What specialist evaluates adrenal adenoma?

From the Guidelines

An endocrinologist is the primary specialist who evaluates and manages adrenal adenomas, often in collaboration with other specialists such as surgeons, radiologists, and urologists, as recommended in the 2023 guideline endorsed by the AUA 1. When an adrenal adenoma is discovered, typically as an incidental finding on imaging, the initial work-up should include a focused history and physical examination aimed at identifying signs/symptoms of adrenal hormone excess, adrenal malignancy, and/or extra-adrenal malignancy, as outlined in the guideline 1. The evaluation process involves:

• A comprehensive hormonal evaluation to determine if the adenoma is functioning or non-functioning
• Tests for cortisol excess (Cushing's syndrome), aldosterone excess (primary aldosteronism), and catecholamine excess (pheochromocytoma)
• Specialized imaging such as CT or MRI scans
• Sometimes additional tests like adrenal vein sampling The endocrinologist plays a crucial role in determining the appropriate treatment plan based on the adenoma's hormonal activity and size, and may recommend adrenalectomy for patients with unilateral cortisol-secreting adrenal masses, aldosterone-secreting adrenal masses, or pheochromocytomas, as suggested in the guideline 1. Key considerations in the management of adrenal adenomas include:
• The size of the adenoma, with larger adenomas (>4 cm) requiring closer monitoring or consideration for surgical removal
• The presence of hormonal excess, which may necessitate medical or surgical intervention
• The patient's overall health and presence of comorbidities, which can influence treatment decisions By prioritizing a multidisciplinary approach and adhering to the recommendations outlined in the 2023 guideline 1, patients with adrenal adenomas can receive optimal care and management.

From the Research

Specialist Evaluation of Adrenal Adenoma

The evaluation of adrenal adenoma typically involves a multidisciplinary approach, including:

• Endocrinologists: to assess hormone excess and functional status of the adrenal mass 2, 3
• Radiologists: to evaluate the characteristics of the adrenal mass using imaging techniques such as CT and MRI 2, 3, 4
• Surgeons: to consider surgical treatment options for patients with adrenal adenoma, particularly those with suspected malignancy or hormone excess 2, 3
• Nuclear medicine specialists: to interpret the results of nuclear medicine scans, such as 18F-FDG PET/CT, to assess the metabolic activity of the adrenal mass 5
• Other specialists: such as oncologists, may be involved in the evaluation and management of patients with adrenal adenoma, particularly those with suspected malignancy or extra-adrenal disease 4, 6

Key Considerations in Specialist Evaluation

Some key considerations in the specialist evaluation of adrenal adenoma include:

• Assessing the risk of malignancy using imaging characteristics and biochemical markers 2, 3, 4
• Evaluating hormone excess using biochemical tests, such as the 1mg overnight dexamethasone suppression test 2, 3, 4
• Considering surgical treatment options for patients with suspected malignancy or hormone excess 2, 3
• Monitoring patients with adrenal adenoma for potential complications, such as cortisol-related comorbidities 2, 3