Which specialist typically sees an adrenal lesion?

Which Specialist Manages Adrenal Lesions

Adrenal lesions require multidisciplinary management involving endocrinologists, urologists, and radiologists, with the specific lead specialist determined by whether the lesion is functional, malignant, or requires surgical intervention. 1

Primary Specialists Involved

Endocrinologists

• Endocrinologists are essential for all adrenal incidentalomas to evaluate hormonal function, as every patient requires complete hormonal screening regardless of imaging appearance or symptoms 2
• They manage the workup for autonomous cortisol secretion (5.3% of cases), primary aldosteronism (1% of cases), and pheochromocytomas (5.1% of cases) 1
• Endocrinologists coordinate the initial hormonal evaluation including 1 mg overnight dexamethasone suppression test, plasma free metanephrines, and aldosterone-to-renin ratio when indicated 3, 4

Urologists (Surgical Management)

• Urologists perform surgical intervention when indicated, including for functional tumors, masses >4 cm with suspicious features, or lesions growing >5 mm/year 2
• They are part of the core multidisciplinary team that developed the 2023 CUA/AUA guidelines for adrenal mass management 1
• Surgical expertise is required for approximately 20% of adrenal incidentalomas that are potential surgical lesions 1

Radiologists

• Radiologists provide critical imaging characterization using unenhanced CT as the mandatory first-line modality 2
• They determine if lesions are benign (≤10 Hounsfield Units) or require further characterization with washout CT or chemical-shift MRI 3, 2
• Radiologists are integral to the multidisciplinary review process, particularly when imaging is indeterminate 1

When Multidisciplinary Review is Mandatory

A low threshold should exist for multidisciplinary discussion involving endocrinologists, surgeons, and radiologists in the following scenarios: 1

• Imaging not consistent with a benign lesion 1, 2
• Evidence of hormone hypersecretion 1, 2
• Tumor has grown significantly during follow-up (>5 mm/year) 1, 2
• Adrenal surgery is being considered 1
• Indeterminate imaging features requiring further characterization 3

Primary Care Role

• Primary care physicians typically discover these lesions incidentally on imaging performed for unrelated indications 5, 6
• They should initiate the referral process but are not equipped to manage the comprehensive hormonal and imaging workup alone 5
• The diagnostic and management complexity necessitates specialist involvement rather than primary care management 5

Common Pitfall to Avoid

Never attempt single-specialty management of adrenal lesions - the 2023 guidelines explicitly emphasize that these lesions require coordinated care between endocrinology, surgery, and radiology to optimize patient outcomes 1, 2