Management of the clinically inapparent adrenal mass ("incidentaloma")
Abstract
The National Institutes of Health Consensus Development Program convened surgeons, endocrinologists, pathologists, biostatisticians, radiologists, oncologists, and other health care professionals, as well as members of the general public, to address the causes, prevalence, and natural history of clinically inapparent adrenal masses, or "incidentalomas"; the appropriate evaluation and treatment of such masses; and directions for future research. Improvements in abdominal imaging techniques have increased detection of adrenal incidentalomas, and because the prevalence of these masses increases with age, appropriate management of adrenal tumors will be a growing challenge in our aging society. To address six predetermined questions, the 12-member nonfederal, nonadvocate state-of-the-science panel heard presentations from 21 experts in adrenal incidentalomas and consulted a systematic review of medical literature on the topic provided by the Agency for Healthcare Research and Quality and an extensive bibliography developed by the National Library of Medicine. The panel recommended a 1-mg dexamethasone suppression test and measurement of plasma-free metanephrines for all patients with an adrenal incidentaloma; additional measurement of serum potassium and plasma aldosterone concentration-plasma renin activity ratio for patients with hypertension; and surgery for patients with biochemical evidence of pheochromocytoma, patients with tumors greater than 6 cm, and patients with tumors greater than 4 cm who also meet other criteria. The panel also advocated a multidisciplinary approach to managing adrenal incidentalomas. The statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the federal government.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
P-cortisol >138 nmol/L following DST has been suggested for diagnosis of ACS by the National Institute of Health.
“P-cortisol >138 nmol/L following DST has been suggested for diagnosis of ACS by the National Institute of Health (21).”
From The diagnostic value of salivary cortisol and salivary cortisone in patients with suspected hypercortisolism (2022) · cites this paper as [21]
There is no international consensus on how ACS in patients with adrenal incidentalomas should be diagnosed, and different recommendations have been provided.
“Currently, there is no international consensus on how ACS in patients with adrenal incidentalomas should be diagnosed, and different recommendations have been provided (1–5, 21–23).”
From The diagnostic value of salivary cortisol and salivary cortisone in patients with suspected hypercortisolism (2022) · cites this paper as [21]
In patients with adrenal incidentalomas, cortisol secretion forms a continuum from normal to clearly increased and varies greatly within the same person.
“particularly in AI patients, cortisol secretion is a continuum from completely normal to clearly increased levels, and it is highly variable in the same individual (3,22).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [3]
The reliability of nearly all markers of hypothalamic-pituitary-adrenal axis activity, especially ACTH and 24-hour urinary free cortisol, is low.
“the reliability of almost all markers of HPA axis activity, particularly ACTH and 24-h urinary free cortisol (UFC), is low (3,14,23)”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [3]
The risk of transformation was reported to be low in patients with adrenal adenomas smaller than 3 cm.
“Although this risk was reported to be low in patients with adrenal adenomas smaller than 3 cm (3)”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [3]
Difficulties in defining a follow-up protocol relate to the variability of cortisol secretion, because even a 2-year follow-up may be too short to ascertain subclinical hypercortisolism.
“The difficulties in defining a protocol are related to the variability of cortisol secretion in these patients (3,22) because even a 2-yr follow-up may be too short to ascertain the presence of SH (79).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [3]
Cited by
Sorted by citations
Welch, H. G., & Black, W. C. (2010) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djq099 · Cited by 1,601 · see citing works
“small pulmonary nodules (40) and adrenal lesions (41,42) incidentally detected on CT.”
BackgroundFassnacht, M., Arlt, W., Bancos, I., Dralle, H., Newell-Price, J., Sahdev, A., Tabarin, A., Terzolo, M., Tsagarakis, S., & Dekkers, O. M. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0467 · Cited by 1,566 · see citing works
The Incidentally Discovered Adrenal Mass
Young, W. F. (2007) · New England Journal of Medicine · doi:10.1056/nejmcp065470 · Cited by 1,090 · see citing works
Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee
Berland, L. L., Silverman, S. G., Gore, R. M., Mayo-Smith, W. W., Megibow, A. J., Yee, J., Brink, J. A., Baker, M. E., Federle, M. P., Foley, W. D., et al. (2010) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2010.06.013 · Cited by 869 · see citing works
The clinically inapparent adrenal mass: update in diagnosis and management
Mansmann, G., Lau, J., Balk, E., Rothberg, M., Miyachi, Y., & Bornstein, S. R. (2004) · Endocrine Reviews · doi:10.1210/er.2002-0031 · Cited by 781 · see citing works
“To provide a standard, the NIH Stateof-Science Conference panel recommended the 1-mg dexamethasone suppression test in all patients with incidentally detected adrenal masses (19).”
