title: Is surgery necessary for incidentally discovered adrenal masses in children?
abstract: BACKGROUND
  There are no guidelines that exist to direct the management of incidental adrenal masses (IAM) in children. The aim of this study was to determine if there is a subset of IAMs that could be safely observed.
  
  
  METHODS
  A retrospective analysis was conducted of all adrenal masses that were either resected or biopsied between 1990 and 2002 (n = 91) at the Hospital for Sick Children, Toronto. IAM was defined as a solitary adrenal mass discovered by either physical examination (n = 6; 23.1%) or diagnostic imaging for other indications (n = 20; 76.9%), without metastases or biochemical activity.
  
  
  RESULTS
  Twenty-six (28.6%) IAMs were detected (mean age, 4.6 years [range, antenatal to 17 years]; 11 boys, 15 girls). Pathologic diagnoses included neuroblastoma (n = 7), ganglioneuroma (n = 6), adrenocortical adenoma (n = 4), adrenal cyst/pseudocyst (n = 3), adrenal hemorrhage (n = 3), ganglioneuroblastoma (n = 1), nodular cortical hyperplasia (n = 1), and teratoma (n = 1). Eight masses were malignant (30.8%). Two of the 5 masses discovered on antenatal ultrasound scan were neuroblastoma. In comparing the benign with malignant lesions, there was no significant difference in mean size (4.8 cm v 4.3 cm; P =.57), radiologic characteristics, or mode of presentation. Benign lesions occurred more frequently in older children (mean age, 6.5 years v 1.3 years; P =.03).
  
  
  CONCLUSIONS
  Clear guidelines cannot be established to predict benign IAM in children. Given the high proportion of malignant lesions, we recommend that all pediatric IAMs should be resected.
authors.affiliation: Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Masiakos
authors.forename: J Ted
authors.initials: JT
authors.lastname: Gerstle
authors.forename: Timothy
authors.initials: T
authors.lastname: Cheang
authors.forename: Sandra
authors.initials: S
authors.lastname: Viero
authors.forename: Peter C W
authors.initials: PC
authors.lastname: Kim
authors.forename: Paul
authors.initials: P
authors.lastname: Wales
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate