Protocolo diagnóstico de las masas adrenales

Abstract

Adrenal incidentaloma is a prevalent pathology; although being benign and non-functional in more than 75% of cases, it must be evaluated to rule out malignancy and functionality, that could increase the risk of mortality and morbidity. Non-contrast computed tomography (CT) is the imaging test of choice and, alternatively, magnetic resonance imaging (MRI). In patients with hypertension and/or hypokalemia hormonal evaluation includes suppression test with 1mg dexamethasone (DST), 24-hour urine fractionated metanephrines, and aldosterone/plasma renin activity ratio. Autonomous cortisol secretion (ACS) is excluded when cortisol values are equal to or less than 1.8μg/dl in DST and is confirmed with values greater than 5μg/l; intermediate levels require further study. The need for study and follow-up of certain groups of patients has to be carefully assessed, due to the high economic cost, risk of radiation-induced cancer and emotional impact.