Investigation and assessment of adrenal incidentalomas

• Published in: Clinical medicine (London, England) Vol. 23; no. 2; pp. 135 - 140
• Main Authors: Cuthbertson, Daniel J, Alam, Uazman, Davison, Andrew S, Belfield, Jane, Shore, Susannah L, Vinjamuri, Sobhan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2023; Royal College of Physicians
• Subjects: Adrenal Gland Neoplasms - complications; Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - therapy; Adrenal glands; Adrenal incidentaloma; Cardiovascular disease; Catecholamines; Cross-Sectional Studies; CT/MRI; Diabetes Mellitus, Type 2 - complications; Endocrine disorders; Etiology; hormone excess; Hormones; Humans; Hydrocortisone; Hyperplasia; Hypertension; Hypokalemia; Lipids; mild autonomous cortisol secretion; Patients; primary aldosteronism; Surveillance; Tumors; CT/MRI; mild autonomous cortisol secretion; hormone excess; primary aldosteronism; Adrenal incidentaloma
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmed.2023-0042

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.