RT Journal Article
SR Electronic
T1 Investigation and assessment of adrenal incidentalomas
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 135
OP 140
DO 10.7861/clinmed.2023-0042
VO 23
IS 2
A1 Daniel J Cuthbertson
A1 Uazman Alam
A1 Andrew S Davison
A1 Jane Belfield
A1 Susannah L Shore
A1 Sobhan Vinjamuri
YR 2023
UL http://www.rcpjournals.org/content/23/2/135.abstract
AB With the increasing volume of diagnostic imaging undertaken in an ageing population, adrenal incidentalomas (AIs) are increasingly commonly seen. These masses are most likely to be benign, but a small proportion may be malignant. Similarly, they are usually non-functional, but ∼14% are functional, ie hormone-secreting tumours. Clinical, biochemical and radiological assessment is mandated to stratify patients into those requiring radiological surveillance, medical management or surgical intervention or who can be discharged. Mass characteristics on cross-sectional (CT/MRI) imaging influence the need for radiological surveillance. Functional tumours where excess cortisol, aldosterone or catecholamine are secreted should be excluded, with mild autonomous cortisol secretion (MACS) and primary aldosteronism (PA) as the two most common functional states. MACS and PA are associated with an increased risk of cardiometabolic disease (eg hypertension, type 2 diabetes) and cardiovascular morbidity/mortality (eg coronary heart disease). Multidisciplinary management is critical for selected cases; the majority of adrenal incidentalomas only require a single assessment.