title: AME position statement on adrenal incidentaloma.
abstract: OBJECTIVE
  To assess currently available evidence on adrenal incidentaloma and provide recommendations for clinical practice.
  
  
  METHODS
  A panel of experts (appointed by the Italian Association of Clinical Endocrinologists (AME)) appraised the methodological quality of the relevant studies, summarized their results, and discussed the evidence reports to find consensus.
  Unenhanced computed tomography (CT) is recommended as the initial test with the use of an attenuation value of ≤10 Hounsfield units (HU) to differentiate between adenomas and non-adenomas. For tumors with a higher baseline attenuation value, we suggest considering delayed contrast-enhanced CT studies. Positron emission tomography (PET) or PET/CT should be considered when CT is inconclusive, whereas fine needle aspiration biopsy may be used only in selected cases suspicious of metastases (after biochemical exclusion of pheochromocytoma). HORMONAL ASSESSMENT: Pheochromocytoma and excessive overt cortisol should be ruled out in all patients, whereas primary aldosteronism has to be considered in hypertensive and/or hypokalemic patients. The 1 mg overnight dexamethasone suppression test is the test recommended for screening of subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l for considering this condition. A value of 50 nmol/l virtually excludes SCS with an area of uncertainty between 50 and 138 nmol/l.
  
  
  RESULTS
  Surgery is recommended for masses with suspicious radiological aspects and masses causing overt catecholamine or steroid excess. Data are insufficient to make firm recommendations for or against surgery in patients with SCS. However, adrenalectomy may be considered when an adequate medical therapy does not reach the treatment goals of associated diseases potentially linked to hypercortisolism.
authors.affiliation: Medicine I, AOU San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano 10043, Italy. terzolo@usa.n
authors.forename: M
authors.initials: M
authors.lastname: Terzolo
authors.forename: A
authors.initials: A
authors.lastname: Stigliano
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
authors.forename: P
authors.initials: P
authors.lastname: Loli
authors.forename: L
authors.initials: L
authors.lastname: Furlani
authors.forename: G
authors.initials: G
authors.lastname: Arnaldi
authors.forename: G
authors.initials: G
authors.lastname: Reimondo
authors.forename: A
authors.initials: A
authors.lastname: Pia
authors.forename: V
authors.initials: V
authors.lastname: Toscano
authors.forename: M
authors.initials: M
authors.lastname: Zini
authors.forename: G
authors.initials: G
authors.lastname: Borretta
authors.forename: E
authors.initials: E
authors.lastname: Papini
authors.forename: P
authors.initials: P
authors.lastname: Garofalo
authors.forename: B
authors.initials: B
authors.lastname: Allolio
authors.forename: B
authors.initials: B
authors.lastname: Dupas
authors.forename: F
authors.initials: F
authors.lastname: Mantero
authors.forename: A
authors.initials: A
authors.lastname: Tabarin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000097:blood; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D000315:Adrenalectomy; D032921:Consensus; D018450:Disease Progression; D006801:Humans; D033162:Incidental Findings; D007558:Italy; D012306:Risk; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones