Adrenal Incidentaloma
Adrenal Incidentaloma Definition
An adrenal incidentaloma is an adrenal mass which is seen during the imaging for other causes that are non-adrenal related. This means that the lesion was discovered serendipitously. Adrenal incidentaloma is the most common adrenal disorder and it is found during 1-5% of CT scans for the abdomen. 5-10% of patients who are diagnosed with adrenal incidentaloma have masses that are non-functioning (this is based on postmortem examinations). This disease affects both males and females with most of the incidentalomas being hormonally inactive and benign. There are only a few numbers of cases where adrenalectomy is required (and this is done only when the lesion becomes functioning and malignant). The diagnostic assessment often evaluates the hormonal activity of the lesion and if it is malignant. Assessment of functions require plasma dihydroepiadosterone; urinary catecholamines for 24 hours and metanephrines; a low dosage of a test of dexamethasone suppression; serum ACTH; standing serum renin to aldosterone ration for hypertension and hypokalemia. The evaluation of the danger of malignancy requires MRI or CT scans; on CT lesions that are malignant are not regular, non-homogeneous and have great attenuation; for lesions that are MRI malignant, an clear concentration on T2 weighed image; it may also be useful to have CT guided cytology; there is also a need to exclude paechromocytoma before this procedure;
Adrenal Incidentaloma Management
Adrenalectomy is required for a patient whose lesion is functioning. This can be performed through laparoscopic or open procedure. It is often best for malignant lesions to be surgically removed (the open surgery method). The treatment of the disease would depend mainly whether the lesion is functioning or not (it is also dependent on the risk of malignancy and the size of the lesion). If the lesion size is at 5 centimeters or greater and the imaging points out that it can be malignant, it is best to consider surgery. If it is less than 5 centimeters or is benign, it is best to redo the CT scanning at 3-6 months.
Adrenal Incidentaloma Metastases
The adrenal gland is an ordinary location for metastases. The primary and most common sites include the lungs, breast, lymphoma, renal and melanoma. They are often bilateral and when there is a patient history of carcinoma, more often than not, 10-40% of the adrenal masses are metastases. The malignancy risks increase as the size increases. Most lesions that are malignant adrenal are bigger than 5 centimeters in diameter.