Part of “CHAPTER 89 – SURGERY OF THE ADRENAL GLANDS“

The more widespread availability and use of high-resolution CT scanners have resulted in the detection of asymptomatic adrenal masses, called adrenal “incidentalomas,” which may have previously gone unrecognized. The dilemma for the surgeon is to identify and resect the minority of such tumors that are malignant or functional, and avoid risks of unnecessary operations for benign, nonfunctional adenomas, which occur commonly and do not require any treatment.

Initial evaluation of a solid incidentaloma consists of a careful history-taking and physical examination to detect signs or symptoms suggestive of hypercortisolism, primary aldosteronism, pheochromocytoma, primary adrenocortical cancer, or adrenal metastasis from an undiagnosed malignancy arising in another tissue (Fig. 89-1). Laboratory studies are obtained based on clinical suspicion of the presence of one of these disorders.4 In addition, a 24-hour urinary free cortisol level should be obtained in each patient with an incidentaloma, because addisonian crisis may occur postoperatively in a few patients with clinically occult Cushing syndrome if stress doses of corticosteroids are not administered.4a Blood pressures and serum potassium level are also measured in each patient to help exclude an aldosteronoma.