Abstract
Currently, adrenal masses are discovered incidentally in 0.35–5% of patients imaged with computed tomography (CT) and are referred to as adrenal incidentalomas [1,2]. As a result, the diagnostic dilemma of separating the small fraction of hypersecretory and/or malignant masses from the majority that are nonhypersecretory adrenal adenomas has become common. Given the fourfold greater autopsy incidence of adrenal adenomas compared with the radiographic incidence, and the oncology data that only 20–41% of adrenal metastases are detected by CT [1,3], it is likely that an increase in prevalence will occur if the spatial resolving capacity of abdominal imaging improves, if abdominal imaging occurs more frequently, and if routine abdominal imaging slice thickness is decreased.
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References
Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. 1995. Incidentally discovered adrenal masses. Endocr Rev 16:460–484.
Kloos RT, Shapiro B, Gross MD. 1995. The adrenal incidentaloma. Curr Opin Endocrinol Diabetes 2:222–230.
Allard P, Yankaskas BC, Fletcher RH, Parker LA, Halvorsen RA Jr. 1990. Sensitivity and specificity of computed tomography for the detection of adrenal metastatic lesions among 91 autopsied lung cancer patients. Cancer 66:457–462.
Rubenstein SC, Benacerraf BR, Retik AB, Mandell J. 1995. Fetal suprarenal masses: Sonographic appearance and differential diagnosis. Ultrasound Obstet Gynecol 5:164–167.
Gicquel C, Bertagna X, Le Bouc Y. 1995. Recent advances in the pathogenesis of adrenocortical tumours. Eur J Endocrinol 133:133–144.
Haak HR, Fleuren GJ. 1995. Neuroendocrine differentiation of adrenocortical tumors. Cancer 75:860–864.
Barnes RD, Abratt RP, Cant PJ, Dent DM. 1995. Synchronous contralateral adrenal metastasis from renal cell carcinoma: A 7 year survival following resection. Aust N Z J Surg 65:540–541.
Higashiyama M, Doi O, Kodama K, Yokouchi H, Imaoka S, Koyama H. 1994. Surgical treatment of adrenal metastasis following pulmonary resection for lung cancer: Comparison of adrenalectomy with palliative therapy. Int Surg 79:124–129.
Korobkin M, Francis IR. 1995. Adrenal imaging. Semin Ultrasound CT MR 16:317–330.
Kasperlik-Zaluska AA, Migdalska BM, Zgliczynski S, Makowska AM, Kasperlik-Zauska AA. 1995. Adrenocortical carcinoma. A clinical study and treatment results of 52 patients. Cancer 75:2587–2591.
Favia G, Lumachi F, Carraro P, D’Amico DF. 1995. Adrenocortical carcinoma. Our experience. Minerva Endocrinol 20:95–99.
Boscaro M, Fallo F, Barzon L, Daniele O, Sonino N. 1995. Adrenocortical carcinoma: Epidemiology and natural history. Minerva Endocrinol 20:89–94.
Lenders JW, Keiser HR, Goldstein DS, Willemsen JJ, Friberg P, Jacobs MC, Kloppenborg PW, Thien T, Eisenhofer G. 1995. Plasma metanephrines in the diagnosis of pheochromocytoma [see comments]. Ann Intern Med 123:101–109.
Bravo EL. 1994. Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma. Endocr Rev 15:356–368.
Bravo EL, Gifford RW Jr. 1984. Current concepts. Pheochromocytoma: Diagnosis, localization and management. N Engl J Med 311:1298–1303.
Weinberger MH, Fineberg NS. 1993. The diagnosis of primary aldosteronism and separation of two major subtypes. Arch Intern Med 153:2125–2129.
Weigel RJ, Wells SA, Gunnells JC, Leight GS. 1994. Surgical treatment of primary hyperaldosteronism. Ann Surg 219:347–352.
Melby JC, Azar ST. 1993. Adrenal steroids and hypertension: New aspects. Endocrinologist 3:344–351.
