Management of endocrine disease: differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas
Abstract
The investigation and management of unilateral adrenal incidentalomas have been extensively considered in the last decades. While bilateral adrenal incidentalomas represent about 15% of adrenal incidentalomas (AIs), they have been less frequently discussed. The differential diagnosis of bilateral incidentalomas includes metastasis, primary bilateral macronodular adrenal hyperplasia and bilateral cortical adenomas. Less frequent etiologies are bilateral pheochromocytomas, congenital adrenal hyperplasia (CAH), Cushing's disease or ectopic ACTH secretion with secondary bilateral adrenal hyperplasia, primary malignancies, myelolipomas, infections or hemorrhage. The investigation of bilateral incidentalomas includes the same hormonal evaluation to exclude excess hormone secretion as recommended in unilateral AI, but diagnosis of CAH and adrenal insufficiency should also be excluded. This review is focused on the differential diagnosis, investigation and treatment of bilateral AIs.
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Bilateral adrenalectomy is recommended for bilateral pheochromocytomas; risk of adrenal insufficiency and side effects of lifelong glucocorticoid replacement have led to certain centers performing adrenal cortex sparing resections in genetic syndromes such as VHL and MEN2A where risk of malignant tumors is low.
“Bilateral adrenalectomy is recommended for bilateral pheochromocytomas; however, the risk of adrenal insufficiency and the side effects of life long glucocorticoid replacement have led to certain centers performing adrenal cortex sparing resections particularly in the setting of genetic syndromes such as VHL and MEN2A where the risk of malignant tumors is low (325).”
From Adrenal incidentaloma (2020) · cites this paper as [325]
On unenhanced CT, both adrenal glands in PBMAH are enlarged usually with multiple nodules, but diffuse enlargement without nodules is also seen.
“On unenhanced CT, both adrenal glands are enlarged usually with multiple nodules but diffuse enlargement without nodules is also seen (325).”
From Adrenal incidentaloma (2020) · cites this paper as [325]
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References 80 · Cited by 98
- Authors
- Bourdeau, I., El Ghorayeb, N., Gagnon, N., & Lacroix, A.
- Affiliations
- Centre Hospitalier de l’Université de Montréal (CA)
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-08
- Volume
- 179
- Issue
- 2
- Pages
- R57-R67
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2800343861
- Cited by
- 98
- References
- 80
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 9 · 2023: 11 · 2022: 13 · 2021: 21 · 2020: 13 · 2019: 9 · 2018: 1
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- differential diagnosis, adrenal metastasis, macronodular adrenal hyperplasia, bilateral pheochromocytoma, congenital adrenal hyperplasia, Cushing's disease, ectopic ACTH secretion, adrenal insufficiency, hormonal evaluation
- MeSH terms
- ACTH Syndrome, Ectopic, Adrenal Cortex Hormones, Adrenal Gland Neoplasms, Adrenal Glands, Adrenal Hyperplasia, Congenital, Combined Modality Therapy, Diagnosis, Differential, Humans, Pheochromocytoma, Practice Guidelines as Topic, Tumor Burden, Pituitary ACTH Hypersecretion
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