Adrenal Incidentaloma

This female patient of 55 years had CT chest for chronic respiratory issues.  She is detected with bilateral pulmonary fibrosis of some extent.  In that CT,  radiologist picked up right supra renal mass... Adrenal incidentaloma. 

Attaching her recently done CT abdomen... 
What are the chances of benign / malignant? 
Any relationship with size/enhancement for benign /malignant?
Pulse,  blood pressure normal. 
Routine lab reports normal 
How to proceed further?

Adrenal Incidentaloma Adrenal Incidentaloma View Document


  • Dr. Isteaq Shameem
    Dr. Isteaq Shameem
    06 Feb 2020 09:22:23 PM

    Thank you Dr Anil

    Is hounsfield unit known?
    Risk of malignancy in Incidentaloma is 25% in adrenal lesion larger than 6cm,6% malignant in size 4-6 cm
    Surgical resection may be considered in appropriate individual
    Dr Shameem

  • Dr. Anil Takvani
    Dr. Anil Takvani
    07 Feb 2020 08:08:34 AM

    Thanks Prof.  Shammem. 

    I am attaching two more images and concluded report received from radiologist....thanks 

  • Nitesh Jain
    Nitesh Jain
    07 Feb 2020 09:45:21 AM

    Two main concern in case of adrenal Incidentlona is 1. Functional 2. Malignancy

    Functional evaluation needs to be tailored based on symptomatology 

    HTN specially episodic or accelerated - 24 hours Urine meta and nor-meta nephreines

    HTN + Hypokalemia + periodic paralysis - Aldosterone:renin ratio

    Cushnogoid features + HTN + DM - overnight 1mg dexamerhasone rest

    If none than less than 4 cm can be observed and kept under follow up 

    Larger than 6 cm if non functional can be malignant but can be benign or functional malignant tumor 

    The characteristic on imaging like enhancement , irregular border and shape , infiltration to surrounding structure can give a clue and suggest malignancy

    This if possible needs to be respected if non respectable needs biopsy

    Adrenal are common sites for metastasis if any past history of malignancy than needs a PET scan and +\- biopsy

    In this case mass looks enhancing, large  and resectable  , will do a functional study and will offer her removal of the same ... will prefer it laparoscopy 

  • Venugopal P
    Venugopal P
    07 Feb 2020 10:39:25 AM

    Dear All,

    I am happy that this subject has initiated some discussion.

    The rapid development and widespread application of modern imaging technologies has led to an increase in the diagnosed number of clinically silent adrenal masses. There are many guidelines available on the diagnosis and management of Adrenal Incidentalomas. Among the many, two recent guidelines are worth reading and understanding. M Fassnacht et al (2016) introduced the ESMO Clinical Practice Guidelines but I found the Korean Society Guideline by Jung-Min Lee, Young Kee Shong et al (2017) more useful and better scripted. I am providing the latter for our reading and understanding.

    I am providing a PDF on ‘Adrenal Incidentalomas Workup Algorithm and CT and MRI findings’.

    Recent studies have found a high incidence of Metastasis in Adrenals from malignancies at various sites.  The adrenal gland is a common site for metastasis of some malignancies because of its rich sinusoidal blood supply. S Cingam et al (2017) reported that Adrenal Glands are the fourth most common site of metastases in malignant diseases. It has been reported that approximately 50–75% of clinically imperceptible adrenal masses of cancer patients were metastases. Hence when discussing on Adrenal Incidentalomas, this aspect cannot be ignored. Lei Tan, Zike Qin* et al (2019) has addressed this aspect well in their article.

    I hope these informations will enhance our knowledge appreciably.

    With warm regards,



    View Document

  • Dr. Anil Takvani
    Dr. Anil Takvani
    11 Feb 2020 08:03:04 AM

    Laboratory investigation related to functionality of this adrenal  incidentaloma: within normal level. 


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