<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Objectives</bold>. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI).<bold>Method</bold>. An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented.<bold>Results</bold>. The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis.<bold>Conclusion</bold>. Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.</abstract>

Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI).Method. An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented.Results. The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis.Conclusion. Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Department of Pediatric Surgery, Attikon University Hospital

Romanian Journal of Internal Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI).Method. An extensive review of the literature was conducted,...

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Published Online: Nov 15, 2017

Page range: 188 - 197

Received: May 03, 2017

DOI: https://doi.org/10.1515/rjim-2017-0025

Keywords
Adrenal incidentaloma, Epinephroma, Diagnosis, Radiology, Treatment, ESE guidelines

© 2017 Frederick-Anthony Farrugia et al., published by De Gruyter Open

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Published Online: Nov 15, 2017

Page range: 188 - 197

Received: May 03, 2017

DOI: https://doi.org/10.1515/rjim-2017-0025

KeywordsAdrenal incidentaloma, Epinephroma, Diagnosis, Radiology, Treatment, ESE guidelines

© 2017 Frederick-Anthony Farrugia et al., published by De Gruyter Open

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
Adrenal incidentaloma, Epinephroma, Diagnosis, Radiology, Treatment, ESE guidelines