open access

Vol 67, No 2 (2016)
Postgraduate education
Published online: 2016-04-13
Submitted: 2015-12-08
Accepted: 2015-12-14
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Adrenal incidentaloma in adults — management recommendations by the Polish Society of Endocrinology

Tomasz Bednarczuk, Marek Bolanowski, Krzysztof Sworczak, Barbara Górnicka, Andrzej Cieszanowski, Maciej Otto, Urszula Ambroziak, Janusz Pachucki, Eliza Kubicka, Anna Babińska, Łukasz Koperski, Andrzej Januszewicz, Aleksander Prejbisz, Maria Górska, Barbara Jarząb, Alicja Hubalewska-Dydejczyk, Piotr Glinicki, Marek Ruchała, Anna Kasperlik-Załuska
DOI: 10.5603/EP.a2016.0039
·
Endokrynologia Polska 2016;67(2):234-258.

open access

Vol 67, No 2 (2016)
Postgraduate education
Published online: 2016-04-13
Submitted: 2015-12-08
Accepted: 2015-12-14

Abstract

Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations.

Methods: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations.

Imaging and hormonal assessment: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and “non-adenomatous” lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia.

Treatment: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases. (Endokrynol Pol 2016; 67 (2): 234–258)

Abstract

Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations.

Methods: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations.

Imaging and hormonal assessment: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and “non-adenomatous” lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia.

Treatment: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases. (Endokrynol Pol 2016; 67 (2): 234–258)

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Keywords

adrenal incidentaloma; adrenocortical carcinoma; pheochromocytoma

About this article
Title

Adrenal incidentaloma in adults — management recommendations by the Polish Society of Endocrinology

Journal

Endokrynologia Polska

Issue

Vol 67, No 2 (2016)

Pages

234-258

Published online

2016-04-13

DOI

10.5603/EP.a2016.0039

Bibliographic record

Endokrynologia Polska 2016;67(2):234-258.

Keywords

adrenal incidentaloma
adrenocortical carcinoma
pheochromocytoma

Authors

Tomasz Bednarczuk
Marek Bolanowski
Krzysztof Sworczak
Barbara Górnicka
Andrzej Cieszanowski
Maciej Otto
Urszula Ambroziak
Janusz Pachucki
Eliza Kubicka
Anna Babińska
Łukasz Koperski
Andrzej Januszewicz
Aleksander Prejbisz
Maria Górska
Barbara Jarząb
Alicja Hubalewska-Dydejczyk
Piotr Glinicki
Marek Ruchała
Anna Kasperlik-Załuska

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