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. 1984 Jan;199(1):116–122. doi: 10.1097/00000658-198401000-00021

The incidentally discovered adrenal mass.

P M Copeland
PMCID: PMC1353269  PMID: 6691725

Abstract

With the wider application of increasingly sensitive computed tomographic scans, more adrenal masses will be discovered incidentally. Because benign lesions of the adrenal are much commoner than malignant ones, an approach is needed to determine which incidentally discovered masses should be removed. The history and physical examination may guide the evaluation. Imaging studies and needle biopsies have limited value. If the history and physical findings do not suggest a diagnosis, an approach using the size of the mass, results of any cyst puncture, and a biochemical assessment may determine which patients should have surgery. This approach is based on the relative prevalence of benign and malignant clinically silent adrenal tumors.

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Selected References

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  1. ABESHOUSE G. A., GOLDSTEIN R. B., ABESHOUSE B. S. Adrenal cysts; review of the literature and report of three cases. J Urol. 1959 Jun;81(6):711–719. doi: 10.1016/S0022-5347(17)66099-3. [DOI] [PubMed] [Google Scholar]
  2. Alterman S. L., Dominguez C., Lopez-Gomez A., Lieber A. L. Primary adrenocortical carcinoma causing aldosteronism. Cancer. 1969 Sep;24(3):602–609. doi: 10.1002/1097-0142(196909)24:3<602::aid-cncr2820240327>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  3. Auda S. P., Brennan M. F., Gill J. R., Jr Evolution of the surgical management of primary aldosteronism. Ann Surg. 1980 Jan;191(1):1–7. doi: 10.1097/00000658-198001000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. BARTELS E. C. Malignant pheochromocytoma. Surg Clin North Am. 1959 Jun;39(3):805–808. doi: 10.1016/s0039-6109(16)35806-6. [DOI] [PubMed] [Google Scholar]
  5. Bertagna C., Orth D. N. Clinical and laboratory findings and results of therapy in 58 patients with adrenocortical tumors admitted to a single medical center (1951 to 1978). Am J Med. 1981 Nov;71(5):855–875. doi: 10.1016/0002-9343(81)90384-3. [DOI] [PubMed] [Google Scholar]
  6. Bradley E. L., 3rd Primary and adjunctive therapy in carcinoma of the adrenal cortex. Surg Gynecol Obstet. 1975 Oct;141(4):507–516. [PubMed] [Google Scholar]
  7. CROUT J. R., SJOERDSMA A. TURNOVER AND METABOLISM OF CATECHOLAMINES IN PATIENTS WITH PHEOCHROMOCYTOMA. J Clin Invest. 1964 Jan;43:94–102. doi: 10.1172/JCI104898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cain J. P., Tuck M. L., Williams G. H., Dluhy R. G., Rosenoff S. H. The regulation of aldosterone secretion in primary aldosteronism. Am J Med. 1972 Nov;53(5):627–637. doi: 10.1016/0002-9343(72)90158-1. [DOI] [PubMed] [Google Scholar]
  9. Charbonnel B., Chatal J. F., Ozanne P. Does the corticoadrenal adenoma with "pre-Cushing's syndrome" exist? J Nucl Med. 1981 Dec;22(12):1059–1061. [PubMed] [Google Scholar]
  10. Didolkar M. S., Bescher R. A., Elias E. G., Moore R. H. Natural history of adrenal cortical carcinoma: a clinicopathologic study of 42 patients. Cancer. 1981 May 1;47(9):2153–2161. doi: 10.1002/1097-0142(19810501)47:9<2153::aid-cncr2820470908>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  11. Dobbie J. W. Adrenocortical nodular hyperplasia: the ageing adrenal. J Pathol. 1969 Sep;99(1):1–18. doi: 10.1002/path.1710990102. [DOI] [PubMed] [Google Scholar]
  12. Engelman K. Phaeochromocytoma. Clin Endocrinol Metab. 1977 Nov;6(3):769–797. doi: 10.1016/s0300-595x(77)80079-0. [DOI] [PubMed] [Google Scholar]
  13. FUKUSHIMA D. K., GALLAGHER T. F. STEROID PRODUCTION IN "NONFUNCTIONING" ADRENAL CORTICAL TUMOR. J Clin Endocrinol Metab. 1963 Sep;23:923–927. doi: 10.1210/jcem-23-9-923. [DOI] [PubMed] [Google Scholar]
