Diagnosis and treatment of adrenal incidentaloma. A cost-effectiveness analysis.
Methods of meta-analysis, decision analysis, and cost-effectiveness analysis were applied to the adrenal incidentaloma dilemma. It was shown that the life expectancy of patients with adrenal incidentalomas is decreased by a mean of about 1 year if left undiagnosed and untreated--more in cases of larger incidentalomas. Overall, selective analysis of adrenomedullary hormonal function (by urinary metanephrines) is the most cost-effective strategy. Other strategies, such as more extensive hormonal testing, imaging, and fine needle aspiration cytology may provide better cost-effectiveness in subgroups of patients, identified by signs, symptoms, and incidentaloma morphology. Full adrenal hormonal analysis is indicated in patients with larger (> or = 6 cm) incidentalomas and if the combination of hypertension and hypokalemia suggests Conn's disease. Small or medium-sized adrenal incidentalomas may be ignored if MR imaging or other tests suggest benign pheochromocytoma disorder, or patients are elderly, or both.
Kievit
J
J
Medical Decision Making Unit, Leiden University Medical Center, The Netherlands. kievit@LUMC.NL
Haak
H R
HR
D000236:Adenoma / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016239:MEDLINE; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome