Management of the Patient with an Incidentally Discovered Adrenal Mass

Management of the Patient with an Incidentally Discovered Adrenal Mass - Flowchart

«Flowchart»

ALGORITHM FOR THE MANAGEMENT OF THE PATIENT WITH AN INCIDENTALLY DISCOVERED ADRENAL MASS

ALGORITHM FOR THE MANAGEMENT OF THE PATIENT WITH AN INCIDENTALLY DISCOVERED ADRENAL MASS LGORITHM FOR THE ANAGEMENT OF THE ATIENT WITH AN NCIDENTALLY ISCOVERED DRENAL ASS

Repeat imaging as needed

CT/MRI finding of incidentally discovered adrenal mass

Screening for hormone excess

Plasma metanephrines or 24-h urine for metanephrine/catecholamine excretion
24-h urine for free cortisol excretion, plasma ACTH, midnight plasma (or salivary) cortisol, dexamethasone 1 mg overnight test (perform at least two out of four tests)
Plasma aldosterone and plasma renin
If tumor >2 cm: Serum 17-hydroxyprogesterone and DHEAS

Screening for hormone excess

Positive

Negative but imaging suggestive of malignancy:

Size >4 cm
High CT density (>20 HU)
CT contrast wash-out <40%

Negative but imaging suggestive of malignancy:

Size >4 cm
High CT density (>20 HU)
CT contrast wash-out <40%

Size >4 cm
High CT density (>20 HU)
CT contrast wash-out <40% Negative but imaging suggestive of malignancy

Negative and imaging not suggestive of malignancy:

Size <4 cm
Low CT density (<10 HU)
CT contrast wash-out >50%

Negative and imaging not suggestive of malignancy:

and not

Size <4 cm
Low CT density (<10 HU)
CT contrast wash-out >50%

Size <4 cm
Low CT density (<10 HU)
CT contrast wash-out >50% Negative and imaging not suggestive of malignancy

Unilateral adrenalectomy

F/U as needed

Repeat screening for hormone excess after 12 months

Neg.

Pos.

End

F/U as needed

Repeat screening for hormone excess after 12 months

Pos.

Neg.

Confirmatory testing

Neg.

Unilateral adrenalectomy