What to do about the incidentally found adrenal mass

Summary

The wider use of abdominal computerized axial tomography (CT) has led to the incidental discovery of increasing numbers of asymptomatic adrenal masses. The significance of these masses and the question as to their management have posed a new and important dilemma in clinical medicine. The majority of asymptomatic masses are benign and nonfunctional. The size of an adrenal mass on CT is still the most helpful finding in its evaluation. We propose that metabolically inactive lesions <3.5 cm in diameter on CT be followed with serial scans at 2, 6, and 18 months. After hormonal assessment, surgery should be carried out on lesions >6 cm, because there is a high probability for malignancy. For tumors 3.0–6.0 cm in diameter, management should be individualized. Under certain circumstances, especially in older and poor-risk patients, a conservative approach with more frequently obtained CT scans (6-week intervals) may be recommended. At the present time, magnetic resonance imaging (MRI) techniques cannot reliably distinguish benign from malignant adrenal masses and should be considered investigational in this setting, pending results of larger studies to determine its true sensitivity and specificity.