Incidentaloma diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The diagnosis of adrenal incidentaloma is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
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; and 2) whether it is hormonally Algorithm depicting the recommended evaluation and treatment of patients with an adrenal incidentaloma. J Clin Endocrinol Metab, July 2011, 96(7):2004–2015 jcem.endojournals.org 2011 active.
- Radiological evaluation including noncontrast CT attenuation value expressed inHUis 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 size that lack characteristic benign imaging features should be removed.
- All patients should undergo hormonal evaluation for SCS 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 cmin size) for up to 5 yr may be reasonable.
- 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 | ||||||||||||||||||||||||||||||||||||||||
| D02 | 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.