Diagnostic Imaging Pathways - Incidental Adrenal Mass 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 Of Last Review Including Any Literature Review
This pathway was last modified in January 2012.
Date Of Next Review
This pathway will be reviewed in January 2013.
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
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.
Some documents for download on this website are in a Portable Document Format (PDF). To read these files you might need to download Adobe Acrobat Reader.