Incidentaloma secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D [2]

Overview

Effective measures for the secondary prevention of adrenal incidentaloma include annual biochemical follow-up for up to 5 yr, no routine follow-up of adrenal incidentalomas with a non-contrast attenuation value no greater than 10 HU. Patients with adrenal masses less than 4 cm in size and a non-contrast attenuation value more than 10 HU should have a repeat CT study in 3–6 months and then yearly for 2 yr.

Excess hormone secretion may develop in up to 20% of patients with previously non-functional adrenal tumors during follow-up.
The transformation rate of non-functional adrenal masses to functional tumors seems to be higher in adrenal masses greater than 3 cm in size.
Annual biochemical follow-up for up to 5 years may be reasonable for patients with adrenal incidentalomas, especially if the tumor is more than 3 cm in size.
No routine follow-up of adrenal incidentalomas with a non-contrast attenuation value no greater than 10 HU.
Malignancy can be detected by an absolute increase in size of 0.8 cm, 0.64 cm growth per year or a 25% increase in size per year.
A one-time follow-up scan in 6–12 months may be reassuring to the physician and the patient.
Patients with adrenal masses less than 4 cm in size and a non-contrast attenuation value more than 10 HU should have a repeat CT study in 3–6 months and then yearly for 2 yr.
Surgical excision may be considered for tumors with indeterminate radiological features that grow at least 0.8 cm over 3- to 12-month follow-up.

↑ Barzon L, Scaroni C, Sonino N, Fallo F, Paoletta A, Boscaro M (1999). “Risk factors and long-term follow-up of adrenal incidentalomas”. J Clin Endocrinol Metab. 84 (2): 520–6. doi:10.1210/jcem.84.2.5444. PMID 10022410.
↑ Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA; et al. (2003). “Management of the clinically inapparent adrenal mass (“incidentaloma”)”. Ann Intern Med. 138 (5): 424–9. PMID 12614096.
↑ Pantalone KM, Gopan T, Remer EM, Faiman C, Ioachimescu AG, Levin HS; et al. (2010). “Change in adrenal mass size as a predictor of a malignant tumor”. Endocr Pract. 16 (4): 577–87. doi:10.4158/EP09351.OR. PMID 20150023.
↑ Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D; et al. (2009). “American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations”. Endocr Pract. 15 (5): 450–3. doi:10.4158/EP.15.5.450. PMID 19632968.
↑ Cawood TJ, Hunt PJ, O’Shea D, Cole D, Soule S (2009). “Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?”. Eur J Endocrinol. 161 (4): 513–27. doi:10.1530/EJE-09-0234. PMID 19439510.