Adrenal incidentalomas – is the present management rational?

Česká verzia

Authors: I. Lazúrová
Authors place of work: I. interná klinika Lekárske fakulty UPJŠ a FN L. Pasteura Košice, Slovenská republika, prednostka prof. MU Dr. Ivica Lazúrová, CSc.
Published in the journal: Vnitř Lék 2010; 56(9): 961-966
Category: 60th Birthday - Andrej Dukat MD, Csc., FESC

Summary

Adrenal incidentalomas, i.e. clinically inapparent adrenal mass, are considered to be one of the most frequent tumours in human pathology. They more frequently occur in women, older age, patients with metabolic syndrome and in patients with malignant diseases. The first step in the management is exclusion of hormonal activity and differentiation of malignant and benign lesions. At present, there is no consensus with respect to differential diagnosis and treatment of adrenal incidentalomas since the development of hormonal hyperfunction and a risk of malignancy are negligible. The most frequent cause of hyperfunction is subclinical hypercortisolism, the clinical significance of which is also questionable. Recently, it has been shown that the existing recommendations lack rationality and, in addition, increase risk of falsely positive hormonal investigations. Repeated CT scans subject the patients to ionising radiation and may carry the same or even higher risk of cancer than the risk of malignant transformation of adrenal incidentaloma. This is why it is important to develop recommendations for screening and subsequent ‘follow‑up’ that will be rational, safe for the patient and reliable.

Key words:
adrenal incidentalomas – management – primary hyperaldosteronism – pheochromocytoma – subclinical hypercortisolism

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