The value of adrenal imaging in adrenal surgery

Abstract

Clinically inapparent adrenal masses (incidentaloma, adrenaloma) are discovered inadvertently during abdominal imaging for several clinical conditions not related to adrenal disease.By definition, the term incidentaloma excludes patients undergoing localization for suspected hormonal excess or those undergoing a staging work-up for previously diagnosed cancer [26]. When detected, these adrenal tumors raise challenging questions for physicians and patients. Not all incidentalomas are of clinical importance and therefore candidates for treatment.After a careful clinical, biochemical and radiological evaluation patients need to be selected for surgery. The indication for surgical treatment and the type of surgical approach depend on hormonal activity,tumor size,localization and suspected malignancy. Independent of their size, functioning or subclinically autonomous adrenal tumors are candidates for surgery,while non-functioning tumors are not (Fig.1). According to the literature the indication for the surgical treatment of non-functioning adrenal lesions depends on their size and indirect signs of malignancy. Non-functioning tumors smaller than 30 mm are usually followed up. In instances of radiologically documented growth they become candidates for operation. Non-functioning tumors between 30 and 50 mm present a relative indication for surgery, since malignancy rarely occurs.The patient's age,co-morbidities and the patient's concern influence therapy. Non-functioning tumors larger than 50 mm need a total histological work-up since malignancy increases dramatically with size.