Russian Association of Endocrinologists clinical practice guideline for adrenal incidentalomas differential diagnosis

Abstract

This article discusses the management guidelines for serendipitously diagnosed adrenal masses cases, assessment of their hormonal activity and malignancy potential, pro- and contra indications for surgical treatment and follow-up algorithm for hormonally inactive tumors. Hypercathecholaminemya, endogenous hypercortisolism, primary hyperaldosteronism should be considered as variants of specific hormonal activity of tumor. The midnight suppression test with dexametasone 1 mg is recommended in all cases. Evaluation of basal ACTH in case of negative result of the test with dexametasone 1 mg (absence of morning cortisol level suppression) should be considered as confirmation test. For primary diagnosis of pheohromocytoma/paraganglioma (PPGL) a free plasma or fractionated urine methanephrines concentrations evaluation should be recommended. If test is positive, comprehensive examination to exclude or confirm PPGL is necessity. The aldosterone/rennin ratio exposure should be considered for patients with arterial hypertension to exclude primary hyperaldosteronism. To evaluate malignant pattern of a tumor in all unclear cases should be provide assessment of computed tomography quantitative indices. Adrenal incidentalomas treatment guidelines isnt considered in the field of this recommendations and reported in relevant guidelines.

Keywords

• adrenal mass
• adrenal incidentaloma
• adrenal cancer
• pheochromocytoma
• paraganglioma
• hyperaldosteronism
• hypercortisolism
• cushing syndrome