  14. Fantl V., Booth M., Gray C. H. Urinary pregn-5-ene-3 ,16 ,20 -triol in adrenal dysfunction. J Endocrinol. 1973 Apr;57(1):135–142. doi: 10.1677/joe.0.0570135. [DOI] [PubMed] [Google Scholar]
  15. GABRILOVE J. L., SHARMA D. C., WOTIZ H. H., DORFMAN R. I. FEMINIZING ADRENOCORTICAL TUMORS IN THE MALE. A REVIEW OF 52 CASES INCLUDING A CASE REPORT. Medicine (Baltimore) 1965 Jan;44:37–79. doi: 10.1097/00005792-196501000-00002. [DOI] [PubMed] [Google Scholar]
  16. Gabrilove J. L., Seman A. T., Sabet R., Mitty H. A., Nicolis G. L. Virilizing adrenal adenoma with studies on the steroid content of the adrenal venous effluent and a review of the literature. Endocr Rev. 1981 Fall;2(4):462–470. doi: 10.1210/edrv-2-4-462. [DOI] [PubMed] [Google Scholar]
  17. Glazer H. S., Weyman P. J., Sagel S. S., Levitt R. G., McClennan B. L. Nonfunctioning adrenal masses: incidental discovery on computed tomography. AJR Am J Roentgenol. 1982 Jul;139(1):81–85. doi: 10.2214/ajr.139.1.81. [DOI] [PubMed] [Google Scholar]
  18. HEINBECKER P., O'NEAL L. W., ACKERMAN L. V. Functioning and nonfunctioning adrenal cortical tumors. Surg Gynecol Obstet. 1957 Jul;105(1):21–33. [PubMed] [Google Scholar]
  19. Hajjar R. A., Hickey R. C., Samaan N. A. Adrenal cortical carcinoma. A study of 32 patients. Cancer. 1975 Feb;35(2):549–554. doi: 10.1002/1097-0142(197502)35:2<549::aid-cncr2820350239>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  20. Hedeland H., Ostberg G., Hökfelt B. On the prevalence of adrenocortical adenomas in an autopsy material in relation to hypertension and diabetes. Acta Med Scand. 1968 Sep;184(3):211–214. doi: 10.1111/j.0954-6820.1968.tb02445.x. [DOI] [PubMed] [Google Scholar]
  21. Hoevels J., Ekelund L. Angiographic findings in adrenal masses. Acta Radiol Diagn (Stockh) 1979;20(2):337–352. doi: 10.1177/028418517902000206. [DOI] [PubMed] [Google Scholar]
  22. Hunt T. K., Schambelan M., Biglieri E. G. Selection of patients and operative approach in primary aldosteronism. Ann Surg. 1975 Oct;182(4):353–361. doi: 10.1097/00000658-197510000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hutter A. M., Jr, Kayhoe D. E. Adrenal cortical carcinoma. Clinical features of 138 patients. Am J Med. 1966 Oct;41(4):572–580. doi: 10.1016/0002-9343(66)90219-1. [DOI] [PubMed] [Google Scholar]
  24. Huvos A. G., Hajdu S. I., Brasfield R. D., Foote F. W., Jr Adrenal cortical carcinoma. Clinicopathologic study of 34 cases. Cancer. 1970 Feb;25(2):354–361. doi: 10.1002/1097-0142(197002)25:2<354::aid-cncr2820250212>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  25. KNIGHT C. D., TRICHEL B. E., MATHEWS W. R. Nonfunctioning carcinoma of the adrenal cortex. Ann Surg. 1960 Mar;151:349–358. doi: 10.1097/00000658-196003000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Karstaedt N., Sagel S. S., Stanley R. J., Melson G. L., Levitt R. G. Computed tomography of the adrenal gland. Radiology. 1978 Dec;129(3):723–730. doi: 10.1148/129.3.723. [DOI] [PubMed] [Google Scholar]
  27. Kearney G. P., Mahoney E. M., Maher E., Harrison J. H. Functioning and nonfunctioning cysts of the adrenal cortex and medulla. Am J Surg. 1977 Sep;134(3):363–368. doi: 10.1016/0002-9610(77)90407-x. [DOI] [PubMed] [Google Scholar]
  28. Kokko J. P., Brown T. C., Berman M. M. Adrenal adenoma and hypertension. Lancet. 1967 Mar 4;1(7488):468–470. doi: 10.1016/s0140-6736(67)91092-6. [DOI] [PubMed] [Google Scholar]
  29. Korobkin M., White E. A., Kressel H. Y., Moss A. A., Montagne J. P. Computed tomography in the diagnosis of adrenal disease. AJR Am J Roentgenol. 1979 Feb;132(2):231–238. doi: 10.2214/ajr.132.2.231. [DOI] [PubMed] [Google Scholar]
  30. LIPSETT M. B., HERTZ R., ROSS G. T. CLINICAL AND PATHOPHYSIOLOGIC ASPECTS OF ADRENOCORTICAL CARCINOMA. Am J Med. 1963 Sep;35:374–383. doi: 10.1016/0002-9343(63)90179-7. [DOI] [PubMed] [Google Scholar]
