title: Adrenal incidentaloma in adults - management recommendations by the Polish Society of Endocrinology.
abstract: BACKGROUND
  A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma.
  
  
  OBJECTIVE
  To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations.
  
  
  METHODS
  Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations.
  Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia.
  
  
  METHODS
  Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases.
authors.affiliation: Department of Internal Medicine and Endocrinology, Medical University of Warsaw. tbednarczuk@wum.edu.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Bednarczuk
authors.forename: Marek
authors.initials: M
authors.lastname: Bolanowski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Sworczak
authors.forename: Barbara
authors.initials: B
authors.lastname: Górnicka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Cieszanowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Otto
authors.forename: Urszula
authors.initials: U
authors.lastname: Ambroziak
authors.forename: Janusz
authors.initials: J
authors.lastname: Pachucki
authors.forename: Eliza
authors.initials: E
authors.lastname: Kubicka
authors.forename: Anna
authors.initials: A
authors.lastname: Babińska
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Koperski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Maria
authors.initials: M
authors.lastname: Górska
authors.forename: Barbara
authors.initials: B
authors.lastname: Jarząb
authors.forename: Alicja
authors.initials: A
authors.lastname: Hubalewska-Dydejczyk
authors.forename: Piotr
authors.initials: P
authors.lastname: Glinicki
authors.forename: Marek
authors.initials: M
authors.lastname: Ruchała
authors.forename: Anna
authors.initials: A
authors.lastname: Kasperlik-Załuska
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000628:therapy; D000315:Adrenalectomy; D000328:Adult; D003937:Diagnosis, Differential; D019468:Disease Management; D004704:Endocrinology; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis; D010673:Pheochromocytoma / Q000175:diagnosis; D011044:Poland; D012955:Societies, Medical
keywords: adrenal incidentaloma; adrenocortical carcinoma; pheochromocytoma