From the Guidelines
A prominent right adrenal gland should be evaluated with a focused history and physical examination, followed by a non-contrast CT scan as first-line imaging to distinguish benign lesions from those requiring further investigation, as recommended by the most recent guidelines 1. The initial step in managing a prominent right adrenal gland is to assess for signs or symptoms of adrenal hormone excess, adrenal malignancy, or extra-adrenal malignancy.
- A low threshold for multidisciplinary review by endocrinologists, surgeons, and radiologists is advised when the imaging is not consistent with a benign lesion, there is evidence of hormone hypersecretion, the tumor has grown significantly during follow-up imaging, or adrenal surgery is being considered 1.
- Patients with an indeterminate incidental adrenal mass should undergo a non-contrast CT as first-line imaging, and if the mass remains indeterminate, second-line imaging with either washout CT or chemical-shift MRI should be performed 1.
- Adrenal mass biopsy should not be performed routinely for the work-up of an adrenal incidentaloma, and all patients with adrenal incidentalomas should be screened for autonomous cortisol secretion using 1 mg dexamethasone suppression testing when clinically appropriate 1.
- Further hormonal evaluation, including tests for excess aldosterone and catecholamines, should be guided by clinical presentation and imaging characteristics.
- The management of adrenal incidentalomas should be individualized, taking into account the size of the lesion, imaging characteristics, hormonal function, and patient preferences, with shared decision-making between patients and their clinicians 1.
From the Research
Prominent RT Adrenal Gland
- The right adrenal gland is one of the two adrenal glands located on top of each kidney, playing a crucial role in producing hormones that regulate various bodily functions 2, 3.
- Adrenal incidentalomas, which are masses found on the adrenal glands incidentally during imaging tests, can be found on either the left or right side, with 15 out of 35 cases found on the right side in one study 2.
- The size of adrenal masses can vary, with most being between 1 and 4 cm in diameter, and the right adrenal gland is no exception 2.
- Imaging techniques such as CT and MRI are used to evaluate adrenal masses, including those on the right adrenal gland, to determine their nature and potential for malignancy or hormonal activity 2, 3, 4, 5.
- Fine-needle aspiration (FNA) cytology can be used to diagnose adrenal lesions, including those on the right adrenal gland, with image guidance and rapid on-site evaluation (ROSE) playing important roles in the procedure 4, 5.
- The evaluation and management of bilateral adrenal masses, which can include the right adrenal gland, require a comprehensive approach that takes into account the patient's clinical history, physical examination, dynamic hormone evaluation, and imaging modalities 6.