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level: Ch5: Adrenal Incidenatloma

Questions and Answers List

level questions: Ch5: Adrenal Incidenatloma

QuestionAnswer
What is an adrenal incidentaloma?Adrenal mass >1cm radio discovered by chance, it is increasingly seen due to advances in radio techniques , occurs for 10% of elderly, diabetics, obese and hypertensive patients It is essential to discover whether it is malignant or benign, secreting or non-secreting
What are the imaging criteria of adrenal masses?Size --> if >4cm in favor of malignancy CT scan --> Spontaneous density if >10UH then sus of malignancy, density with contrast high >37 at 30 min then malignancy, washout if <50% after 10 min in favor of malignancy (else 100% adenoma) MRI -->Max contrast and low washout in malignancy PET --> maybe FDG or MTO useful in case of sus
Why do we use fine needle cytology?It is not very recommended, used to distinguish between adrenal carcinoma and metastasis (not carcinoma and adenoma) Rule out pheochromocytoma before this procedure.
How to distinguish secreting vs. non-secreting adrenal masses?Majority are non-secreting (90%), we distinguish by seeing Subclinical Cushing's, pheochromocytoma (increased catecholamines), and hyperaldosteronism (but not usually seen only with HTN or hypokalemia)
How is subclinical Cushing's seen?5-6% It is the most frequently seen condition of secretory mass, asymptomatic often, sometimes HTN, dyslipidemia, diabetes, weight gain... Dx: minute brake test with dexamethasone 1mg, rule out pheochromo before it to not have catecholaminergic crisis. Low DHEAs -->Chronic ACTH suppression
How is pheochromocytoma seen?3% spontaneous density >10UH, may be normal biology if <1.5 cm
What are aldosteronomas?<1% of incidentalomas, look for arterial HTN, and spontaneous hypokalemia.
What is the treatment course of action in case of incidentalomas?Surgery done for secreting ones (pheo, hyperaldo, auto cushings (if young pt or comorbidities), sus cirteria masses (>4cm size)) Myelolipomas (xray followup for pruning, if >6cm operate) Bilateral masses (Macronodular hyperplasia, bilateral adrenalectomy if clinical, unilateral if subclinical guided by catheterization)) Surgery may be laparoscopic if mass <10cm, or open if >10cm
How is the follow up of incidentaloma tx?benign (repeat imaging after 1 year - resect if size >4cm or size increased >1cm between two imagings) For subclinical cushing's annual screening for 4 years