Adrenal Incidentaloma

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup, and clinical symptoms and signs are required in every case. Adrenocortical carcinoma remains a real concern but is restricted to <2% of all cases. Functional adrenal incidentaloma lesions are commoner (but still probably <10% of total) and the greatest challenge remains the diagnosis and optimum management of autonomous cortisol secretion. Modern-day surgery has improved outcomes and novel radiological and urinary biomarkers will improve early detection and patient stratification in future years to come.

Graphical Abstract

Related collections

Most cited references 352

Record: found
Abstract: found
Article: not found

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

John Funder, Robert Carey, Franco Mantero … (2016)

To develop clinical practice guidelines for the management of patients with primary aldosteronism.

0 comments Cited 919 times – based on 0 reviews      Review now

Record: found
Abstract: not found
Article: not found

Wnt signaling and cancer.

Paul Polakis (2000)

0 comments Cited 513 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.

Gian Paolo Rossi, Giampaolo Bernini, Chiara Caliumi … (2006)

We prospectively investigated the prevalence of curable forms of primary aldosteronism (PA) in newly diagnosed hypertensive patients. The prevalence of curable forms of PA is currently unknown, although retrospective data suggest that it is not as low as commonly perceived. Consecutive hypertensive patients referred to 14 hypertension centers underwent a diagnostic protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio >40 at baseline, and/or >30 after captopril, and/or a probability of PA (by a logistic discriminant function) > or =50% underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical scintigraphy to identify the underlying adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in patients who in addition to excess autonomous aldosterone secretion showed: 1) lateralized aldosterone secretion at AVS or adrenocortical scintigraphy, 2) adenoma at surgery and pathology, and 3) a blood pressure decrease after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism (IHA). A total of 1,180 patients (age 46 +/- 12 years) were enrolled; a conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) had an APA and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at centers where AVS was available (p = 0.002); the opposite occurred where AVS was unavailable. In newly diagnosed hypertensive patients referred to hypertension centers, the prevalence of APA is high (4.8%). The availability of AVS is essential for an accurate identification of the adrenocortical pathologies underlying PA.

0 comments Cited 353 times – based on 0 reviews      Review now

All references

Author and article information

Journal

Journal ID (nlm-ta): Endocr Rev

Journal ID (iso-abbrev): Endocr. Rev

Journal ID (publisher-id): edrv

Title: Endocrine Reviews

Publisher: Oxford University Press (US )

ISSN (Print): 0163-769X

ISSN (Electronic): 1945-7189

Publication date Collection: December 2020

Publication date (Electronic): 08 April 2020

Publication date PMC-release: 08 April 2020

Volume: 41

Issue: 6

Electronic Location Identifier: bnaa008

Affiliations

[1 ] Department of Endocrinology, Beaumont Hospital , Dublin, Ireland

[2 ] Royal College of Surgeons in Ireland , Dublin, Ireland

[3 ] Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James University Hospital , Leeds, UK

[4 ] Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James University Hospital , Leeds, UK

[5 ] Department of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, St James University Hospital , Leeds, UK

[6 ] Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way , Leeds, UK

Author notes

Correspondence and Reprint Requests: Professor Paul M Stewart, University of Leeds, Room 9.14, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK. E-mail: p.m.stewart@ 123456leeds.ac.uk

Author information

Mark Sherlock http://orcid.org/0000-0003-4078-624X

Afroze Abbas http://orcid.org/0000-0003-2497-6887

Rosemary Dineen http://orcid.org/0000-0001-9740-7621

Paul M Stewart http://orcid.org/0000-0002-1749-9640

Article

Publisher ID: bnaa008

DOI: 10.1210/endrev/bnaa008

PMC ID: 7431180

PubMed ID: 32266384

SO-VID: 5aa1b9bd-f34d-41a7-b71d-9b4854c4a8a4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 August 2019

Date accepted : 06 April 2020

Date: 17 August 2020

Page count

Pages: 46

Comments

Comment on this article

Cited by 120

See all cited by

Most referenced authors 4,860

See all reference authors