAL MASSES

INCIDENTAL ADRENAL MASSES is a topic covered in the Harrison's Manual of Medicine.

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Adrenal masses are common findings on abdominal CT or MRI scans (1–7% prevalence with increasing age). The majority (70–80%) of such “incidentalomas” are clinically nonfunctional, and the probability of an adrenal carcinoma is low (<0.01%). Genetic syndromes such as MEN 1, MEN 2, Carney syndrome, and McCune-Albright syndrome are all associated with adrenal masses. The first step in evaluation is to determine the functional status by measurement of plasma free metanephrines to screen for pheochromocytoma (Fig. 171-2). In a pt with a known extraadrenal malignancy, there is a 30–50% chance that the incidentaloma is a metastasis. Additional hormonal evaluation should include 24-h urine for urinary free cortisol or overnight 1-mg dexamethasone suppression testing, plasma renin activity/aldosterone ratio in hypertensives, DHEAS in women with signs of androgen excess, and estradiol in males with feminization. Fine-needle aspiration is rarely indicated and absolutely contraindicated if a pheochromocytoma is suspected. Adrenocortical cancer is suggested by large size (>4–6 cm), irregular margins, tumor inhomogeneity, soft tissue calcifications, and high unenhanced CT attenuation values (>10 HU).

FIGURE 171-2

Management of the patient with an incidentally discovered adrenal mass. F/U, follow-up.

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Citation

Loscalzo, Joseph, et al., editors. "INCIDENTAL ADRENAL MASSES." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES.
INCIDENTAL ADRENAL MASSES. In: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES. Accessed April 21, 2019.
INCIDENTAL ADRENAL MASSES. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES
INCIDENTAL ADRENAL MASSES [Internet]. In: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 April 21]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - INCIDENTAL ADRENAL MASSES ID - 623425 ED - Loscalzo,Joseph, ED - Jameson,J Larry, ED - Longo,Dan L, ED - Hauser,Stephen L, ED - Fauci,Anthony S, ED - Kasper,Dennis L, BT - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES PB - McGraw Hill Inc. ET - 19 DB - Harrison's Manual of Medicine DP - Unbound Medicine ER -