title: Incidental and metastatic adrenal masses.
abstract: In the last decades discoveries of adrenal masses incidentally during the course of diagnostic procedures for unrelated disorders (incidentalomas) have become progressively more frequent. The clinician in this position must answer two main questions: Is the mass benign or malignant?, and To what extent is the adrenal secretion altered? To come to a clinical decision, several diagnostic tools need to be engaged, starting with an accurate and correct radiological evaluation and a hormonal assessment of the adrenal function. When necessary, other diagnostic procedures such as functional imaging and fine-needle biopsy (FNB) can be considered in selected cases. Surgical removal is recommended for clinically relevant hypersecretory masses, as well as for masses suspected to be malignant. Most frequently, adrenal incidentalomas (AIs) are represented by benign cortical adenomas, a subset of which causes a mild hypercortisolism, known as subclinical Cushing's syndrome (SCS). The criteria to define this syndrome, as well as its treatment, are still debated and controversial. AIs that are not surgically removed should be re-examined in time to exclude a supervening increase in size or function. Follow-up criteria have not been established. Laparoscopic surgery is the recommended procedure to remove benign masses. The surgical procedure for adrenal malignancies is still debated.
authors.affiliation: Department of Clinical Pathophysiology, Endocrinology Unit, University of Florence, Florence, Italy. m.mannelli@dfc.unifi.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Mannelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Colagrande
authors.forename: Andrea
authors.initials: A
authors.lastname: Valeri
authors.forename: Gabriele
authors.initials: G
authors.lastname: Parenti
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000307:Adrenal Gland Diseases / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary / Q000601:surgery; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000175:diagnosis; D000465:Algorithms; D003937:Diagnosis, Differential; D006801:Humans; D033162:Incidental Findings; D018209:Myelolipoma / Q000175:diagnosis; D010673:Pheochromocytoma / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D000305:Adrenal Cortex Hormones