Practice Clinical Updates

Management of incidental adrenal tumours

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5674 (Published 18 January 2018) Cite this as: BMJ 2018;360:j5674
  1. Fahmy W F Hanna, professor of endocrinology and metabolism1,
  2. Basil G Issa, consultant endocrinologist2,
  3. Julius Sim, professor of healthcare research3,
  4. Brian Keevil, professor of clinical biochemistry4,
  5. Anthony A Fryer, professor of clinical biochemistry5
  1. 1Staffordshire University, University Hospital of North Midlands, Stoke-on-Trent, UK
  2. 2University Hospital of South Manchester, Manchester, UK
  3. 3Keele Medical School, Keele University, Staffordshire, UK
  4. 4University Hospital of South Manchester, Manchester, UK
  5. 5Institute for Applied Clinical Sciences, Keele University, University Hospital of North Midlands, Stoke-on-Trent, UK
  1. Correspondence to Fahmy W F Hanna Fahmy.hanna{at}uhns.nhs.uk

What you need to know

  • An adrenal incidentaloma is an adrenal lesion found incidentally in asymptomatic patients undergoing imaging scans not performed for suspected adrenal disease. Adrenal incidentalomas are becoming more common due to increased scanning, as well as an older population

  • Most incidentalomas are benign and non-functioning (~85%) and require only minimal evaluation (but are frequently over investigated). The remaining 15% (functioning and/or malignant lesions) are at risk of under investigation, delay, or even being missed

  • Patients with adrenal incidentalomas can experience anxiety once an adrenal incidentaloma is detected and while awaiting investigations or appointments

Sources and selection criteria

References were selected from Medline search, focusing on published guidelines. Sub-references were selected to ensure full coverage of the areas identified within the initial search.

An incidental adrenal tumour, described in this article as an “adrenal incidentaloma,” is an adrenal mass discovered during imaging that was not performed for suspected adrenal disease. These are being detected more frequently in an ageing population1 through the increased use of computed tomography (eg, computed tomography urogram, or colonoscopy) and magnetic resonance imaging (MRI) scans with enhanced resolution.2

This article highlights the management of adrenal incidentalomas, collating recommendations from international guidelines, and is aimed at non-specialists.

What is an adrenal incidentaloma?

Adrenal incidentalomas are defined as adrenal masses incidentally discovered during imaging that was not performed for suspected adrenal disease. Hence, an adrenal lesion discovered while investigating raised catecholamines would not be classified as an adrenal incidentaloma. Most definitions have restricted the diagnosis to lesions ≥10 mm34 unless there are clinical stigmas of adrenal hormone over-production identified after the detection of the lesion that warrant further investigation.

In view of variation in diagnostic criteria, referral patterns, and surgical rates, it is challenging to precisely classify the underlying adrenal incidentaloma pathology from published literature.2Figure 1 provides a simplified description of the adrenal gland …

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