Abstract
Incidentally discovered adrenal masses are common and most of these are nonfunctional and benign. However, when faced with an adrenal mass it is paramount to determine if it represents a hyperfunctional tumor, a primary tumor of the adrenal gland (adrenal cortical carcinoma), or a metastatic deposit from other primary tumor. Biochemical workup focuses in ruling out a cortisol-producing adenoma with a 1 mg dexamethasone suppression test; a pheochromocytoma with plasma or 24-hour urine metanephrines and an aldosteronoma—if patient is hypertensive—with plasma aldosterone and renin ratio. Dedicated adrenal computer tomography is the imaging of choice to evaluate adrenal masses. Malignant adrenal tumor is typically >6 cm, heterogeneous with irregular boarders, and have increased noncontrast attenuation (>10 Hounsfield units) and slower washout. Thorough patient past medical history will elicit prior history of cancer and if present, adrenal mass will likely represent a metastatic deposit. Adrenal biopsy is reserved only for patients evaluated for metastatic disease if the results will alter treatment plan and pheochromocytoma must be excluded prior to biopsy.
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