Adrenal Incidentaloma

W. KEAT CHEAH, MBBS, FRACS QUAN-YANG DUH, MD

An incidentaloma of the adrenal gland (or adrena-loma) is defined as an adrenal tumor that is discovered incidentally and unexpectedly on radiologic imaging without prior knowledge that the patient has adrenal disease. The widespread use of imaging studies such as computed tomography (CT) (Figure 12-1), ultrasonography, and magnetic resonance imaging (MRI) (Figure 12-2) has increased the detection of adrenal incidentalomas, which range from 0.4 to 2% of abdominal CT scans.1-3 This chapter provides a practical approach to managing patients with adrenal incidentalomas.

Incidentalomas comprise a variety of pathologies (Table 12-1). Most incidentalomas are benign cortical adenomas that do not secrete hormones and are termed nonfunctioning tumors. Some tumors, however, are hormonally active and secrete cortisol (Cushing's syndrome), aldosterone (primary hyper-aldosteronism), or catecholamines (pheochromocy-toma). A third group consists of malignant tumors that are either primary adrenocortical carcinomas or metastatic cancers to the adrenal gland. In the workup of incidentalomas, it then becomes important to determine whether the adrenal mass is (1) a functioning or nonfunctioning tumor, (2) a metasta-tic tumor, or (3) an adrenal carcinoma.

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