Incidentaloma diagnostic criteria: Difference between revisions
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* The diagnostic approach in patients with adrenal incidentalomas should focus on two main questions: | * The diagnostic approach in patients with adrenal incidentalomas should focus on two main questions: | ||
* 1) | * 1) Whether the lesion is [[malignant]] | ||
* 2) | * 2) Whether it is [[Hormone|hormonally]] active | ||
* Algorithm depicting the recommended evaluation and treatment of patients with an adrenal incidentaloma. | * Algorithm depicting the recommended evaluation and treatment of patients with an adrenal incidentaloma. | ||
* Radiological evaluation including noncontrast [[Computed tomography|CT]] attenuation value expressed in HU is the best tool to differentiate between [[benign]] and [[malignant]] [[Adrenal mass causes|adrenal masses.]] | * Radiological evaluation including noncontrast [[Computed tomography|CT]] attenuation value expressed in HU is the best tool to differentiate between [[benign]] and [[malignant]] [[Adrenal mass causes|adrenal masses.]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
The diagnosis of adrenal incidentaloma is based on the definition, which includes
Diagnostic Criteria
- The guidelines recommend urgent assessment of adrenal mass in children, adolescents, pregnant females, and adults younger than 40 years of age because of a higher likelihood of malignancy.[1]
- The diagnostic approach in patients with adrenal incidentalomas should focus on two main questions:
- 1) Whether the lesion is malignant
- 2) Whether it is hormonally active
- Algorithm depicting the recommended evaluation and treatment of patients with an adrenal incidentaloma.
- Radiological evaluation including noncontrast CT attenuation value expressed in HU is the best tool to differentiate between benign and malignant adrenal masses.
- All adrenal tumors with suspicious radiological features, most functional tumors, and all tumors more than 4 cm in sizewith malignant radiological features should be removed.
- All patients should undergo hormonal evaluation for subclinical Cushing's syndrome and pheochromocytoma, and those with hypertension should also be evaluated for primary hyperaldosteronism.
- Annual biochemical follow- up of most patients with an adrenal incidentaloma (especially if the tumor is more than 3 cm in size) for up to 5 years is resonsnat.
- Patients with adrenal masses less than 4 cm in size and a noncontrast attenuation value greater than 10 HU should have a repeat CT study in 3–6 months and then yearly for 2 years.
- Adrenal tumors with indeterminate radiological features that grow at least 0.8 cm over 3–12 months should be considered for surgical resection once other imaging and clinical characteristics have been taken into consideration.
| Adrenal mass | |||||||||||||||||||||||||||||||||||||||||||
| CT attenuation value< 10HU | CT attenuation value> 10HU | ||||||||||||||||||||||||||||||||||||||||||
| Nonfunctional | Functional | < 4cm | > 4cm | ||||||||||||||||||||||||||||||||||||||||
| Yearly hormonal evlauation for up to 5 years | Surgical removal | Functional | Nonfunctional | Surgical removal | |||||||||||||||||||||||||||||||||||||||
| surgical removal | Calculate enhancement washout within 15 minutes | ||||||||||||||||||||||||||||||||||||||||||
| <60% | >60% | ||||||||||||||||||||||||||||||||||||||||||
| Surgical removal | No change in size in 12 months | > 0.8 increase in size in 12 months | |||||||||||||||||||||||||||||||||||||||||
| Follow up CT image for two years | |||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Sahdev A (2017). "Recommendations for the management of adrenal incidentalomas: what is pertinent for radiologists?". Br J Radiol. 90 (1072): 20160627. doi:10.1259/bjr.20160627. PMID 28181818.