From the Guidelines
A CT finding of adrenal adenoma typically does not require further action if it is small (less than 4 cm), has benign imaging characteristics (low density on unenhanced CT with less than 10 Hounsfield units), and is found incidentally in a patient without symptoms or history of cancer, as stated in the recent guideline by 1. When an adrenal adenoma is identified, the initial step should involve a focused history and physical examination to identify signs or symptoms of adrenal hormone excess, adrenal malignancy, or extra-adrenal malignancy, as recommended by 1. Key considerations for further actions include:
- The size of the adenoma: Adenomas less than 4 cm with benign characteristics may not require further follow-up imaging or functional testing, according to 1.
- Imaging characteristics: A non-contrast CT is recommended as the first-line imaging to distinguish benign lesions from those requiring further investigation, as suggested by 1.
- Presence of symptoms or history of cancer: Patients with symptoms of hormone excess or a history of malignancy may require further evaluation, including hormonal testing and possibly surgical consultation, as indicated by 1.
- Hormonal testing: Screening for autonomous cortisol secretion and primary aldosteronism may be necessary, depending on the patient's clinical presentation, as recommended by 1. It is crucial to approach each case individually, considering the patient's overall clinical context and the specific characteristics of the adrenal adenoma, and to involve a multidisciplinary team when necessary, as advised by 1.
From the Research
CT Findings of Adrenal Adenoma
A CT finding of adrenal adenoma may require further actions to determine the functional capacity of the tumor.
- The study 2 found that adenomas from Cushing's syndrome, nonhyperfunctioning adenomas, and some of the aldosterone-producing adenomas had moderate to high expression of CYP17, which is an enzyme involved in steroidogenesis.
- Another study 3 described the imaging findings of adrenocortical adenoma and compared the sensitivities of different imaging modalities for adenoma characterization.
- The study 4 discussed the diagnostic approach, typical and atypical imaging features of adrenal adenomas, as well as other lesions that mimic adrenal adenomas.
Further Actions
Further actions may include:
- Hormonal studies to evaluate the functional capacity of the tumor, as seen in the study 5 where hormonal studies revealed unequivocal evidence of primary aldosteronism and subclinical hypercortisolemia of adrenal origin.
- Imaging parameters such as mass diameters and attenuation values on CT scans, which can predict subclinical cortisol hypersecretion in patients with adrenal adenomas, as shown in the study 6.
- A CT predictive score, which can differentiate secreting from nonsecreting adenomas with a diagnostic accuracy of 84.9%, as described in the study 6.
Considerations
Considerations for further actions include:
- The clinical manifestations associated with hyperaldosteronism and hypercortisolemia, which can masquerade the hyperandrogenic findings, as seen in the study 5.
- The possibility of coexisting hyperfunctioning adrenal and ovarian lesions, which can affect the clinical manifestations and treatment outcomes, as described in the study 5.