Bravo EL. 1993. Primary aldosteronism: New approaches to diagnosis and management. Cleve Clin J Med 60:379–386.
Bunnag P, Tuck ML. 1995. Captopril test in the evaluation of primary aldosteronism. Endocrinologist 5:253–257.
Hoefnagel CA. 1994. Metaiodobenzylguanidine and somatostatin in oncology: Role in the management of neural crest tumours. Eur J Nucl Med 21:561–581.
Pujol P, Bringer J, Faurous P, Jaffiol C. 1995. Metastatic phaeochromocytoma with a long-term response after iodine-131 metaiodobenzylguanidine therapy. Eur J Nucl Med 22:382–384.
Elgazzar AH, Gelfand MJ, Washburn LC, Clark J, Nagaraj N, Cummings D, Hughes J, Maxon HR. 1995.1-123 MIBG scintigraphy in adults. A report of clinical experience. Clin Nucl Med 20:147–152.
Tenenbaum F, Lumbroso J, Schlumberger M, Mure A, Plouin PF, Caillou B, Parmentier C. 1995. Comparison of radiolabeled octreotide and meta-iodobenzylguanidine (MIBG) scintigraphy in malignant pheochromocytoma. J Nucl Med 36:1–6.
Maurea S, Lastoria S, Cuocolo A, Celentano L, Salvatore M. 1995. The diagnosis of nonfunctioning pheochromocytoma. The role of I-123 MIBG imaging. Clin Nucl Med 20:22–24.
Flecchia D, Mazza E, Carlini M, Blatto A, Olivieri F, Serra G, Camanni F, Messina M. 1995. Reduced serum levels of dehydroepiandrosterone sulphate in adrenal incidentalomas: A marker of adrenocortical tumour. Clin Endocrinol (Oxf) 42:129–134.
Ambrosi B, Peverelli S, Passini E, Re T, Ferrario R, Colombo P, Sartorio A, Faglia G. 1995. Abnormalities of endocrine function in patients with clinically’ silent’ adrenal masses [see comments]. Eur J Endocrinol 132:422–428.
Terzolo M, Osella G, Ali A, Reimondo G, Borretta G, Magro GP, Luceri S, Paccotti P, Angeli A. 1995. Adrenal incidentaloma, a five year experience. Minerva Endocrinol 20:69–78.
Papanicolaou DA, Yanovski JA, Cutler GB, Chrousos GP, Nieman LK. 1994. A single midnight cortisol measurement discriminates Cushing syndrome from pseudoCushing states. 76th Annual Meeting of the Endocrine Society Program and Abstracts Book; June 15–18; Anaheim, CA The Endocrine Society Press, Bethesda, MD, p 518.
Crapo L. 1979. Cushing’s syndrome: A review of diagnostic tests. Metabolism 28:955–977.
Suzuki H, Shibata H, Takita T, Wakino S, Ogishima T, Ishimura Y, Saruta T. 1994. Steroid contents and cortical steroidogenic enzymes in non-hyperfunctioning adrenal adenoma. Endocr J 41:267–274.
Thrall JH, Freitas JE, Beierwaltes WH. 1978. Adrenal scintigraphy. Semin Nucl Med 8:23–41.
Gross MD, Shapiro B. 1989. Scintigraphic studies in adrenal hypertension. Semin Nucl Med 19:122–143.
Gross MD, Valk TW, Swanson DP, Thrall JH, Grekin RJ, Beirewaltes WH. 1981. The role of pharmacologic manipulation in adrenal cortical scintigraphy. Semin Nucl Med 11:128–148.
Gross MD, Thrall JH, Beierwaltes WH. 1980. The adrenal scan: A current status report on radiotracers, dosimetry, and clinical utility. In Freeman LM, Weissmann HS, eds. Nuclear Medicine Annual 1980. New York: Raven Press, pp 127–175.