BackgroundMethodInfluentialFaßnacht, M., Tsagarakis, S., Terzolo, M., Tabarin, A., Sahdev, A., Newell-Price, J. D. C., Pelsma, I. C. M., Marina, L., Lorenz, K., Bancos, I., et al. (2023) · European Journal of Endocrinology · doi:10.1093/ejendo/lvad066 · Cited by 849 · see citing works
Adrenocortical Carcinoma: Clinical Update
Allolio, B., & Fassnacht, M. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2639 · Cited by 775 · see citing works
Integrated genomic characterization of adrenocortical carcinoma
Assié, G., Letouzé, E., Fassnacht, M., Jouinot, A., Luscap, W., Barreau, O., Omeiri, H., Rodriguez, S., Perlemoine, K., René-Corail, F., et al. (2014) · Nature Genetics · doi:10.1038/ng.2953 · Cited by 732 · see citing works
Prevalence of adrenal incidentaloma in a contemporary computerized tomography series
Bovio, S., Cataldi, A., Reimondo, G., Sperone, P., Novello, S., Berruti, A., Borasio, P., Fava, C., Dogliotti, L., Scagliotti, G. V., et al. (2006) · Journal of Endocrinological Investigation · doi:10.1007/bf03344099 · Cited by 712 · see citing works
Prevalence and natural history of adrenal incidentalomas
Barzon, L., Sonino, N., Fallo, F., Palu, G., & Boscaro, M. (2003) · European Journal of Endocrinology · doi:10.1530/eje.0.1490273 · Cited by 642 · see citing works
Song, J. H., Chaudhry, F. S., & Mayo-Smith, W. W. (2008) · American Journal of Roentgenology · doi:10.2214/ajr.07.2799 · Cited by 579 · see citing works
AME Position Statement on adrenal incidentaloma
Terzolo, M., Stigliano, A., Chiodini, I., Loli, P., Furlani, L., Arnaldi, G., Reimondo, G., Pia, A., Toscano, V., Zini, M., et al. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-1147 · Cited by 519 · see citing works
“Screening for pheochromocytoma should be done also in normotensive patients and even if the imaging characteristics of the tumor are not suggestive for a catecholamine-producing tumor (6, 14, 17).”
InfluentialZeiger, M. A., Thompson, G. B., Duh, Q.-Y., Hamrahian, A. H., Angelos, P., Elaraj, D., Fishman, E., Kharlip, J., Zeiger, M. A., Thompson, G. B., et al. (2009) · Endocrine Practice · doi:10.4158/ep.15.s1.1 · Cited by 499 · see citing works
“Suppression of the plasma cortisol level to 1.8 m g/dL has the best negative predictive value for Cushing syndrome (5 [EL 4]) .”
InfluentialUrine steroid metabolomics as a biomarker tool for detecting malignancy in adrenal tumors
Arlt, W., Biehl, M., Taylor, A. E., Hahner, S., Libé, R., Hughes, B. A., Schneider, P., Smith, D. J., Stiekema, H., Krone, N., et al. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1565 · Cited by 458 · see citing works
“The risk of malignancy increases with the diameter of the adrenal mass (1, 2, 8).”
BackgroundMethodInfluentialBertherat, J. Y., Horvath, A., Groussin, L., Grabar, S., Boikos, S. A., Cazabat, L., Libé, R., René-Corail, F., Stergiopoulos, S. G., Bourdeau, I., et al. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2333 · Cited by 448 · see citing works
Self-citationConstitutive activation of PKA catalytic subunit in adrenal Cushing’s syndrome
Beuschlein, F., Fassnacht, M., Assié, G., Calebiro, D., Stratakis, C. A., Osswald, A., Ronchi, C. L., Wieland, T., Sbiera, S., Faucz, F. R., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1310359 · Cited by 443 · see citing works
“Adrenal adenomas are common, with a prevalence of at least 3% among persons older than 50 years of age.(3) Whereas only a subset of these tumors is associated with overt Cushing’s syndrome, some degree of cortisol excess is present, depending on the diagnostic criteria applied,(4) in up to 47% of patients with adrenal…”
BackgroundAdrenocortical carcinoma: a clinician’s update
Fassnacht, M., Libé, R., Kroiss, M., & Allolio, B. (2011) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2010.235 · Cited by 396 · see citing works
“(2) In patients with R2 resection, consider re-surgery by an expert surgeon or see”
BackgroundAmar, L., Servais, A., Gimenez‐Roqueplo, A., Zinzindohoué, F., Châtellier, G., & Plouin, P. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1398 · Cited by 389 · see citing works
“Presymptomatic diagnosis is possible in patients with phenotypic evidence or family history of a genetic disease that is associated with PHEO/PGL (1–4) and in patients with incidentally discovered adrenal masses, the so-called incidentalomas (10).”
