ADRENAL INCIDENTALOMAS: DIAGNOSIS AND MANAGEMENT
https://doi.org/10.18705/1607-419X-2013-19-6-532-537
Abstract
Adrenal incidentaloma is an unsuspected and asymptomatic mass, usually detected by an imaging study performed for other purposes. The widespread use of diagnostic ultrasound, computed tomography, magnetic resonance imaging has resulted in the frequent incidental discovery of asymptomatic adrenal mass. Adrenal incidentalomas represent a public health challenge because they are increasingly recognized in current medical practice. The majority of adrenal incidentalomas are benign, but careful evaluation of all patients is warranted to be certain that malignant tumours and functional adenomas are not missed. The article reviews the presentation, evaluation and management of adrenal incidentalomas.
About the Authors
E. N. Grineva
Federal Almazov Medical Research Centre, St Petersburg
Russian Federation
Russian Federation
Corresponding author: Federal Almazov Medical Research Centre, 2 Akkuratov st., St Petersburg, Russia, 197341. E-mail: grineva@almazovcentre.ru, grineva_e@mail.ru (Elena N. Grineva, MD, DSc, the Director of the Institute of Endocrinology at Federal Almazov Medical Research Centre).
L. V. Belousova
Federal Almazov Medical Research Centre, St Petersburg
Russian Federation
Russian Federation
I. V. Basek
Federal Almazov Medical Research Centre, St Petersburg
Russian Federation
Russian Federation
References
1. Aron D.C. The adrenal incidentaloma: disease of modern technology and public health problem // Rev. Endocr. Metab. Disord. — 2001. — Vol. 2, № 3. — P. 335–342.
2. Young W.F. Clinical practice. The incidentally discovered adrenal mass // N. Engl. J. Med. — 2007. — Vol. 356, № 6. — P. 601–610.
3. Kloos R.T., Gross M.D., Francis I.R., Korobkin M., Shapiro B. Incidentally discovered adrenal masses // Endocr. Rev. — 1995. — Vol. 16, № 4. — P. 460–484.
4. Mansmann G., Lau J., Balk E., Rothberg M., Miyachi Y., Bornstein S.R. The clinically inapparent adrenal mass: updatein diagnosis and management // Endocr. Rev. — 2004. — Vol. 25, № 2. — P. 309–340.
5. Barzon L., Sonino N., Fallo F., Palu G., Boscaro M. Prevalence and natural history of adrenal incidentalomas // Eur. J. Endocrinol. — 2003. — Vol. 149, № 4. — P. 273–285.
6. Bovio S., Cataldi A., Reimondo G. et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series // J. Endocrinol. Invest. — 2006. — Vol. 29, № 4. — P. 298–302.
7. Lacroix A. ACTH-independent macronodular adrenal hyperplasia // Best Pract. Res. Clin. Endocrinol. Metab. — 2009. — Vol. 23, № 2. — P. 245–259.
8. Terzolo M., Stigliano A., Chiodini P. et al. AME Position Statement on adrenal incidentaloma // Eur J Endocrinol . — 2011. — Vol. 164, № 6. — P. 851–870.
9. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas // Endocr. Pract. — 2009. — Vol. 15, Suppl. 1. — P. 1–20.
10. Kim J., Bae К., Choi Y. et al. Clinical characteristics for 348 patients with adrenal incidentaloma // Endocrinol. Metab. — 2013. — Vol. 28, № 1. — P. 20–25.
11. Andoulakis H., Kaltsas G., Piaditis G., Grossman A. The clinical significance of adrenal incidentalomas // Eur. J. Clin. Invest. — 2011. — Vol. 41, № 5. — P. 552–560.
12. Yeh H.C. Sonography of the adrenal glands: normal glands and small masses // Am. J. Roentgenol. — 1980. — Vol. 135, № 6. — P. 1167–1177.
13. Hamrahian A.H., Ioachimescu A.G., Remer E.M. et al. Clinical utility of noncontrast computed tomography attenuation value (Hounsfield units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience // J. Clin. Endocrinol. Metab. — 2005. — Vol. 90, № 2. — P.871–877.
14. ACR Appropriateness Criteria incidentally discovered adrenal mass. — 1996 (revised 2012) NGC:009245 American College of Radiology — Medical Specialty Society.
15. Kaltsas G., Chrisolidou A., Piaditis G., Kassi E., Chrousos G. Current status and controversies in adrenal incidentalomas // Trends Endocrinol. Metab. — 2012. — Vol. 23, № 12. — P. 602–609.
16. Caoili E.M., Korobkin M., Francis I.R. et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT // Radiology. — 2002. — Vol. 222, № 3. — P. 629–633.
17. Pantalone K.M., Gopan T., Remer E.M. et al. Change in adrenal mass size as a predictor of a malignant tumor // Endocr. Pract. — 2010. — Vol. 16, № 4. — P. 577–587.
