What type of doctor diagnoses an adrenal gland spot?

Which Doctor Diagnoses an Adrenal Gland Spot

An adrenal gland spot (incidentaloma) requires multidisciplinary evaluation, but the initial diagnosis and workup is typically coordinated by an endocrinologist, with radiologists providing imaging interpretation and surgeons (urologists or endocrine surgeons) involved when surgical intervention is indicated. 1, 2

Initial Detection and Referral

• Radiologists are often the first to identify an adrenal mass on cross-sectional imaging (CT, MRI, or ultrasound) performed for unrelated reasons 1
• Once detected, the patient should be referred to an endocrinologist for comprehensive hormonal evaluation and initial management 3
• The primary care physician or referring specialist typically initiates this referral after the radiologist reports the finding 1

Multidisciplinary Team Composition

There should be a low threshold for multidisciplinary review involving endocrinologists, surgeons, and radiologists when:

• Imaging is not consistent with a benign lesion 1, 2
• Evidence of hormone hypersecretion exists 1, 3
• The tumor has grown significantly during follow-up (>5 mm/year) 1, 4
• Adrenal surgery is being considered 1, 3

Role of Each Specialist

Endocrinologist (Primary Coordinator)

• Completes comprehensive hormonal evaluation including 1 mg dexamethasone suppression testing for cortisol excess, aldosterone-to-renin ratio for primary aldosteronism, and plasma/urinary metanephrines for pheochromocytoma 2, 3
• Provides preoperative medical optimization for specific functional tumors, such as alpha-blockade for pheochromocytoma 3
• Coordinates postoperative hormone replacement when needed 3

Radiologist

• Performs and interprets non-contrast CT as the first-line imaging study to measure Hounsfield Units (HU) 2, 4
• Determines if second-line imaging with washout CT or chemical shift MRI is needed for indeterminate masses (>10 HU) 1, 2
• Provides ongoing imaging surveillance for non-surgical masses 4

Surgeon (Urologist or Endocrine Surgeon)

• Evaluates surgical candidacy when masses are >5 cm, demonstrate growth >5 mm/year, or show hormonal hypersecretion 1, 3
• Performs minimally invasive adrenalectomy when feasible for functioning adenomas and suspected malignancies 1, 3
• Manages surgical complications and coordinates with endocrinology for postoperative care 3

Critical Pitfall to Avoid

Never proceed with biopsy or surgery before definitively excluding pheochromocytoma, as failure to screen for catecholamine excess can be fatal. 3, 4 All patients with adrenal masses >10 HU on non-contrast CT or any symptoms of adrenergic excess (headaches, palpitations, sweating) require pheochromocytoma screening with plasma or 24-hour urinary metanephrines before any intervention 2, 3

Practical Algorithm for Referral

• Step 1: Radiologist identifies adrenal mass ≥1 cm on imaging 1
• Step 2: Referring physician sends patient to endocrinologist for hormonal workup 2, 3
• Step 3: Endocrinologist orders appropriate biochemical tests and coordinates with radiology for imaging characterization 2, 4
• Step 4: If surgery indicated, endocrinologist refers to urologist or endocrine surgeon 3
• Step 5: Multidisciplinary team meeting occurs for complex cases 1, 4