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Adrenal incidentaloma

Inzidentalome der Nebenniere

  • Main Topics: Adrenal Tumors
  • Adrenocortical Tumors
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Abstract

Background

Approximately 0.5 to 10% of patients undergoing an abdominal imaging study will be found to have an incidentally discovered adrenal mass (adrenal incidentaloma). The question remains which of these lesions represent early, significant “disease”, and which do not. Presented here are relevant considerations for the evaluation of an adrenal incidentaloma.

Methods

Our experience with the evaluation of over 250 incidentally discovered adrenal masses is the basis for the proposed algorithm. Utilizing the patient's clinical presentation, physical examination, findings on imaging study(ies), biochemical assessment, and adrenal scintigraphy, we have found that a decision can be made regarding such lesions with a high degree of reliability, confidence, and predictive value.

Results

Among reported cases of adrenal incidentaloma, 38% are benign cortical adenomas, 22% are metastases to the adrenal, 3.1% are adrenal cysts, 2.6% are myelolipomas or lipomas, 1.7% are adrenocortical carcinomas, and only 1% are pheochromocytomas. At least 5% of adrenal incidentalomas are associated with subclinical Cushing's syndrome. The sensitivity and specificity of adrenal scintigraphy using NP-59 are 74 and 100% respectively.

Conclusions

Following a careful workup, it is possible for the endocrine surgeon to be reasonably confident in the decision to excise or observe an adrenal incidentaloma in the majority of cases.

Zusammenfassung

Grundlagen

Rund 0,5% bis 10% aller Patienten zeigen bei bildgebenden Untersuchungen des Abdomenns als Zufallsbefund einen Nebennierentumor (Inzidentalom der Nebenniere). Es stellt sich nun die Frage, welche dieser Läsionen tätsächlich eine Frühform einer “Erkrankung” darstellt. In vorliegender Übersicht werden wichtige Schritte zur Abklärung eines Inzidentaloms dargestellt.

Methodik

Grundlagen für das hier empfohlene Vorgehen bilden Erfahrungen an mehr als 250 eigenen “zufällig” entdeckten Nebennierentumoren. Die Beachtung des klinischen Bildes, eine exakte physikalische Untersuchung, die kritische Interpretation bildgebender Verfahren, biochemischer Untersuchungen und der Nebennierenszintigraphie erlauben mit hoher Wahrscheinlichkeit eine Voraussage der Art des diagnostizierten Tumors.

Ergebnisse

Unter den analysierten Nebenniereninzidentalomen fanden sich 38% gutartige Adenome, 22% Nebennierenmetastasen, 2,6% Myelolipome und Lipome, 1,7% Nebennierenkarzinome und nur 1% Phäochromozytome. Bei zumindest 5% aller Inzidentalome liegt subklinisch ein Cushing-Syndrom vor. Die Sensitivität bzw. Spezifität der NP-59-Nebennierenszintigraphie liegt bei 74% bzw. 100%.

Schlußfolgerungen

In der Mehrzahl der Fälle ermöglicht eine sorgfältige Abklärung dem endokrinen Chirurgen die Entscheidung zur Operation oder Beobachtung eines Nebenniereninzidentaloms.

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Authors and Affiliations

  1. Department of Surgery, Division of Endocrine Surgery, University of Michigan, Medical Center, Ann Arbor, Michigan, USA

    M. K. McLeod

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McLeod, M.K. Adrenal incidentaloma. Acta Chir Austriaca 25, 202–209 (1993). https://doi.org/10.1007/BF02602104

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