title: Adrenal incidentaloma imaging - the first steps in therapeutic management.
abstract: The term "adrenal incidentaloma" refers to clinically unapparent adrenal mass detected during imaging examination performed for reasons other than the evaluation of adrenal glands. These tumors must be carefully examined in order to assess the indications for surgical treatment. The main method of finding evidence of potential malignancy in these lesions is computed tomography (CT), before and after i.v. contrast media enhancement. Density of a malignant lesion is higher than 10 HU and the relative percentage washout is less than 40% at 10 min. Other useful methods utilized in tumor assessment, include magnetic resonance imaging (MRI), scintigraphy techniques (SPECT) and PET. Basal hormonal investigations include urine and plasma catecholamines with their metabolites, plasma cortisol before and after dexamethasone administration, plasma renin activity and aldosterone level. Cases not suitable for surgery should be followed with repeat imaging techniques and hormonal testing at the recommended 6, 12, and 24 months. Surgery should be performed when tumor growth rate exceeds 0,8 cm per year.
authors: Clinic of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland.
authors: Lucyna
authors: L
authors: Papierska
authors: Department of Surgery, Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors: Andrzej
authors: A
authors: Cichocki
authors: Department of Radiology, Central Clinical Hospital of Ministry of Internal Affairs, Warsaw, Poland.
authors: Artur J
authors: AJ
authors: Sankowski
authors: Department of Radiology, Faculty of Medical Science, University of Warmia and Masuria, Olsztyn, Poland.
authors: Jarosław B
authors: JB
authors: Cwikła
keywords: adrenal adenoma; adrenal cancer; adrenal incidentaloma; pheochromocytoma; pre-Cushing’s syndrome