Diagnostic Imaging Pathways - Adrenal Mass (Incidental On CT)
Population Covered By The Guidance
This pathway provides guidance for further investigating adult patients with an incidental adrenal mass detected on computed tomography.
Date reviewed: January 2012
Date of next review: January 2015
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- Incidental adenomas ("incidentalomas") are found in up to 5% of scans done for other indications
- The first stage in investigating the significance of the mass is biochemical screening for Cushing's Syndrome, Phaeochromocytoma and Hyperaldosteronism
- CT is the initial imaging modality to investigate the characteristics of the mass
- The aim of imaging is to determine whether the mass is a carcinoma, as early identification can lead to biopsy and potentially curative surgical resection
- Follow-up of a lesion, to assess growth characteristics as well as biochemical activity is crucial
- Young WF Jr. Management approaches to adrenal incidentalomas. Endocrinol Metab Clin North Am 2000;29(1):159-85.
- Herrera MF, Grant CS, van Heerden JA, et al. Incidentally discovered adrenal tumours: an institutional perspective. Surgery 1991;110(6):1014-21.
- Barry MK, van Heerden JA, Farley DR, et al. Can adrenal incidentalomas be safely observed? World J Surg 1998;22:599-604. (Level III evidence)
- McNicholas MM, Lee MJ, Mayo-Smith WW, et al. An imaging algorithm for the differential diagnosis of adrenal adenomas and metastases. AJR 1995;165:1453-9. (Level III evidence)
- Pender SM, Boland GW, Lee MJ, et al. The incidental nonhyperfunctioning adrenal mass: an imaging algorithm for characterisation. Clinical Radiology 1998;53:796-804.
- Lee MJ, Hahn PF, Papanicolaou N, et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology 1991;179:415-8. (Level III evidence)
- Boland GWL, Lee MJ, Gazelle GS, et al. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR 1998;171:201-4. (Level II evidence). Click here to view reference
- Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F. CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR 1998;170:747-52. (Level II/III evidence)
- Bulow B, Jansson S, Juhlin C et al. Adrenal Incidentaloma - Follow-up results from a Swedish prospective study. Eur J Endocrinol 2006; 154:419-423 (Level II Evidence) Click here to view reference
- Heinz- Peer G, Honigschnabl S, Schneider B, et al. Characterization of adrenal masses using MR imaging with histopathologic correlation. AJR 1999;173:15-22. (Level II evidence). Click here to view reference
- Lee MJ, Mayo-Smith WW, Hahn PF, et al. State-of-the-art MR imaging of the adrenal gland. Radiographics 1994:14:1015-32 (Review article)
- Welch TJ, Sheedy PF, Stephens DH, et al. Percutaneous adrenal biopsy: review of a 10-year experience. Radiology 1994;193:341-4. (Level III evidence)
- Silverman SG, Mueller PR, Pinkney LP, et al. Predictive value of image-guided adrenal biopsy: analysis of results of 101 biopsies. Radiology 1993;187:715-8. (Level III/IV evidence)
- Candel AG, Gattuso P, Reyes CV, et al. Fine needle aspiration biopsy of adrenal masses in patients with extra-adrenal malignancy. Surgery 1993;114(6):1132-7. (Level III evidence)
- Graham DJ, Mc Henry CR. The adrenal incidentaloma: guidelines for evaluation and recommendations for management. Surg Oncology Clinics of North America 1998;7:749-64.
- Young F The Incidentally Discovered Adrenal Mass. NEJM 2007; 356(6): 601-608 (Review Article)
- Angeli A, Osella G, Ali A et al. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res 1887; 47:279-283 (Level II Evidence) Click here to view reference
- Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in Characterizing Adrenal Lesions Detected on CT or MRI. J Nucl Med 2001;42:1795-99. (Level III evidence)
- Szolar DH, Kammerhuber FH. Adrenal adenomas and nonadenomas: assessment of washout at delayed contrast-enhanced CT. Radiology 1998; 207:369-375. (Level III evidence)
- Hamrahian AH, Iochimescu AG, Remer EM et al. Clinical utility of noncontrast computed tomography attenuation value (Hounsfield units) to differentiate adrenal adenomas/hyperplasia from nonadenomas: Cleveland Clinic experience. J Clin Endocrin Metab 2005; 90:871-877. (Level II evidence)
- Pena CS, Boland GW, Hahn PF, Lee MJ, Mueller PR. Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 2000; 217:798-802. (Level III evidence)
- Caoili EM, Korobkin M, Francis IR, Cohan RH, Dunnick NR. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 2002; 222:629-633. (Level III evidence)
- Bae KT, Fuangtharnthip P, Prasad SR et al. Adrenal masses: CT characterization with histogram analysis method. Radiology 2003; 228:735-742. (Level I evidence) Click here to view reference
- Mantero F, Terzolo M, Arnaldi G et al. A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab 2000; 85:637-644. (Level III evidence)
- Grumbach MM, Beverly MK, Braunstein GD et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med 2003; 138:424-429. (Review Article) Click here to view reference
- Terzolo M, Bovio S, Reimondo G et al. Subclinical Cushing's syndrome in adrenal incidentalomas. Endocrinol Metab Clin North Am 2005; 34:423-439. (Review Article) Click here to view reference
- 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; 87:4872-4878. (Level IV evidence)
- Bovio S, Cataldi, Reimondo G et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 2006; 29:298-302. (Level II Evidence) Click here to view reference
- Mengden T, Hubmann P, Muller J et al. Urinary free cortisol versus 17-hydroxycorticosteroids: a comparative study of their diagnostic value in Cushing's Syndrome Clinical Invest 1992; 70(7): 545-548 (Level III Evidence)
- Song J, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy Am J Roentgenol 2008; 190(5): 1163-1168 (Level II Evidence)Click here to view reference
- Boland GWL, Blake MA, Hahn PF et al. Incidental adrenal lesions: Principles, techniques and algorithms for imaging characterization. Radiology 2008; 249(3): 756-775 (Review)
- Teeger S, Papanicolaou N, Vaughan ED Jr. Current concepts in imaging adrenal masses. World J Urol 1999;17:3-8.
- Barzon L, Boscaro M. Diagnosis and management of adrenal incidentalomas. J Urology 2000;163:398-407.
- Boland G, Blake M, Hahn P, Mayo-Smith W. Incidental adrenal lesions: principles, techniques and algorithms for imaging characterisation. Radiology 2008;249:756-775.
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