Aupetit-Faisant B, Blanchouin-Emeric N, Tenenbaum F, Battaglia C, Tabarin A, Amar J, Kuttenn F, Warnet A, Assayag M, Chamontin B. 1995. Plasma levels of aldosterone versus aldosterone precursors: A way to estimate the malignancy of asymptomatic and nonsecretory adrenal tumors: A French Retrospective Multicentric Study. J Clin Endocrinol Metab 80:2715–2721.
Osella G, Terzolo M, Borretta G, Magro G, Ali A, Piovesan A, Paccotti P, Angeli A. 1994. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J Clin Endocrinol Metab 79:1532–1539.
Del Monte P, Bernasconi D, Bertolazzi L, Meozzi M, Badaracco B, Torre R, Marugo M. 1995. Increased 17 alpha-hydroxyprogesterone response to ACTH in silent adrenal adenoma: Cause or effect? Clin Endocrinol (Oxf) 42:273–277.
Sciarra F, Tosti-Croce C, Toscano V. 1995. Androgen-secreting adrenal tumors. Minerva Endocrinol 20:63–68.
Palmer WE, Gerard-McFarland EL, Chew FS. 1991. Adrenal myelolipoma [clinical conference]. Am J Roentgenol 156:724.
Wolverson MK, Kannegiesser H. 1984. CT of bilateral adrenal hemorrhage with acute adrenal insufficiency in the adult. Am J Roentgenol 142:311–314.
Bowen AD, Keslar PJ, Newman B, Hashida Y. 1990. Adrenal hemorrhage after liver transplantation. Radiology 176:85–88.
Murphy BJ, Casillas J, Yrizarry JM. 1988. Traumatic adrenal hemorrhage: Radiologic findings. Radiology 169:701–703.
Spinelli C, Materazzi G, Berti P, Cecchi M, Morelli G, Miccoli P. 1995. Symptomatic adrenal myelolipoma: Therapeutic considerations. Eur J Surg Oncol 21:403–407.
Sanders R, Bissada N, Curry N, Gordon B. 1995. Clinical spectrum of adrenal myelolipoma: Analysis of 8 tumors in 7 patients. J Urol 153:1791–1793.
Johnson CD, Baker ME, Dunnick NR. 1985. CT demonstration of an adrenal pseudocyst. J Comput Assist Tomogr 9:817–819.
Wilson DA, Muchmore HG, Tisdal RG, Fahmy A, Pitha JV. 1984. Histoplasmosis of the adrenal glands studied by CT. Radiology 150:779–783.
Fishman EK, Deutch BM, Hartman DS, Goldman SM, Zerhouni EA, Siegelman SS. 1987. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. Am J Roentgenol 148:531–535.
Dunnick NR, Heaston D, Halvorsen R, Moore AV, Korobkin M. 1982. CT appearance of adrenal cortical carcinoma. J Comput Assist Tomogr 6:978–982.
van Erkel AR, van Gils AP, Lequin M, Kruitwagen C, Bloem JL, Falke TH. 1994. CT and MR distinction of adenomas and nonadenomas of the adrenal gland. J Comput Assist Tomogr 18:432–438.
Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, Simeone JF. 1991. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology 179:415–418.
Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, Kazerooni EA. 1996. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. Am J Roentgenol 166:531–536.
Wilms GE, Baert AL, Kint EJ, Pringot JH, Goddeeris PG. 1983. Computed tomographic findings in bilateral adrenal tuberculosis. Radiology 146:729–730.
Brodeur FJ, Korobkin M, Francis IR, Quint LE, Dunnick NR. 1995. Delayed enhanced CT: A method of differentiating adrenal adenomas from nonadenomas (abstr). Radiology 197:185.
Reinig JW, Doppman JL, Dwyer AJ, Frank J. 1986. MRI of indeterminate adrenal masses. Am J Roentgenol 147:493–496.
