INCIDENTAL ADRENAL MASSES
Adrenal masses are common findings on abdominal CT or MRI scans (1–7% prevalence with increasing age). The majority of such “incidentalomas” are clinically nonfunctional, and the probability of an adrenal carcinoma is low (<5%) (Fig. 174-2). 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. 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, aldosterone/renin 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 174-2
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Citation
Kasper, Dennis L., et al., editors. "INCIDENTAL ADRENAL MASSES." Harrison's Manual of Medicine, 20th ed., McGraw Hill Inc., 2020. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES.
INCIDENTAL ADRENAL MASSES. In: Kasper DLD, Fauci ASA, Hauser SLS, et al, eds. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES. Accessed November 9, 2024.
INCIDENTAL ADRENAL MASSES. (2020). In Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (Eds.), Harrison's Manual of Medicine (20th ed.). McGraw Hill Inc.. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623425/all/INCIDENTAL_ADRENAL_MASSES
INCIDENTAL ADRENAL MASSES [Internet]. In: Kasper DLD, Fauci ASA, Hauser SLS, Longo DLD, Jameson JLJ, Loscalzo JJ, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. [cited 2024 November 09]. 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
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BT - Harrison's Manual of Medicine
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PB - McGraw Hill Inc.
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DB - Harrison's Manual of Medicine
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