Backgroundde Reyniès, A., Assié, G., Rickman, D. S., Tissier, F., Groussin, L., René-Corail, F., Dousset, B., Bertagna, X., Clauser, E., & Bertherat, J. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.18.5678 · Cited by 382 · see citing works
Clinical management of adrenocortical carcinoma
Fassnacht, M., & Allolio, B. (2009) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2008.10.008 · Cited by 349 · see citing works
Current Approaches and Recommended Algorithm for the Diagnostic Localization of Pheochromocytoma
Ilias, Ι., & Pacák, K. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031091 · Cited by 331 · see citing works
“Adrenal masses are present in about 5–9% of the general population (21, 22, 116, 117).”
BackgroundSherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works
Cawood, T. J., Hunt, P. J., O'Shea, D., Cole, D., & Soule, S. (2009) · European Journal of Endocrinology · doi:10.1530/eje-09-0234 · Cited by 300 · see citing works
Approach to the patient with an adrenal incidentaloma
Nieman, L. K. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-0457 · Cited by 290 · see citing works
Brix, D., Allolio, B., Fenske, W., Agha, A., Dralle, H., Jurowich, C., Langer, P., Mussack, T., Nies, C., Riedmiller, H., et al. (2010) · European Urology · doi:10.1016/j.eururo.2010.06.024 · Cited by 286 · see citing works
“For example, hormonally inactive incidentally discovered adrenal masses with evidence of growth during follow-up are currently often removed [28].”
BackgroundDiagnosis and Treatment of Subclinical Hypercortisolism
Chiodini, I. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2722 · Cited by 279 · see citing works
“nomas smaller than 3 cm (3), two studies suggested that in”
BackgroundInfluentialAdrenocortical cancer: pathophysiology and clinical management
Libé, R., Fratticci, A., & Bertherat, J. Y. (2007) · Endocrine Related Cancer · doi:10.1677/erc.1.01130 · Cited by 271 · see citing works
“By contrast, adrenocortical cancer (ACC) is rare, with an estimated prevalence between 4 and 12 per million in Endocrine-Related Cancer (2007) 14 13–28 1351–0088/07/014–013 q 2007 Society for Endocrinology Printed in Great adults (Grumbach et al. 2003).”
BackgroundInfluentialHamrahian, A. H., Ioachimescu, A. G., Remer, E. M., Motta-Ramírez, G. A., Bogabathina, H., Levin, H. S., Reddy, S. S. K., Gill, I. S., SIPERSTEIN, A. E., & Bravo, E. L. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1627 · Cited by 264 · see citing works
“The prognosis of PAC is greatly improved by early diagnosis and surgical resection of the adrenal mass (30, 55, 56).”
BackgroundInfluentialThe optimal imaging of adrenal tumours: a comparison of different methods
Ilias, Ι., Sahdev, A., Reznek, R. H., Grossman, A. B., & Pacák, K. (2007) · Endocrine Related Cancer · doi:10.1677/erc-07-0045 · Cited by 266 · see citing works
Extra-Intestinal Manifestations of Familial Adenomatous Polyposis
Groen, E. J., Roos, A., Muntinghe, F. L. H., Enting, R. H., de Vries, J., Kleibeuker, J. H., Witjes, M. J. H., Links, T. P., & van Beek, A. P. (2008) · Annals of Surgical Oncology · doi:10.1245/s10434-008-9981-3 · Cited by 259 · see citing works
“For lesions between 4 and 6 cm, with benign characteristics on imaging, that do not appear to overproduce hormones, both close followup and adrenalectomy are considered a reasonable approach.(81)”
BackgroundThe Laboratory Diagnosis of Adrenal Pheochromocytoma: The Mayo Clinic Experience
Kudva, Y. C., Sawka, A. M., & Young, W. F. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030720 · Cited by 255 · see citing works
Toniato, A., Merante-Boschin, I., Opocher, G., Pelizzo, M. R., Schiavi, F., & Ballotta, E. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e31819a47d2 · Cited by 245 · see citing works
High Diagnostic and Prognostic Value of Steroidogenic Factor-1 Expression in Adrenal Tumors
Sbiera, S., Schmull, S., Assié, G., Voelker, H.-U., Kraus, L., Beyer, M., Ragazzon, B., Beuschlein, F., Willenberg, H. S., Hahner, S., et al. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-0653 · Cited by 241 · see citing works
Gaujoux, S., Mihai, R., Carnaille, B. M. L., Dousset, B. E., Fiori, C., Porpiglia, F., Hellman, P., Iacobone, M., Kraimps, J. L., Donatini, G., et al. (2017) · British journal of surgery · doi:10.1002/bjs.10414 · Cited by 224 · see citing works
Groussin, L., Bonardel, G., Silvéra, S., Tissier, F., Coste, J., Abiven, G., Libé, R., Bienvenu, M., Alberini, J.-L., Salenave, S., et al. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2302 · Cited by 215 · see citing works
“The second CT scan parameter used to predict malignancy is the tumor size (2).”