Glazer GM, Woolsey EJ, Borrello J, Francis IR, Aisen AM, Bookstein F, Amendola MA, Gross MD, Bree RL, Martel W. 1986. Adrenal tissue characterization using MR imaging. Radiology 158:73–79.
Chang A, Glazer HS, Lee JK, Ling D, Heiken JP. 1987. Adrenal gland: MR imaging. Radiology 163:123–128.
Baker ME, Blinder R, Spritzer C, Leight GS, Herfkens RJ, Dunnick NR. 1989. MR evaluation of adrenal masses at 1.5dT. Am J Roentgenol 153:307–312.
Kier R, McCarthy S. 1989. MR characterization of adrenal masses: Field strength and pulse sequence considerations. Radiology 171:671–674.
Mitchell DG, Outwater EK, Matteucci T, Rubin DL, Chezmar JL, Saini S. 1995. Adrenal gland enhancement at MR imaging with Mn-DPDP. Radiology 194:783–787.
Korobkin M, Lombardi TJ, Aisen AM, Francis IR, Quint LE, Dunnick NR, Londy F, Shapiro B, Gross MD, Thompson NW. 1995. Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 197:411–418.
Schlund JF, Kenney PJ, Brown ED, Ascher SM, Brown JJ, Semelka RC. 1995. Adrenocortical carcinoma: MR imaging appearance with current techniques. J Magn Reson Imaging 5:171–174.
Tsushima Y, Ishizaka H, Matsumoto M. 1993. Adrenal masses: Differentiation with chemical shift, fast low-angle shot MR imaging. Radiology 186:705–709.
Bilbey JH, McLoughlin RF, Kurkjian PS, Wilkins GE, Chan NH, Schmidt N, Singer J. 1995. MR imaging of adrenal masses: Value of chemical-shift imaging for distinguishing adenomas from other tumors [see comments]. Am J Roentgenol 164:637–642.
Mayo-Smith WW, Lee MJ, McNicholas MM, Hahn PF, Boland GW, Saini S. 1995. Characterization of adrenal masses (<5cm) by use of chemical shift MR imaging: Observer performance versus quantitative measures. Am J Roentgenol 165:91–95.
Reinig JW. 1991. Differentiation of hepatic lesions with MR imaging: The last word? [editorial]. Radiology 179:601–602.
Outwater EK, Siegelman ES, Radecki PD, Piccoli CW, Mitchell DG. 1995. Distinction between benign and malignant adrenal masses: Value of T1-weighted chemical-shift MR imaging. Am J Roentgenol 165:579–583.
McNicholas MM, Lee MJ, Mayo-Smith WW, Hahn PF, Boland GW, Mueller PR. 1995. An imaging algorithm for the differential diagnosis of adrenal adenomas and metastases. Am J Roentgenol 165:1453–1459.
Outwater EK, Siegelman ES, Shapiro MA. 1995. Correlation of CT and chemical shift MR imaging measurements of lipid in adrenal lesions (abstr). Radiology 197:184.
Korobkin MT, Giordano TJ, Brodeur FJ, Francis IR, Quint LE, Dunnick NR. 1995. Relationship between histologic lipid and CT and MR imaging findings in surgically resected adrenal adenomas (abstr). Radiology 197:185.
Orth DN, Kovacs WJ, deBold CR. 1991. The adrenal cortex. In Wilson JD, Foster DW, eds. Williams’ Textbook of Endocrinology 8th ed. Philadelphia: WB Saunders, pp 489–619.
Nakagawa T, Ueyama Y, Nozaki S, Yamashita S, Menju M, Funahashi T, Kameda-Takemura K, Kubo M, Tokunaga K, Tanaka T. 1995. Marked hypocholesterolemia in a case with adrenal adenoma — enhanced catabolism of low density lipoprotein (LDL) via the LDL receptors of tumor cells. J Clin Endocrinol Metab 80:92–96.
Dominguez-Gadea L, Diez L, Bas C, Crespo A. 1994. Differential diagnosis of solid adrenal masses using adrenocortical scintigraphy. Clin Radiol 49:796–799.
