A 22-year-old female comes with an incidentally detected mass in the right adrenal gland of 2 cm size detected during a CT scan done for abdominal pain. She has no hypertension, no cushingoid features and no virilization. She has no family history of multiple endocrine neoplasia. She has no history of renal calculi. The cause of abdominal pain is finally diagnosed as abdominal migraine. How will you evaluate this case of adrenal incidentaloma? An adrenal “incidentaloma” is an adrenal mass, generally 1 cm or more in diameter that is discovered ‘incidentally’ during a radiologic examination performed for indications other than an evaluation for adrenal disease. The definition of incidentaloma excludes patients undergoing imaging procedures as part of staging and work-up for cancer and patients with symptomatic adrenal disease not elicited due to oversight. Adrenal incidentaloma is not a single entity; rather it is an ‘umbrella’ defini-tion comprising a spectrum of different pathological entities that share the same path of discovery. The widespread use of computed tomography (CT), diagnostic ultrasound, and magnetic resonance imaging (MRI) has resulted in the frequent incidental discovery of asymptomatic adrenal masses. The optimal diagnostic approach to a patient who has an adrenal incidentaloma is by taking a careful history and performing a physical examination, focusing on the signs and symptoms suggestive of adrenal hyperfunction or malignant disease followed by hormonal testing, when indicated. The two important questions to be answered at the end of evaluation are:
• Does the patient have a lesion suggestive of malignancy?
• Is the lesion hormonally active?
• Do you want any further information from the CT scan done?
What is the frequency of an incidental adrenal mass in the population?
Medicine
In radiological studies, the frequency of adrenal incidentalomas was estimated at 4% in middle age and increases up to more than 10% in the elderly, peaking around the fifth and seventh decade. The frequency of adrenal incidentalomas is very low in childhood and adolescence. The prevalence of adrenal incidentalomas (AIs) has been reported as high as 8% in autopsy series and 4% in radiologic series. As improved imaging techniques become available and the frequency of abdominal imaging increases, the radiologic prevalence is expected to continue escalating and concerning is the evidence supporting increased prevalence with age.
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