Adrenal incidentaloma imaging - the first steps in therapeutic management.

[adrenal incidentaloma]

The term "adrenal incidentaloma " refers to clinically unapparent adrenal mass detected during imaging examination performed for reasons other than the evaluation of adrenal glands . These tumors must be carefully examined in order to assess the indications for surgical treatment . The main method of finding evidence of potential malignancy in these lesions is computed tomography (CT ), before and after i .v . contrast media enhancement . Density of a malignant lesion is higher than 10 HU and the relative percentage washout is less than 40 % at 10 min . Other useful methods utilized in tumor assessment , include magnetic resonance imaging (MRI ), scintigraphy techniques (SPECT ) and PET . Basal hormonal investigations include urine and plasma catecholamines with their metabolites , plasma cortisol before and after dexamethasone administration , plasma renin activity and aldosterone level . Cases not suitable for surgery should be followed with repeat imaging techniques and hormonal testing at the recommended 6 , 12 , and 24 months . Surgery should be performed when tumor growth rate exceeds 0 ,8 cm per year .