Evaluation and Management of Adrenal Masses

Sergio Gugisch Moreira, Jr, MD, and Julio M. Pow-Sang, MD


Cancer Control. 2002;9(4) 

In This Article

Abstract and Introduction

Background: The widespread use of abdominal imaging has led to increased detection of adrenal tumors. The significance of these masses, as well as the optimal management approach to treatment, has generated some controversy regarding further evaluation and therapy.
Methods: The authors reviewed the literature regarding the evaluation and management of these masses, particularly adrenal incidentalomas. Based on their institutional experience, they propose a diagnostic, evaluation, and management algorithm for treating adrenal masses.
Results: Appearance and clinical history should indicate how to perform the biochemical evaluation, keeping in mind that the presence of pheochromocytomas must be ruled out. Radiological evaluation by CT or MRI provides useful parameters to identify malignant lesions. Surgery is indicated for masses that are larger than 5 cm in diameter or suspected of malignancy. Fine-needle aspiration biopsy should be used when other extra-adrenal malignancies are suspected and after pheochromocytoma has been ruled out.
Conclusions: Careful analysis of each adrenal mass is essential to effectively avoid potential problems. Guidelines to manage patients with adrenal masses are needed.

The presence and importance of the adrenal glands as well as their physiology were initially described more than 500 years ago. In the 1850s, Addison[1] and Brown-Séquard[2] proved the essential role of the adrenal glands in mineral and corticoid function.

The etiology of adrenal masses includes benign or malignant adrenal cortical tumors, adrenal medullary tumors, and other benign lesions. A review of reported series of incidentally found adrenal masses shows that adrenal cortical adenomas are 60 times more common than primary adrenal cortical carcinomas, that primary adrenal cortical carcinomas are rare, and that many of the malignant lesions are metastatic from extra-adrenal neoplasms.[3] The approaches to the different types of adrenal masses are discussed in this report. Special attention is given to adrenal incidentalomas since the increasing frequency in the diagnosis of this entity has become a common clinical problem.


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