Adrenal Incidentaloma

Kebebew, Electron M.D.

From the Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.

Caren G. Solomon, M.D., M.P.H., Editor

Address reprint requests to Dr. Kebebew at the Division of General Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr., H3642, Stanford, CA 94305-2200, or at [email protected].

No potential conflict of interest relevant to this article was reported.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

I thank Ms. Rebecca Gaw (Stanford University) for her help with drafting and organizing an earlier version of the manuscript, Dr. Ryan L. Brunsing (Department of Radiology, Stanford University) for the analysis of the imaging features, and Drs. André Lacroix (Centre Hospitalier de l'Université de Montréal) and Quan-yang Duh (University of California, San Francisco) for their helpful comments on the initial draft of the manuscript.

New England Journal of Medicine 384(16):p 1542-1551, April 22, 2021. | DOI: 10.1056/NEJMcp2031112

KEY CLINICAL POINTS

ADRENAL INCIDENTALOMA

All patients with an adrenal mass that is discovered during diagnostic testing for another condition (an “incidentaloma”) should undergo biochemical testing to detect pheochromocytoma and excess cortisol secretion, and those who also have high blood pressure should undergo biochemical testing to detect primary hyperaldosteronism.
Patients with pheochromocytoma should undergo adrenalectomy after adequate presurgical alpha-blockade and beta-blockade, if necessary.
Patients with mild autonomous cortisol excess and primary hyperaldosteronism may benefit from adrenalectomy, but treatment should be individualized.
Nonfunctioning adrenal tumors that have an attenuation of 10 Hounsfield units or less on computed tomographic (CT) evaluation and that are smaller than 4 cm in greatest diameter generally do not warrant intervention or long-term follow-up.
All other adrenal incidentalomas with indeterminate features on imaging may warrant additional imaging with contrast-enhanced CT, magnetic resonance imaging with chemical-shift analysis, positron-emission tomography–CT with ¹⁸F-fluorodeoxyglucose, or all of these tests. The management of these masses should be individualized and should involve a multidisciplinary team consisting of an endocrinologist, an endocrine surgeon, and a radiologist.