- To review the current medical, surgical and radiological worldwide recognized guidelines for the work up and management of incidental adrenal lesions.

- To provide radiologists in practice and training key elements to correctly identify the rare unexpected malignant lesion sparing the majority of patients who have benign, clinically insignificant disease.

- To avoid overdiagnosis of adrenal lesions which can potentially place patients at risk for anxiety and unnecessary harms from diagnostic procedures and treatments.

Background

Incidental adrenal masses are common, estimated to occur in approximately 3% to 7% of adults(1–4). Clinical variables such as the presence of a primary malignancy are determinant in the assessment. The majority of adrenal masses in patients with no known malignancy are benign.  Taking in account the high prevalence of benign adrenal masses in the general population, even in an oncology patient, the lesion can be considered most likely benign(5,6). 

The most frequent incidental lesion is the benign, non-functioning adenoma. This can be confidentially diagnosed in an unenhanced CT placing an ROI covering at least 2/3 of the circumference of the nodule obtaining an attenuation value less than 10 HU (Figure 1).

Physician desire for...

...read more

- Adequate knowledge of the current radiologic, medical and surgical societies guidelines can improve radiologist value in terms of recommendations, active participation on multidisciplinary rounds and role in patient care.

- There is substantial variability in radiologist reporting and recommendations regarding incidental adrenal nodules which can impact management and follow up strategies.

- Physician’s desire for diagnostic certainty and discomfort with diagnostic uncertainty has led to increased demands of follow up tests which can end up in overdiagnosis and patient's anxiety.