BackgroundMethodInfluentialGiovanni Lughezzani, A., Sun, M., Perrotte, P., Claudio Jeldres, A., Alasker, A., Hendrik Isbarn, A., Budäus, L., Shariat, S. F., Guazzoni, G. F., Montorsi, F., et al. (2010) · European Journal of Cancer · doi:10.1016/j.ejca.2009.12.007 · Cited by 214 · see citing works
“In clinical practice, the existing evaluation and management criteria do not require treatment or work-up for adrenal masses less than 5 cm, unless such masses are associated with symptoms or have high intensity signal in T2 MRI imaging.(31,32) Several other limitations of our study warrant mention.”
BackgroundPheochromocytoma: Current Approaches and Future Directions
Adler, J. T., Meyer-Rochow, G. Y., Chen, H., Benn, D. E., Robinson, B. G., Sippel, R. S., & Sidhu, S. B. (2008) · The Oncologist · doi:10.1634/theoncologist.2008-0043 · Cited by 196 · see citing works
Espiard, S., Drougat, L., Libé, R., Assié, G., Perlemoine, K., Guignat, L., Barrande, G., Brucker-Davis, F., Doullay, F., Lopez, S., et al. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-4204 · Cited by 196 · see citing works
“007 Total weight, g 81 [0–331] 107 [53–187] 50 [23–166] .”
InfluentialSturgeon, C., Shen, W. T., Clark, O. H., Duh, Q.-Y., & Kebebew, E. (2006) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2005.11.005 · Cited by 194 · see citing works
Chiodini, I., Morelli, V., Salcuni, A. S., Eller-Vainicher, C., Torlontano, M., Coletti, F., Iorio, L., Cuttitta, A., Ambrosio, A., Vicentini, L., et al. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2387 · Cited by 191 · see citing works
Brunaud, L., Bresler, L., Ayav, A., et al. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.04.016 · Cited by 187 · see citing works
Subclinical Cushing’s syndrome in adrenal incidentalomas
Terzolo, M., Bovio, S., Reimondo, G., Pia, A., Osella, G., Borretta, G., & Angeli, A. (2005) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2005.01.008 · Cited by 179 · see citing works
“The traditional threshold of 5 lg/dL (138 nmol/L) was recommended in the NIH consensus statement [ 2 ]; however, some experts proposed using lower cut points to increase the detection of subclinical hypercortisolism [55].”
BackgroundMethodInfluentialHorvath, A., Bertherat, J. Y., Groussin, L., Guillaud-Bataille, M., Tsang, K., Cazabat, L., Libé, R., Remmers, E. F., René-Corail, F., Faucz, F. R., et al. (2010) · Human Mutation · doi:10.1002/humu.21178 · Cited by 175 · see citing works
Self-citationDevelopment of adrenal cortex zonation
Xing, Y., Lerario, A. M., Rainey, W., & Hammer, G. D. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2015.02.001 · Cited by 174 · see citing works
“Adrenocortical tumors (ACTs) are common neoplasms, especially in older adults, in whom the prevalence can reach up to 6%of the population.(163) Unlike the hyperplasias,”
Stratakis, C. A. (2008) · KARGER eBooks · doi:10.1159/000134829 · Cited by 158 · see citing works
Lattin, G. E., Sturgill, E. D., Tujo, C. A., Marko, J., Sanchez-Maldonado, K. W., Craig, W. D., & Lack, E. E. (2014) · Radiographics · doi:10.1148/rg.343130127 · Cited by 157 · see citing works
Biopsy of pheochromocytomas and paragangliomas: Potential for disaster
Vanderveen, K. A., Thompson, S. M., Callstrom, M. R., Young, W. F., Grant, C. S., Farley, D. R., Richards, M. L., & Thompson, G. B. (2009) · Surgery · doi:10.1016/j.surg.2009.09.013 · Cited by 148 · see citing works
Bancos, I., Tamhane, S., Shah, M., Delivanis, D. A., Alahdab, F., Arlt, W., Fassnacht, M., & Murad, M. H. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0297 · Cited by 144 · see citing works
Adrenal tumors: How to establish malignancy?
