Urgent considerations
See Differentials for more details
Malignancy
Exclusion of malignancy is the major concern when an incidental adrenal mass is diagnosed. Clinical history and mass size are important considerations. In patients without prior history of cancer, 66% of adrenal incidentalomas are benign tumors; in patients with a history of cancer, 75% are metastatic lesions. Adrenocortical carcinoma accounts for 2% of tumors ≤4 cm, 6% of tumors 4.1 cm to 6 cm, and 25% of tumors >6 cm.[1] In patients with a history of extra-adrenal cancer, differentiation between adrenal metastasis versus benign adrenal mass is paramount in clinical management.
Endocrine function
Up to 20% of patients with an incidental adrenal mass have some form of subclinical hormonal dysfunction and may represent a population at higher risk for metabolic disorders and cardiovascular disease. Biochemical evaluation is warranted to assess for Cushing syndrome, pheochromocytoma, and primary aldosteronism.[21]
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