S-13-1: MANAGEMENT OF ADRENAL INCIDENTALOMAS

Abstract

 

Adrenal tumours are commonly discovered incidentally on cross-sectional abdominal imaging performed for reasons other than adrenal mass. Incidence of adrenal tumours increased 10-fold in the past 2 decades, with most diagnosed in older adults. In any patient with a newly discovered adrenal mass, determining whether the adrenal mass is malignant and whether it is hormonally active is equally important to guide the best management. Malignancy is diagnosed in 5% to 8% of patients with adrenal tumours, with a higher risk in young patients, if history of extra-adrenal malignancy, in those with large adrenal tumours with indeterminate imaging characteristics, and in bilateral adrenal tumours. Although overt hormone excess is uncommon in adrenal incidentalomas, mild autonomous cortisol secretion can be diagnosed in 30% to 50% of patients. Because autonomous cortisol secretion is associated with increased cardiovascular morbidity and metabolic abnormalities, all patients with adrenal incidentalomas require workup with dexamethasone suppression test. Management of adrenal tumours varies based on aetiology, associated comorbidities, and patient preference. This presentation will focus on the current evidence on the diagnosis and evaluation of patients with adrenal mass, including the management of the most common aetiologies of adrenal incidentalomas.