Faßnacht, M., Kenn, W., & Allolio, B. (2004) · Journal of Endocrinological Investigation · doi:10.1007/bf03351068 · Cited by 141 · see citing works
Hennings, J., Lindhe, Ö., Bergström, M., Långström, B., Sundin, A., & Hellman, P. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2273 · Cited by 140 · see citing works
“Pheochromocytoma 6 (6) 4.8 3.5 Metastasis 2 ( 3 ) 5.7 0.6 Normal adrenald 13 (19) 6.6 5.0 12.5 5.9 1.00c 0.12c”
InfluentialWolf, S. M. (2013) · Annual Review of Genomics and Human Genetics · doi:10.1146/annurev-genom-091212-153506 · Cited by 138 · see citing works
“Indeed, the term “incidentaloma” is defined in medical dictionaries as an occult adrenal tumor that is accidentally discovered (32, 66).”
BackgroundMedical and Surgical Evaluation and Treatment of Adrenal Incidentalomas
Zeiger, M. A., Siegelman, S. S., & Hamrahian, A. H. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0085 · Cited by 134 · see citing works
“The National Institutes of Health consensus statement included recommendations for limited follow-up only for nonfunctional adenomas of less than 3 cm with no specific recommendations (20).”
BackgroundMethodInfluentialAdrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?
Leboulleux, S., Deandreis, D., Al Ghuzlan, A., Aupérin, A., Goéré, D., Dromain, C., Elias, D., Caillou, B., Travagli, J. P., De Baere, T., et al. (2010) · European Journal of Endocrinology · doi:10.1530/eje-09-1096 · Cited by 133 · see citing works
Exploration and management of adrenal incidentalomas.
Tabarin, A., Bardet, S., Bertherat, J. Y., Dupas, B., Chabre, O., Hamoir, E., Laurent, F., Tenenbaum, F., Cazalda, M., Lefèbvre, H., et al. (2008) · Annales d Endocrinologie · doi:10.1016/j.ando.2008.09.003 · Cited by 129 · see citing works
Pheochromocytoma: an update on genetics and management
Karagiannis, A. I., Mikhailidis, D. P., Athyros, V. G., & Harsoulis, F. (2007) · Endocrine Related Cancer · doi:10.1677/erc-07-0142 · Cited by 130 · see citing works
“Adrenal masses are present in about 5–9% of the general population (Angeli & Terzolo 2002, Grumbach et al. 2003, Thompson & Young 2003).”
Stratakis, C. A., & Boikos, S. A. (2007) · Nature Clinical Practice Endocrinology & Metabolism · doi:10.1038/ncpendmet0648 · Cited by 129 · see citing works
“These two disorders were only briefly mentioned in the most recent discussion of the clinical management of incidentally discovered adrenal masses (incidentalomas), published in 2003”
BackgroundNunes, M.-L., Vattaut, S., Corcuff, J.-B., Rault, A., Loiseau, H., Gatta, B., Valli, N., Letenneur, L., & Tabarin, A. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1542 · Cited by 129 · see citing works
Subclinical Cushing’s syndrome: definition and management
Terzolo, M., Pia, A., & Reimondo, G. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04253.x · Cited by 129 · see citing works
Biochemical Diagnosis and Localization of Pheochromocytoma
Grossman, A. B., Pacák, K., Sawka, A. M., Lenders, J. W. M., HARLANDER, D., Peaston, R., Reznek, R. H., Sisson, J. C., & Eisenhofer, G. (2006) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1353.038 · Cited by 127 · see citing works
Adrenal incidentaloma—follow-up results from a Swedish prospective study.
Bülow, B., Jansson, S., Juhlin, C., Steen, L., Thorén, M., Wahrenberg, H., Valdemarsson, S., Wängberg, B., Ahréen, B., & _, _. (2006) · European Journal of Endocrinology · doi:10.1530/eje.1.02110 · Cited by 124 · see citing works
“Recent investigations have shown that plasma free metanephrines can be measured with high diagnostic accuracy and it has therefore been suggested that this test may replace or complement the measurement of urine catecholamines for the diagnosis of phaeochromocytoma in patients with incidentaloma (18, 21 ).”
