Ed. Staren et Ra. Prinz, SELECTION OF PATIENTS WITH ADRENAL INCIDENTALOMAS FOR OPERATION, The Surgical clinics of North America, 75(3), 1995, pp. 499-509
An adrenal mass may be discovered incidentally in as many as 2% of pat
ients having an abdominal CT scan. The clinical dilemma is to identify
the rare functioning or malignant adrenal tumor, which warrants resec
tion, while avoiding unnecessary testing and surgery in the majority o
f patients whose adrenal lesions are nonfunctioning and benign. A thor
ough history and physical examination and judicious use of screening l
aboratory tests are important in determining the likelihood of a clini
cally significant adrenal mass. There is little debate that functional
or large (<6 cm) adrenal masses should be excised; adrenalectomy for
adrenal masses 3 to 6 cm in patients younger than 50 years of age and
for those masses with ominous CT characteristics also is advised. Obse
rvation with serial CT scans and screening studies are recommended for
patients 50 years of age or older whose adrenal masses are between 3
to 6 cm and for all patients with hormonally inactive masses that are
smaller than 3 cm.