Incidentaloma diagnostic criteria: Difference between revisions
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** Whether the lesion is [[malignant]] | ** Whether the lesion is [[malignant]] | ||
** Whether it is [[Hormone|hormonally]] active | ** Whether it is [[Hormone|hormonally]] active | ||
* 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 Hounsfield unit (HU) is the best tool to differentiate between [[benign]] and [[malignant]] [[Adrenal mass causes|adrenal masses.]] | ||
* All [[Adrenal tumor|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 [[Adrenal tumor|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|hyperaldosteronism.]] | * All patients should undergo [[hormonal]] evaluation for subclinical [[Cushing's syndrome]] and [[pheochromocytoma]], and those with [[hypertension]] should also be evaluated for primary [[Hyperaldosteronism|hyperaldosteronism.]] | ||
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{{familytree |||| | | | | A01 |A01=Adrenal mass}} | {{familytree |||| | | | | A01 |A01=Adrenal mass}} | ||
{{familytree | | | |,|-|-|-|-|^|-|-|-|-|.| | | }} | {{familytree | | | |,|-|-|-|-|^|-|-|-|-|.| | | }} | ||
{{familytree | | | B01 | | | | | | | | B02 | | |B01=CT attenuation value< 10HU|B02=CT attenuation value> 10HU}} | {{familytree | | | B01 | | | | | | | | B02 | | |B01=CT attenuation value< 10HU|B02=CT attenuation value> 10HU*}} | ||
{{familytree | | |,|^|-|-|.| | | | | |,|-|^|-|-|-|.| }} | {{familytree | | |,|^|-|-|.| | | | | |,|-|^|-|-|-|.| }} | ||
{{familytree | | C04 | |C01| | | | |C02| | |C03|C01=Functional|C04=Nonfunctional|C02=< 4cm|C03=> 4cm}} | {{familytree | | C04 | |C01| | | | |C02| | |C03|C01=Functional|C04=Nonfunctional|C02=< 4cm|C03=> 4cm}} | ||
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{{familytree | | | | | | | | | | | | H01| |H01=Follow up CT image for two years}} | {{familytree | | | | | | | | | | | | H01| |H01=Follow up CT image for two years}} | ||
{{familytree/end}} | {{familytree/end}} | ||
<small>HU;Hounsfield unit. </small> | |||
==References== | ==References== | ||
Revision as of 14:25, 16 October 2017
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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
There are no definitive diagnostic criteria for adrenal incidentaloma management but there are guidelines to diagnose and treat the mass according to Endocrine Society. Radiological evaluation including noncontrast CT attenuation value expressed in Hounsfield unit (HU) is the best tool to differentiate between benign and malignant adrenal masses. All patients should undergo hormonal evaluation for subclinical Cushing's syndrome and pheochromocytoma, and those with hypertension should also be evaluated for primary hyperaldosteronism.
Diagnostic Criteria
- There are no definitive diagnostic criteria for adrenal incidentaloma management but there are guidelines to diagnose and treat the mass according to Endocrine Society.[1]
- 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.[2]
- The diagnostic approach in patients with adrenal incidentalomas should focus on two main questions:
- Whether the lesion is malignant
- Whether it is hormonally active
- Radiological evaluation including noncontrast CT attenuation value expressed in Hounsfield unit (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 resonable.
- 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 | > 0.8cm increase in size in 12 months | |||||||||||||||||||||||||||||||||||||||||
| Follow up CT image for two years | |||||||||||||||||||||||||||||||||||||||||||
HU;Hounsfield unit.
References
- ↑ Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A; et al. (2016). "Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors". Eur J Endocrinol. 175 (2): G1–G34. doi:10.1530/EJE-16-0467. PMID 27390021.
- ↑ 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.