BackgroundInfluentialWnt/β-catenin signalling in adrenal physiology and tumour development
Berthon, A., Martinez, A., Bertherat, J., & Val, P. (2012) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2011.09.009 · Cited by 125 · see citing works
Rechache, N. S., Wang, Y., Stevenson, H. S., Killian, J. K., Edelman, D. C., Merino, M. J., Zhang, L., Nilubol, N., Stratakis, C. A., Meltzer, P. S., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3298 · Cited by 123 · see citing works
Quayle, F. J., Spitler, J. A., Pierce, R. A., et al. (2007) · Surgery · doi:10.1016/j.surg.2007.07.013 · Cited by 121 · see citing works
Differential Diagnosis and Imaging in Cushing's Syndrome
Lindsay, J. R., & Nieman, L. K. (2005) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2005.01.009 · Cited by 116 · see citing works
“Features suggestive of a benign adenoma include tumor size less than 4 cm, attenuation values of \ 10 Hounsfield units on unenhanced CT, homogeneity, and regular tumor margins [77].”
BackgroundCushing's Syndrome and Fetal Features Resurgence in Adrenal Cortex–Specific Prkar1a Knockout Mice
Sahut‐Barnola, I., de Joussineau, C., Val, P., Lambert-Langlais, S., Damon‐Soubeyrand, C., Lefrançois‐Martinez, A., Pointud, J., Marceau, G., Sapin, V., Tissier, F., et al. (2010) · PLoS Genetics · doi:10.1371/journal.pgen.1000980 · Cited by 118 · see citing works
“Most adrenocortical tumours and Cushing’s syndrome are more frequent in females than in males [52].”
BackgroundManagement of adrenal incidentaloma
Terzolo, M., Bovio, S., Pia, A., Reimondo, G., & Angeli, A. (2009) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2009.04.001 · Cited by 113 · see citing works
Arnaldi, G., & Boscaro, M. (2012) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2011.12.006 · Cited by 117 · see citing works
Munk, M.-D., Peitzman, A. B., Hostler, D. P., et al. (2008) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2008.01.021 · Cited by 115 · see citing works
Matyakhina, L., Freedman, R. J., Bourdeau, I., Wei, M.-H., Stergiopoulos, S. G., Chidakel, A. R., Walther, M. M., Abu-Asab, M. S., Tsokos, M., Keil, M. F., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-2377 · Cited by 114 · see citing works
Genetics and epigenetics of adrenocortical tumors
Lerário, A. M., Moraitis, A. G., & Hammer, G. D. (2013) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2013.10.028 · Cited by 112 · see citing works
Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications.
Tsagarakis, S., Vassiliadi, D., & Thalassinos, N. (2006) · Journal of Endocrinological Investigation · doi:10.1007/bf03344133 · Cited by 113 · see citing works
Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study
Vassilatou, E., Vryonidou, A., Michalopoulou, S., Manolis, J., Caratzas, J., Phenekos, C., & Tzavara, I. (2009) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2008.03492.x · Cited by 112 · see citing works
Adrenal Imaging: A Comprehensive Review
Taffel, M. T., Haji-Momenian, S., Nikolaidis, P., & Miller, F. H. (2012) · Radiologic Clinics of North America · doi:10.1016/j.rcl.2012.02.009 · Cited by 108 · see citing works
Contemporary Management of Adrenocortical Carcinoma
Laurent Zini, A., Porpiglia, F., & Faßnacht, M. (2011) · European Urology · doi:10.1016/j.eururo.2011.07.062 · Cited by 111 · see citing works
“In most large series, the median tumour size of ACCs at initial diagnosis is about 10–11 cm (range: 2–40 cm), whereas most benign adrenal tumours have a diameter <5 cm [21].”