18. Zeiger M.A., Siegelman S.S., Hamrahian A.H. et al. Medical and surgical evaluation and treatment of adrenal incidentalomas // J. Clin. Endocrinol. Metab. — 2011. — Vol. 96, № 7. — Р. 2004–2015.
19. Рыжкова Д.В., Тихонова Д.Н., Гринева Е.Н. Методы ядерной медицины в диагностике нейроэндокринных опухолей // Сибирский онкологический журнал. — 2013. — Т. 60, № 6. — C. 56–63. / Ryzhkova D.V., Tikhonova D.N., Grineva E.N. Methods of nuclear medicine in diagnosis of neuroendocrine tumours // Siberian Oncology Journal [Sibirskiy Onkologicheskiy Zhurnal]. — 2013. — Vol. 60, № 6. — P. 56–63 [Russian].
20. Stenström G., Svärdsudd K. Pheochromocytoma in Sweden1958–1981. An analysis of the National Cancer Registry Data // Acta Med. Scand. — 1986. — Vol. 220, № 3. — P. 225–232.
21. Motta-Ramirez G.A., Remer E.M., Herts B.R., Gill I.S., Hamrahian AH. Сomparison of CT findings in symptomatic and incidentally discovered pheochromocytomas // AJR Am. J. Roentgenol. — 2005. — Vol. 185, № 3. — P. 684–688.
22. Nieman L.K., Biller B.M., Findling J.W. et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline // J. Clin. Endocrinol. Metab. — 2008. — Vol. 93, № 5. — P. 1526–1540.
23. Terzolo M., Bovio S., Reimondo G. et al. Subclinical Cushing’s syndrome in adrenal incidentalomas. // Endocrinol. Metab. Clin. North Am. — 2005. — Vol. 34, № 2. — P. 423–439.
24. Charbonnel B., Chatal J.F., Ozanne P. Does the corticoadrenal adenoma with «pre-Cushing’s syndrome» exist? // J. Nucl. Med. — 1981. — Vol. 22, № 12. — P. 1059–1061.
25. Medeau V., Moreau F., Trinquart L. et al. Clinical and biochemical characteristics of normotensive patients with primary aldosteronism: a comparison with hypertensive cases // Clin. Endocrinol. — 2008. — Vol. 69, № 1. — P. 20–28.
26. Funder J.W., Carey R.M., Fardella C. et al. Сase detection diagnosis and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline // J. Clin. Endocrinol. Metab. — 2008. — Vol. 93, № 9. — P. 3266–3281.
27. Звартау Н.Э., Коростовцева Л.С., Емельянов И.В., Свиряев Ю.В. Первичный альдостеронизм и резистентная артериальная гипертензия // Артериальная гипертензия. — 2012. — Т. 18, № 6. — С. 514–521. / Zvartau N.E., Korostovtseva L.S., Emelyanov I.V., Sviryaev Yu.V. Primary aldosteronism and resistant arterial hypertension // Arterial Hypertension [ARterialnaya Gipertenziya]. — 2012. — Vol. 18, № 6. — Р. 514–521 [Russian].
28. Young W.F. Primary aldosteronism: renaissance of a syndrome // Clin. Endocrinol. — 2007. — Vol. 66, № 5. — P. 607–618.
29. Nishikawa T., Omura M., Satoh F. et al. Guidelines for the diagnosis and treatment of primary aldosteronism — The Japan Endocrine Society 2009 // Endocr. J. — 2011. — Vol. 58, № 9. — P. 711–721.
30. Mulatero P., Bertello C., Rossato D. et al. Roles of clinical criteria, computed tomography scan, and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes // J. Clin. Endocrinol. Metab. — 2008. — Vol. 93, № 4. — P. 1366–1371.
31. Vistel K., Grytaas M.A., Jorstad M.D. et al. Efficacy of adrenal venous sampling is increased by point of care cortisol analysis // Endocr. Connect. — 2013. — Vol. 2, № 4. — P. 236–242.
32. Kanagarajah P., Ayyathural R., Manoharan M. et al. Current concepts in the management of adrenal incidentalomas // Urol. Ann. — 2012. — Vol. 4, № 3. — P. 137–144.
33. Tauchmanova L., Rossi R., Biondi B. et al. Patients with subclinical Cushing’s Syndrome due to adrenal adenoma have increased cardiovascular risk // J. Clin. Endocrinol. Metab. — 2002. — Vol. 87, № 11. — P. 4872–4878.
34. Erbil Y., Ademoðlu E., Ozbey N. et al. Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery // World J. Surg. — 2006. — Vol. 30, № 9. — P. 1665–1671.
35. Chiodini I., Morelli V., Salcuni A. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism // J. Clin. Endocrinol. Metab. — 2010. — Vol. 95, № 6. — P. 2736–2745.
Review
For citations:
Grineva E.N., Belousova L.V., Basek I.V. ADRENAL INCIDENTALOMAS: DIAGNOSIS AND MANAGEMENT. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2013;19(6):532-537. (In Russ.) https://doi.org/10.18705/1607-419X-2013-19-6-532-537
Views:
1021
Email this article 