Diagnostic workup of adrenal masses

Abstract

With the increasing use of abdominal imaging, adrenal masses are more frequently detected. Depending on the clinical context, the detection of an adrenal mass has different consequences for downstream testing and therapy. As adrenal masses comprise various benign and malignant aetiologies, all lesions >1 cm need further diagnostic workup. Evaluation should address radiological features with respect to potential malignancy and endocrine activity of the lesion. The majority of adrenal masses are benign, functionally inactive adenomas that need no further therapy or follow-up. Nonetheless, functional adenomas, pheochromocytomas, metastases, adrenal cancer or others account for arelevant proportion of lesions. To determine an appropriate therapy, suspicious, malignant or hormonally active tumours should be discussed in an interdisciplinary tumour board. In case of surgery of alesion with concomitant hormonal excess, perioperative management needs to be guided by the specific requirements of this entity to avoid increased morbidity and mortality.