New targets and therapeutic approaches for endocrine malignancies☆
Fassnacht, M., Kreissl, M. C., Weismann, D., & Allolio, B. (2009) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2009.03.013 · Cited by 104 · see citing works
EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies
Eloubeidi, M. A., Seewald, S., Tamhane, A. R., et al. (2004) · Gastrointestinal Endoscopy · doi:10.1016/s0016-5107(04)00296-2 · Cited by 103 · see citing works
“The decision for EUSFNA of the left adrenal should be individualized and based on potential clinical impact and indication, inasmuch as adrenal adenomas are relatively common in the general population and in patients with cancer.(26) In centers with EUS expertise, EUSFNA provides a minimally invasive alternative to ad…”
MethodDiagnostic value of urinary steroid profiling in the evaluation of adrenal tumors
Kerkhofs, T. M. A., Kerstens, M. N., Kema, I. P., Willems, T. P., & Haak, H. R. (2015) · Hormones and Cancer · doi:10.1007/s12672-015-0224-3 · Cited by 102 · see citing works
Giordano, R., Marinazzo, E., Berardelli, R., Picu, A., Maccario, M., Ghigo, E., & Arvat, E. (2010) · European Journal of Endocrinology · doi:10.1530/eje-09-0957 · Cited by 99 · see citing works
Outcomes of adrenal cortical carcinoma in the United States
Paton, B. L., Novitsky, Y. W., Zerey, M., Harrell, A. G., Norton, H. J., Asbun, H., Kercher, K. W., & Heniford, B. T. (2006) · Surgery · doi:10.1016/j.surg.2006.07.035 · Cited by 97 · see citing works
[123I]Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes
Hahner, S., Stuermer, A., Kreissl, M., Reiners, C., Fassnacht, M., Haenscheid, H., Beuschlein, F., Zink, M., Lang, K., Allolio, B., et al. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0050 · Cited by 95 · see citing works
Terzolo, M., Reimondo, G., Chiodini, I., Castello, R., Giordano, R., Ciccarelli, E., Limone, P., Crivellaro, C., Martinelli, I., Montini, M., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1323 · Cited by 89 · see citing works
Limited Value of Adrenal Biopsy in the Evaluation of Adrenal Neoplasm
Mazzaglia, P. J. (2009) · Archives of Surgery · doi:10.1001/archsurg.2009.59 · Cited by 94 · see citing works
“The traditional definition of incidentaloma excludes patients undergoing imaging procedures as part of staging and workup for cancer, as well as those in whom the diagnosis of a symptomatic adrenal-dependent syndrome was missed because of insufficient suspicion or investigation.(1,2) The incidence of adrenal incidenta…”
BackgroundMethodInfluentialIchijo, T., Ueshiba, H., Nawata, H., & Yanase, T. (2019) · Endocrine Journal · doi:10.1507/endocrj.ej18-0486 · Cited by 92 · see citing works
Adrenocortical Development, Maintenance, and Disease
Yates, R., Katugampola, H., Cavlan, D., Cogger, K., Meimaridou, E., Hughes, C. R., Metherell, L., Guasti, L., & King, P. (2013) · Current topics in developmental biology/Current Topics in Developmental Biology · doi:10.1016/b978-0-12-416021-7.00007-9 · Cited by 92 · see citing works
Yanase, T., Oki, Y., Katabami, T., Otsuki, M., Kageyama, K., Tanaka, T., Kawate, H., Tanabe, M., Doi, M., Akehi, Y., et al. (2018) · Endocrine Journal · doi:10.1507/endocrj.ej17-0456 · Cited by 90 · see citing works
“The cutoff a 4 cm is also recommended for the indication of adrenalectomy in several guidelines of adrenal incidentaloma [13-15, 43, 44].”
BackgroundTerzolo, M., Bovio, S., Pia, A., Conton, P. A., Reimondo, G., Dall’Asta, C., Bemporad, D., Angeli, A., Opocher, G., Mannelli, M., et al. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.01959 · Cited by 89 · see citing works
“The 1 mg dexamethasone suppression test has been extensively employed to detect subclinical hypercortisolism in patients with adrenal incidentaloma (13) and it has been recommended at the recent National Institutes of Health consensus conference as the screening test with the classic threshold of 5mg/dl (138 nmol/l) (…”
BackgroundInfluentialFleseriu, M., & Castinetti, F. (2016) · Pituitary · doi:10.1007/s11102-016-0742-1 · Cited by 87 · see citing works
“Some guidelines recommend adrenalectomy, particularly for patients with worsening comorbidities, while others advocate for careful monitoring of the patient [6, 66, 67].”
BackgroundSurgical management of adrenal metastases
Sancho, J., Triponez, F., Montet, X., & Sitges‐Serra, A. (2011) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-011-0889-1 · Cited by 89 · see citing works
Bernini, G. P., Moretti, A., Oriandini, C., Bardini, M., Taurino, C., & Salvetti, A. (2005) · British Journal of Cancer · doi:10.1038/sj.bjc.6602459 · Cited by 87 · see citing works
“…size have been reported in adrenal incidentalomas (Bastounis et al, 1997; Barry et al, 1998; Terzolo et al, 1998; Barzon et al, 1999; Siren et al, 2000; Libe et al, 2002; Grumbach et al, 2003), with such variations sometimes believed to reflect a more aggressive growth rate (Mansmann et al, 2004).”
