Anatomy of the thyroid, parathyroid and suprarenal (adrenal) glands.
Harold Ellis.
Surgery 2003. The Medicine Publishing Company
Disorders of the adrenal gland.
L. Michael Blunt.
ACS Surgery: Principles & Practice. 2007 WebMD
J Clin Endocrinol Metab. 2010 Sep;95(9):4106-13.
Approach to the patient with an adrenal incidentaloma.
Nieman LK.
Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, National Institutes of Health,
Unsuspected adrenal masses, or incidentalomas, are increasingly found with the
widespread use of thoracic and abdominal imaging. These masses may be hormonally
active or nonfunctional and malignant or benign. Clinicians must determine the
nature of the mass to decide what treatment, if any, is needed. Measurement of
precontrast Hounsfield units (HU) and contrast washout on computed tomography
scan provide useful diagnostic information. All patients should undergo
biochemical testing for pheochromocytoma, either with plasma or urinary
catecholamine measurements. This is particularly important before surgical
resection, which is routinely recommended for masses larger than 4 cm in diameter
without a clear-cut diagnosis and for others with hormonal secretion or ominous
imaging characteristics. Hypertensive patients should undergo biochemical testing
for hyperaldosteronism. Patients with features consistent with Cushing's
syndrome, such as glucose intolerance, weight gain, and unexplained osteopenia,
should be evaluated for cortisol excess. Here, the dexamethasone suppression test
and late-night salivary cortisol may be preferred over measurement of urine
cortisol. The ability of surgical resection to reverse features of mild
hypercortisolism is not well established. For masses that appear to be benign
(<10 HU; washout, >50%), small (<3 cm), and completely nonfunctioning, imaging
and biochemical reevaluation (pheochromocytoma and hypercortisolism only) at 1-2
yr (or more) is appropriate. For more indeterminate lesions, repeat evaluation
for growth after 3-12 months is useful, with subsequent testing intervals based
Hormones (Athens). 2009 Jul-Sep;8(3):163-84.
Adrenal incidentaloma: a diagnostic challenge.
Anagnostis P, Karagiannis A, Tziomalos K, Kakafika AI, Athyros VG, Mikhailidis
DP.
Second Propedeutic Department of Internal Medicine, Medical School, Aristotle
University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
The widespread application of abdominal imaging procedures has resulted in an
increased frequency of clinically silent adrenal masses. Adrenal incidentaloma
(AI) is a term applied to an accidentally discovered adrenal mass on imaging
performed for the investigation of an unrelated complaint. Adrenal incidentalomas
(AIs) are a cluster of different pathologies, the majority of which are benign
and non-functioning adrenal adenomas. However, mild hormonal alterations as well
as metabolic abnormalities may be present in patients with AIs. Thus, a
multidisciplinary approach with biochemical and radiologic evaluation is needed
to characterize these lesions and identify patients who are at high risk for
hormonal or malignant evolution. Significant new information has helped resolve
controversies regarding the most reliable approach to this clinical problem. The
present review considers the prevalence, pathology and natural history of AIs. We
also discuss the reliability of available screening methods and localization
techniques and consider optimal management and follow-up strategies.
