American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress
Adrenal incidentalomas are increasing in prevalence and continue to
climb due to advancements of cross-sectional imaging, according to Geoffrey
B. Thompson, MD, FACS, FACE.
“The root cause of this increase is our excellent, cross-sectional
imaging modalities that are picking up these lesions,” Thompson, who is a
professor of surgery at the Mayo Clinic, said today at the American Academy of
Clinical Endocrinologists 17th Annual Meeting & Clinical
Congress.
Potential morbidities and possible mortalities associated with the
excessive numbers of adrenalectomies, paired with an endless number of possible tests may leave physicians in a
quandary.
When deciding whether or not to remove functioning adrenocortical and
medullary nodules, Thompson highlighted the importance of obtaining history and
a physical exam to probe for signs and symptoms that would suggest primary
aldosteronism, pheochromocytoma, clinical or sublicincal Cushing’s
syndrome or virilizing/feminizing syndromes.
“We need to identify the basic screening tests for function. We
need to make it simple so that we as endocrine surgeons can do it and our
primary care colleagues can do it as well,” he said.
Adrenal tumors with suspicious radiographic phenotype, which Thompson
classified as an often overlooked criteria in the decision making process, should
be considered for adrenalectomy.
Controversy concerning the maximal tumor diameter in relation
to the risk for underlying primary adrenocortical malignancies makes decision
making more difficult. A general consensus stated that adrenal incidentalomas
greater than 6 cm in diameter have about a 25% risk of being an adrenocortical
carcinoma, while those between 4 cm and 6 cm have a 6% risk and those under 4
cm have about a 2% risk, according to Thompson.
“One cannot differentiate an adrenal cortical carcinoma from
adenoma by performing a biopsy on an adrenal mass,” he said.
Like those for tumor diameter, few guidelines exist concerning
follow-up; however, Thompson suggests healthcare professionals consider
practicality, cost-effectiveness and absolute necessity when deciding to remove
an adrenal incidentaloma.
“In an ideal world, one would like to perform radiographic
follow-up at three, six, 12 and 24 months, and functional follow-up yearly for four years,” said Thompson. – by
Stacey L. Adams
For more information:
- Zeiger MA, Carty SE, McHenry CR, Thompson GB. Updates and controversies
in the surgical management of well-differentiated thyroid cancer, primary
hyperparathyroidism, and adrenal neoplasms. Presented at: the American
Association of Clinical Endocrinologists 17th Annual Meeting &
Clinical Congress; May 14-18, 2008; Orlando, Fla.