BackgroundCushing Syndrome: Maybe Not So Uncommon of an Endocrine Disease
Guaraldi, F., & Salvatori, R. (2012) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2012.02.110227 · Cited by 86 · see citing works
“Recent literature obtained from a small series of patients points to the potential utility of unilateral adrenalectomy, even in bilateral macronodular hyperplasia, in reducing urinary cortisol, blood pressure, and weight.(16,39,40) Transsphenoidal adenomectomy (TSA) is the initial treatment of choice for most patients…”
BackgroundAndrogen-secreting adrenal tumors
Cordera, F., Grant, C. S., van Heerden, J., Thompson, G. B., & Young, W. F. (2003) · Surgery · doi:10.1016/s0039-6060(03)00410-0 · Cited by 85 · see citing works
Pheochromocytoma as a catecholamine producing tumor: Implications for clinical practice
Zelinka, T., Eisenhofer, G., & Pacák, K. (2007) · Stress · doi:10.1080/10253890701395896 · Cited by 83 · see citing works
“The prevalence of adrenal incidentalomas increases with age and may reach 7% in subjects more than 70 years old (Grumbach et al. 2003).”
Background“Subclinical Cushing’s syndrome” is not subclinical: improvement after adrenalectomy in 9 patients
Mitchell, I. C., Auchus, R. J., Juneja, K., Chang, A. Y., Holt, S. A., Snyder, W. H., & Nwariaku, F. E. (2007) · Surgery · doi:10.1016/j.surg.2007.10.001 · Cited by 84 · see citing works
Ansquer, C., Scigliano, S., Mirallié, É., Taïeb, D., Brunaud, L., Sebag, F. A., Leux, C., Drui, D., Dupas, B., Renaudin, K., et al. (2010) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-010-1471-8 · Cited by 83 · see citing works
“As recommended in the literature [1, 2], CE included systematically recording medical history, physical examination, hormonal tests and CT with a measurement of the unenhanced attenuation value of the adrenal lesion [24].”
BackgroundMethodWilliams, A. R., Hammer, G. D., & Else, T. (2014) · European Journal of Endocrinology · doi:10.1530/eje-13-1033 · Cited by 82 · see citing works
Albiger, N. M., Ceccato, F., Zilio, M., Barbot, M., Occhi, G., Rizzati, S., Fassina, A., Mantero, F., Boscaro, M., Iacobone, M., et al. (2015) · Clinical Endocrinology · doi:10.1111/cen.12763 · Cited by 83 · see citing works
Genetics of tumors of the adrenal cortex
Bonnet-Serrano, F., & Bertherat, J. (2018) · Endocrine Related Cancer · doi:10.1530/erc-17-0361 · Cited by 80 · see citing works
Subclinical Cushing's syndrome.
Terzolo, M., Reimondo, G., Bovio, S., & Angeli, A. (2004) · Pituitary · doi:10.1007/s11102-005-4024-6 · Cited by 80 · see citing works
The Evaluation of Incidentally Discovered Adrenal Masses
Vaidya, A., Hamrahian, A. H., Bancos, I., Fleseriu, M., & Ghayee, H. K. (2019) · Endocrine Practice · doi:10.4158/dscr-2018-0565 · Cited by 78 · see citing works
Adrenal incidentaloma: a diagnostic challenge
Anagnostis, P. G., Karagiannis, A. I., Τζιόμαλος, Κ., Kakafika, A. I., Athyros, V. G., & Mikhailidis, D. P. (2009) · HORMONES · doi:10.14310/horm.2002.1233 · Cited by 79 · see citing works
“The latter term refers to radiological images that seem to be of adrenal origin but in fact derive from adjacent structures, such as kidney, spleen, pancreas, stomach and lymph nodes.(1,3-6) Occasionally, mixed adrenal tumors occurring in the same patient have been described, either as a hormonal-hypersecretory mass c…”
BackgroundInfluential
- Authors
- Grumbach, M. M., Biller, B. M. K., Braunstein, G. D., Campbell, K. K., Carney, J. A., Godley, P. A., Harris, E. L., Lee, J. K. T., Oertel, Y. C., Posner, M. C., Schlechte, J. A., & Wieand, H. S.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Grumbach, Melvin M.
- ORCID
- Schlechte, Janet A.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2003-03-04
- Volume
- 138
- Issue
- 5
- Pages
- 424-429
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2148626383
- Cited by
- 945
- References
- 0
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 21 · 2023: 26 · 2022: 25 · 2021: 44 · 2020: 40 · 2019: 31 · 2018: 35 · 2017: 45 · 2016: 39 · 2015: 55 · 2014: 58 · 2013: 48 · 2012: 54
- FWCI
- 33.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- adrenal incidentaloma, adrenal tumors, dexamethasone suppression test, plasma free metanephrines, aldosterone, renin-aldosterone system, hypertension, pheochromocytoma, surgical management, tumor size, multidisciplinary management, natural history (disease)
- MeSH terms
- Adrenal Gland Neoplasms, Biopsy, Needle, Diagnostic Imaging, Humans, Pheochromocytoma, Prevalence, Clinical Chemistry Tests
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