Gross MD, Shapiro B, Francis IR, Glazer GM, Bree RL, Arcomano MA, Schteingart DE, McLeod MK, Sanfield JA, Thompson NW. 1994. Scintigraphic evaluation of clinically silent adrenal masses [see comments]. J Nucl Med 35:1145–1152.
Kloos RT, Gross MD, Shapiro B, Francis IR, Korobkin M, Thompson NW. 1996. The diagnostic dilemma of small incidentally discovered adrenal masses: A role for 131-I-b-iodomethyl-norcholesterol (NP59) scintigraphy. World J Surg, in press.
Dwamena BA, Kloos RT, Fendrick AM, Gross MD, Francis IR, Korobkin MT, Shapiro B. 1996. The adrenal incidentaloma: Decision and cost-effectiveness analyses of diagnostic management strategies (abstr). J Nucl Med 37:158P.
Haab F, Duclos JM, Julien J, Plouin PF. 1994. [Tumors of both adrenal glands. 12 consecutive cases]. Presse Med 23:511–514.
Gross MD, Shapiro B, Francis IR, Bree RL, Korobkin M, McLeod MK, Thompson NW, Sanfield JA. 1995. Incidentally discovered bilateral adrenal masses. Eur J Nucl Med 22:315–321.
Boland GW, Goldberg MA, Lee MJ, Mayo-Smith WW, Dixon J, McNicholas MM, Mueller PR. 1995. Indeterminate adrenal mass in patients with cancer: Evaluation at PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 194:131–134.
Keyes JW Jr. 1995. SUV: Standard uptake or silly useless value? J Nucl Med 36:1836–1839.
Welch TJ, Sheedy PF, Stephens DH, Johnson CM, Swensen SJ. 1994. Percutaneous adrenal biopsy: Review of a 10-year experience. Radiology 193:341–344.
Kloos RT, Gross MD, Shapiro B. 1994. Investigation of incidentally discovered, biochemically non-hypersecretory benign adrenal adenomas: A review of the current knowledge and areas for future investigation. Intern Med 2:9–15.
Mody MK, Kazerooni EA, Korobkin M. 1995. Percutaneous CT-guided biopsy of adrenal masses: Immediate and delayed complications. J Comput Assist Tomogr 19:434–439.
Candel AG, Gattuso P, Reyes CV, Prinz RA, Castelli MJ. 1993. Fine-needle aspiration biopsy of adrenal masses in patients with extraadrenal malignancy. Surgery 114:1132–1137.
Yankaskas BC, Staab EV, Craven MB, Blatt PM, Sokhandan M, Carney CN. 1986. Delayed complications from fine-needle biopsies of solid masses of the abdomen. Invest Radiol 21:325–328.
Silverman SG, Mueller PR, Pinkney LP, Koenker RM, Seltzer SE. 1993. Predictive value of image-guided adrenal biopsy: Analysis of results of 101 biopsies. Radiology 187:715–718.
Pagani JJ. 1983. Normal adrenal glands in small cell lung carcinoma: CT-guided biopsy. Am J Roentgenol 140:949–951.
Katz RL, Patel S, Mackay B, Zornoza J. 1984. Fine needle aspiration cytology of the adrenal gland. Acta Cytol 28:269–282.
Bernardino ME, Walther MM, Phillips VM, Graham SD Jr, Sewell CW, Gedgaudas-McClees K, Baumgartner BR, Torres WE, Erwin BC. 1985. CT-guided adrenal biopsy: Accuracy, safety, and indications. Am J Roentgenol 144:67–69.
Wadih GE, Nance KV, Silverman JF. 1992. Fine-needle aspiration cytology of the adrenal gland. Fifty biopsies in 48 patients. Arch Pathol Lab Med 116:841–846.
