Professional Area

Incidental Adrenal lesions

Incidental adrenal lesions are the masses that are found in the adrenal glands. It is also called incidentaloma. The size of the lesions is usually more than 1 cm.

Prevalence

The prevalence of incidentaloma is as high as 8% in the autopsy series and 4% in the radiologic series. The prevalence of the disease was found to increase with age.

Symptoms

The common symptoms include

  • Hypertension
  • Hyperglycaemia
  • Hyperlipidaemia
  • Osteoporosis
  • Hypokalaemia
  • Weight loss

Evaluation

The preliminary evaluation is performed to distinguish benign tumours from malignant ones, followed by the differentiation of non-functioning tumours from hyperfunctioning tumours. A complete evaluation for adrenocortical carcinoma, pheochromocytoma, primary aldosteronism, and Cushing‘s syndrome is performed by the clinician. Computed tomography (CT) scans can detect incidental adrenal lesions.

  • Diagnostic imaging, such as a CT scan, is a powerful tool to delineate the type of lesions.
  • In addition to CT scans, chemical shift magnetic resonance imaging (CSI), like unenhanced CT, is used to differentiate benign tumours from malignant ones. CSI detects the lipid-rich properties of adenomas.
  • 2-[18F] fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) is useful to detect metastasis.
  • Metaiodobenzylguanidine (MIBG) scintiscan is recommended to detect pheochromocytoma.
  • A clinical examination is performed to detect the signs and symptoms of adrenal disease.
  • In patients with metastasis, fine-needle aspiration biopsy (FNB) is recommended, but not in routine cases.
  • In some cases, dexamethasone suppression test (DST), hyperaldosteronism evaluation, sex hormone production (dehydroepiandrosterone [DHEAS], 17-hydroxyprogresterone [17-OHP]), and testosterone are assessed.

Treatment

Patients with adrenal lesions are not initially operated on but are suggested to visit the Endocrinologist for follow-up. The patient has to undergo regular hormonal evaluation and imaging during follow-up visits. However, in advanced stages where the size of the mass is greater than 4 cm, surgery is suggested. Surgery is performed by laparoscopic means to remove the lesions.

Prompt diagnosis and treatment help in the management of incidental adrenal lesions.