Management approaches to adrenal incidentalomas - A view from Ann Arbor, Michigan

Adrenal masses are discoved incidentally in 1 to 3% of abdominal CT scans p erformed for investigation of nonadrenal-related abdominal complaints. Alth ough most incidentally discoved masses are clinically silent, 10% are hormo ne-secreting and are associated with subtle symptoms of hormone excess. The major concern is the possibility that such a mass is malignant and require s surgical intervention. Benign adrenal cortical adenomas are 60 times more common than primary adrenal cortical carcinomas, which are rare, and many of the lesions that are malignant are metastatic from extra-adrenal neoplas ms. Size is a significant factor in determining the probability that the le sion is benign or malignant, and there is concensus that most benign lesion s are smaller than 3 cm, whereas most malignant lesions are larger than 6 c m. Uncertainty remains, however, as to the potential malignant character of masses measuring 3 to 6 cm; thus, size alone is insufficient for determini ng if an incidentally-found adrenal mass is benign or malignant, and inform ation obtained from other diagnostic techniques, such as CT, MR imaging, an d adrenal scintigraphy with I-131 6 beta-iodomethylnorcholesterol, should b e considered. Fine needle biopsy of an adrenal mass is not recommended unle ss there is strong suspicion that the mass is metastatic from an extra-adre nal neoplasm.