Diagnosis and treatment of adrenal incidentaloma - A cost-effectiveness analysis

Methods of mete-analysis, decision analysis, and cost-effectiveness analysi s were applied to the adrenal incidentaloma dilemma. It was shown that the life expectancy of patients with adrenal incidentalomas is decreased by a m ean of about 1 year if left undiagnosed and untreated-more in cases of larg er incidentalomas. Overall, selective analysis of adrenomedullary hormonal function (by urinary metanephrines) is the most cost-effective strategy. Ot her strategies, such as more extensive hormonal testing, imaging, and fine needle aspiration cytology may Provide better cost-effectiveness in subgrou ps of patients, identified by signs, symptoms, and incidentaloma morphology . Full adrenal hormonal analysis is indicated in patients with larger (grea ter than or equal to 6 cm) incidentalomas and if the combination of hyperte nsion and hypokalemia suggests Conn's disease. Small or medium-sized adrena l incidentalomas may be ignored if MR imaging or other tests suggest benign pheochromocytoma disorder, or patients are elderly, or both.