Rossi R, Savastano S, Tommaselli AP, Valentino R, Iaccarino V, Tauchmanova L, Luciano A, Gigante M, Lombardi G. 1995. Percutaneous computed tomography-guided ethanol injection in aldosterone-producing adrenocortical adenoma [see comments]. Eur J Endocrinol 132:302–305.
Regge D, Balma E, Lasciarrea P, Martina C, Serrallonga M, Gandini G. 1995. Interventional radiology of the adrenal glands. Minerva Endocrinol 20:15–26.
Mandressi A, Buizza C, Antonelli D, Chisena S, Servadio G. 1995. Retroperitoneoscopy. Ann Urol (Paris) 29:91–96.
Deans GT, Kappadia R, Wedgewood K, Royston CM, Brough WA. 1995. Laparoscopic adrenalectomy. Br J Surg 82:994–995.
Heintz A, Junginger T, Bottger T. 1995. Retroperitoneal endoscopic adrenalectomy. Br J Surg 82:215.
Hata M, Nakagawa K, Yanaihara H, Uchida A, Hayakawa K, Ohashi M, Ishikawa H. 1995. [Experience in seven cases of laparoscopic adrenalectomy]. Hinyokika Kiyo 41:507–510.
Mugiya S, Ishikawa A, Kageyama S, Ushiyama T, Hata M, Ohta N, Ohtawara Y, Suzuki K, Fujita K, Tajima A. 1995. [Adrenalectomy for nonfunctioning adrenal tumors-comparison between open and laparoscopic surgery, and indication for operation]. Hinyokika Kiyo 41:81–83.
Guazzoni G, Montorsi F, Bocciardi A, Da Pozzo L, Rigatti P, Lanzi R, Pontiroli A. 1995. Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: A comparative study [see comments]. J Urol 153:1597–1600.
Schlinkert RT, van Heerden JA, Grant CS, Thompson GB, Segura JW. 1995. Laparoscopic left adrenalectomy for aldosteronoma: Early Mayo Clinic experience. Mayo Clin Proc 70:844–846.
Chapuis Y, Maignien B, Abboud B. 1995. [Adrenalectomy under celioscopy. Experience of 25 operations]. Presse Med 24:845–848.
Go H, Takeda M, Imai T, Komeyama T, Nishiyama T, Morishita H. 1995. Laparoscopic adrenalectomy for Cushing’s syndrome: Comparison with primary aldosteronism. Surgery 117:11–17.
Walz MK, Peitgen K, Krause U, Eigler FW. 1995. [Dorsal retroperitoneoscopic adrenalectomy — a new surgical technique]. Zentralbl Chir 120:53–58.
Meurisse M, Joris J, Hamoir E, Hubert B, Charlier C. 1995. Laparoscopic removal of pheochromocytoma. Why? When? and Who? (reflections on one case report). Surg Endosc 9:431–436.
Pertsemlidis D. 1995. Minimal-access versus open adrenalectomy [editorial]. Surg Endosc 9:384–386.
Ayabe H, Tsuji H, Hara S, Tagawa Y, Kawahara K, Tomita M. 1995. Surgical management of adrenal metastasis from bronchogenic carcinoma. J Surg Oncol 58:149–154.
Piga A, Bracci R, Porfiri E, Cellerino R. 1995. Metastatic tumors of the adrenals. Minerva Endocrinol 20:79–83.
Schomer NS, Mohler JL. 1995. Partial adrenalectomy for renal cell carcinoma with bilateral adrenal metastases. J Urol 153:1196–1198.
Sakamoto K, Ariyoshi A, Okazaki M. 1995. Metastatic adrenocortical carcinoma treated by repeated resection: A case report of long-term survival over 18 years. Int J Urol 2:50–52.
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Kloos, R.T., Korobkin, M., Thompson, N.W., Francis, I.R., Shapiro, B., Gross, M.D. (1997). Incidentally discovered adrenal masses. In: Arnold, A. (eds) Endocrine Neoplasms. Cancer Treatment and Research, vol 89. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-6355-6_13
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