INCIDENTALOMAS OF THE ADRENAL-GLAND - DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS

Incidentally discovered adrenal masses are common since the advent and application of sensitive noninvasive imaging methods. The significanc e of these so-called ''incidentalomas'' and the question of further ev aluation or treatment remains elusive. This report describes a retrosp ective study of 86 patients with incidentaloma. Adrenalectomy was perf ormed on 26 patients during initial admission. Histologically, two cor tisol-producing adenomas, an adenoma with subclinical cortisol product ion, and two pheochromocytomas (all of the preceding detected during t he preoperative hormonal evaluation), three cystic lesions, one myelol ipoma, and one hematoma were found. One primary and two metastatic adr enal carcinomas were also found in this series. Sixty patients with a nonfunctioning incidentaloma smaller than 6 cm were observed in an ave rage of 43 months with serial CT scans performed at 3, 9, and 18 month s after the initial diagnosis. Enlargement of the mass was detected in two patients; both proved to be nonfunctioning adenomas. Based on the se observations, it is concluded that the initial laboratory evaluatio n is mandatory in cases of incidentalomas, including parameters of adr enocortical and medullar function. Hormonally active incidentalomas an d those suspected for malignancy should be treated surgically. Masses greater than 6 cm should also be removed. Smaller incidentalomas witho ut endocrine activity or signs of malignancy should be followed by CT scan at 3, 9, and 18 months after the initial diagnosis.