  31. LIPSETT M. B., WILSON H. Adrenocortical cancer: steroid biosynthesis and metabolism evaluated by urinary metabolites. J Clin Endocrinol Metab. 1962 Sep;22:906–915. doi: 10.1210/jcem-22-9-906. [DOI] [PubMed] [Google Scholar]
  32. Levin N. P. Fine needle aspiration and histology of adrenal cortical carcinoma: a case report. Acta Cytol. 1981 Jul-Aug;25(4):421–426. [PubMed] [Google Scholar]
  33. Lewinsky B. S., Grigor K. M., Symington T., Neville A. M. The clinical and pathologic features of "non-hormonal" adrenocortical tumors. Report of twenty new cases and review of the literature. Cancer. 1974 Mar;33(3):778–790. doi: 10.1002/1097-0142(197403)33:3<778::aid-cncr2820330325>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  34. Mackett M. C., Crane M. G., Smith L. L. Surgical management of aldosterone-producing adrenal adenomas: a review of 16 patients. Am J Surg. 1981 Jul;142(1):89–95. doi: 10.1016/s0002-9610(81)80033-5. [DOI] [PubMed] [Google Scholar]
  35. Pheochromocytoma: current concepts of diagnosis and treatment. Combined clinical staff conference at the National Institutes of Health. Ann Intern Med. 1966 Dec;65(6):1302–1326. [PubMed] [Google Scholar]
  36. Pickering R. S., Hartman G. W., Weeks R. E., Sheps S. G., Hattery R. R. Excretory urographic localization of adrenal cortical tumors and pheochromocytomas. Radiology. 1975 Feb;114(2):345–349. doi: 10.1148/114.2.345. [DOI] [PubMed] [Google Scholar]
  37. Prinz R. A., Brooks M. H., Churchill R., Graner J. L., Lawrence A. M., Paloyan E., Sparagana M. Incidental asymptomatic adrenal masses detected by computed tomographic scanning. Is operation required? JAMA. 1982 Aug 13;248(6):701–704. [PubMed] [Google Scholar]
  38. Rizza R. A., Wahner H. W., Spelsberg T. C., Northcutt R. C., Moses H. L. Visualization of nonfunctioning adrenal adenomas with iodocholesterol: possible relationship to subcellular distribution of tracer. J Nucl Med. 1978 May;19(5):458–463. [PubMed] [Google Scholar]
  39. SHAMMA A. H., GODDARD J. W., SOMMERS S. C. A study of the adrenal status in hypertension. J Chronic Dis. 1958 Nov;8(5):587–595. doi: 10.1016/0021-9681(58)90051-1. [DOI] [PubMed] [Google Scholar]
  40. Sample W. F., Sarti D. A. Computed tomography and gray scale ultrasonography of the adrenal gland: a comparative study. Radiology. 1978 Aug;128(2):377–383. doi: 10.1148/128.2.377. [DOI] [PubMed] [Google Scholar]
  41. Santander R., González A., Suárez J. A. Case of probable mineralocorticoid excess without hypercortisolism due to a carcinoma of the adrenal cortex. J Clin Endocrinol Metab. 1965 Nov;25(11):1429–1435. doi: 10.1210/jcem-25-11-1429. [DOI] [PubMed] [Google Scholar]
  42. Scheible W., Coel M., Siemers P. T., Siegel H. Percutaneous aspiration of adrenal cysts. AJR Am J Roentgenol. 1977 Jun;128(6):1013–1016. doi: 10.2214/ajr.128.6.1013. [DOI] [PubMed] [Google Scholar]
  43. Schteingart D. E., Seabold J. E., Gross M. D., Swanson D. P. Iodocholesterol adrenal tissue uptake and imaging adrenal neoplasms. J Clin Endocrinol Metab. 1981 Jun;52(6):1156–1161. doi: 10.1210/jcem-52-6-1156. [DOI] [PubMed] [Google Scholar]
  44. Solomon A., Kreel L. Computed tomographic assessment of adrenal masses. Clin Radiol. 1980 Mar;31(2):137–141. doi: 10.1016/s0009-9260(80)80137-1. [DOI] [PubMed] [Google Scholar]
  45. Sullivan M., Boileau M., Hodges C. V. Adrenal cortical carcinoma. J Urol. 1978 Dec;120(6):660–665. doi: 10.1016/s0022-5347(17)57317-6. [DOI] [PubMed] [Google Scholar]
  46. Sutton M. G., Sheps S. G., Lie J. T. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354–360. [PubMed] [Google Scholar]
  47. Tang C. K., Gray G. F. Adrenocortical neoplasms. Prognosis and morphology. Urology. 1975 May;5(5):691–695. doi: 10.1016/0090-4295(75)90135-1. [DOI] [PubMed] [Google Scholar]
  48. Thrall J. H., Freitas J. E., Beierwaltes W. H. Adrenal scintigraphy. Semin Nucl Med. 1978 Jan;8(1):23–41. doi: 10.1016/s0001-2998(78)80005-1. [DOI] [PubMed] [Google Scholar]

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