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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.
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In the citing paper
“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]
In the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
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Sorted by citations
Welch, H. G., & Black, W. C. (2010) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djq099 · Cited by 1,627
“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
The Incidentally Discovered Adrenal Mass
Young, W. F. (2007) · New England Journal of Medicine · doi:10.1056/nejmcp065470 · Cited by 1,090
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
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
“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).”
BackgroundMethodInfluential
Metadata
- 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
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