This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mansmann, G. Articles by Bornstein, S. R. Search for Related Content PubMed PubMed Citation Articles by Mansmann, G. Articles by Bornstein, S. R.

The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management

Department of Endocrinology (G.M., S.R.B.), Heinrich-Heine-University, 40225 Düsseldorf, Germany; New England Medical Center (J.L., E.B.), Tufts University School of Medicine, Boston, Massachusetts 02111; Baystate Medical Center (M.R.), Springfield, Massachusetts 01107; and First Department of Medicine (Y.M.), Toho University School of Medicine, Tokyo 143-0015, Japan

Correspondence: Address all correspondence to: Georg Mansmann, M.D., Heinrich-Heine-University, Department of Endocrinology, Moorenstr. 5, D-40225 Düsseldorf, Germany. E-mail: mansmann{at}med.uni-duesseldorf.de

Clinically inapparent adrenal masses are incidentally detected after imaging studies conducted for reasons other than the evaluation of the adrenal glands. They have frequently been referred to as adrenal incidentalomas. In preparation for a National Institutes of Health State-of-the-Science Conference on this topic, extensive literature research, including Medline, BIOSIS, and Embase between 1966 and July 2002, as well as references of published metaanalyses and selected review articles identified more than 5400 citations. Based on 699 articles that were retrieved for further examination, we provide a comprehensive update of the diagnostic and therapeutic approaches focusing on endocrine and radiological features as well as surgical options. In addition, we present recent developments in the discovery of tumor markers, endocrine testing for subclinical disease including autonomous glucocorticoid hypersecretion and silent pheochromocytoma, novel imaging techniques, and minimally invasive surgery. Based on the statements of the conference, the available literature, and ongoing studies, our aim is to provide practical recommendations for the management of this common entity and to highlight areas for future studies and research.

This article has been cited by other articles:

				G. W. L. Boland, M. A. Blake, P. F. Hahn, and W. W. Mayo-Smith Incidental Adrenal Lesions: Principles, Techniques, and Algorithms for Imaging Characterization Radiology, December 1, 2008; 249(3): 756 - 775. [Abstract] [Full Text] [PDF]

				P K Singh and H N Buch Adrenal incidentaloma: evaluation and management J. Clin. Pathol., November 1, 2008; 61(11): 1168 - 1173. [Abstract] [Full Text] [PDF]

				S. Hahner, A. Stuermer, M. Kreissl, C. Reiners, M. Fassnacht, H. Haenscheid, F. Beuschlein, M. Zink, K. Lang, B. Allolio, et al. [123I]Iodometomidate for Molecular Imaging of Adrenocortical Cytochrome P450 Family 11B Enzymes J. Clin. Endocrinol. Metab., June 1, 2008; 93(6): 2358 - 2365. [Abstract] [Full Text] [PDF]

				J. H. Song, F. S. Chaudhry, and W. W. Mayo-Smith The Incidental Adrenal Mass on CT: Prevalence of Adrenal Disease in 1,049 Consecutive Adrenal Masses in Patients with No Known Malignancy Am. J. Roentgenol., May 1, 2008; 190(5): 1163 - 1168. [Abstract] [Full Text] [PDF]

				T. Else, T. J. Giordano, and G. D. Hammer Evaluation of Telomere Length Maintenance Mechanisms in Adrenocortical Carcinoma J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1442 - 1449. [Abstract] [Full Text] [PDF]

				A. L Rosas, A. A Kasperlik-Zaluska, L. Papierska, B. L. Bass, K. Pacak, and G. Eisenhofer Pheochromocytoma crisis induced by glucocorticoids: a report of four cases and review of the literature Eur. J. Endocrinol., March 1, 2008; 158(3): 423 - 429. [Abstract] [Full Text] [PDF]

				M. d'Herbomez, G. Forzy, C. Bauters, C. Tierny, P. Pigny, B. Carnaille, F. Pattou, J.-L. Wemeau, and N. Rouaix An analysis of the biochemical diagnosis of 66 pheochromocytomas Eur. J. Endocrinol., May 1, 2007; 156(5): 569 - 575. [Abstract] [Full Text] [PDF]

				W. F. Young Jr. The Incidentally Discovered Adrenal Mass N. Engl. J. Med., February 8, 2007; 356(6): 601 - 610. [Full Text] [PDF]

				D. Weismann, M. Fassnacht, B. Schubert, R. Bonfig, A. Tschammler, S. Timm, S. Hahner, C. Wunder, and B. Allolio A Dangerous Liaison--Pheochromocytoma in Patients with Malignant Disease Ann. Surg. Oncol., December 1, 2006; 13(12): 1696 - 1701. [Abstract] [Full Text] [PDF]

				B. Allolio and M. Fassnacht Adrenocortical Carcinoma: Clinical Update J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2027 - 2037. [Abstract] [Full Text] [PDF]

				J. Hennings, O. Lindhe, M. Bergstrom, B. Langstrom, A. Sundin, and P. Hellman [11C]Metomidate Positron Emission Tomography of Adrenocortical Tumors in Correlation with Histopathological Findings J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1410 - 1414. [Abstract] [Full Text] [PDF]

				B. Bulow, S. Jansson, C. Juhlin, L. Steen, M. Thoren, H. Wahrenberg, S. Valdemarsson, B. Wangberg, B. Ahreen, and on behalf of the Swedish Research Council Study Gr Adrenal incidentaloma - follow-up results from a Swedish prospective study. Eur. J. Endocrinol., March 1, 2006; 154(3): 419 - 423. [Abstract] [Full Text] [PDF]

				U. Metser, E. Miller, H. Lerman, G. Lievshitz, S. Avital, and E. Even-Sapir 18F-FDG PET/CT in the Evaluation of Adrenal Masses J. Nucl. Med., January 1, 2006; 47(1): 32 - 37. [Abstract] [Full Text] [PDF]

				R Nawar and D Aron Adrenal incidentalomas -- a continuing management dilemma Endocr. Relat. Cancer, September 1, 2005; 12(3): 585 - 598. [Abstract] [Full Text] [PDF]

				M. Terzolo, S. Bovio, A. Pia, P. A. Conton, G. Reimondo, C. Dall'Asta, D. Bemporad, A. Angeli, G. Opocher, M. Mannelli, et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma Eur. J. Endocrinol., August 1, 2005; 153(2): 307 - 315. [Abstract] [Full Text] [PDF]

				A. Thorin-Savoure, F. Tissier-Rible, L. Guignat, A. Pellerin, X. Bertagna, J. Bertherat, and H. Lefebvre Collision/Composite Tumors of the Adrenal Gland: A Pitfall of Scintigraphy Imaging and Hormone Assays in the Detection of Adrenal Metastasis J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4924 - 4929. [Abstract] [Full Text] [PDF]

				S. R. Bornstein and P. J. Hornsby What Can We Learn from Gene Expression Profiling for Adrenal Tumor Management? J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1900 - 1902. [Full Text] [PDF]

				F. de Fraipont, M. El Atifi, N. Cherradi, G. Le Moigne, G. Defaye, R. Houlgatte, J. Bertherat, X. Bertagna, P.-F. Plouin, E. Baudin, et al. Gene Expression Profiling of Human Adrenocortical Tumors Using Complementary Deoxyribonucleic Acid Microarrays Identifies Several Candidate Genes as Markers of Malignancy J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1819 - 1829. [Abstract] [Full Text] [PDF]