Lec 7 endocrine

Lec: 7 Dr. Mohammed Alhamdany
Incidental adrenal mass
It is not uncommon for a mass in the adrenal gland to be identified on a CT or MRI scan of the abdomen that has been performed for another indication. Such lesions are known as adrenal ‘incidentalomas’. They are present in up to 10% of adults and the prevalence increases with age.
Eighty-five per cent of adrenal incidentalomas are non-functioning adrenal adenomas. The remainder includes functional tumours of the adrenal cortex (secreting cortisol, aldosterone or androgens), phaeochromocytomas, primary and secondary carcinomas.
There are two key questions to be resolved: is the lesion secreting hormones, and is it benign or malignant?
clinical signs and symptoms:
Including feature of excess glucocorticoids, mineralocorticoids, catecholamines, and, in women, androgens should be sought.
Investigations
Include a dexamethasone suppression test, urine or plasma metanephrines and, in virilised women, measurement of serum testosterone, DHEA. Patients with hypertension should be investigated for mineralocorticoid excess.
CT and MRI are equally effective in assessing the malignant potential of an adrenal mass, using the following parameters:
1- Size: The larger the lesion, the greater the malignant potential.
2- Configuration: Homogeneous and smooth lesions are more likely to be benign.
3- Presence of lipid: Adenomas are usually lipid-rich, resulting in an attenuation of below 10 Hounsfield Units (HU), so low density lesion tend to be benign.
4- Enhancement: malignant lesion tend to take more contrast (enhanced).
Management
Functional lesions and tumours of more than 4 cm in diameter should be considered for removal by adrenal surgery.