Sherlock email extractor 1.14/24/2023 Current guidelines do not recommend that incidentally discovered adrenal lesions with a diameter <1 cm undergo further investigation unless clinically indicated ( 4, 6-8). This strict definition, recognized by the European Society of Endocrinology and European Network for the Study of Adrenal Tumors (ESE/ENSAT), excludes adrenal lesions discovered during the screening of patients with hereditary syndromes or extra-adrenal tumors ( 4). The term “incidentaloma” was coined in 1982 by Geelhoed and Druy ( 5), who recognized that with the advent of improved resolution of radiological techniques clinicians were faced with the unfamiliar dilemma of early diagnosis of an asymptomatic adrenal mass. An adrenal incidentaloma (AI) is defined as a clinically unapparent adrenal mass greater than 1 cm in diameter detected during imaging performed for reasons other than for suspected adrenal disease ( 4). One of the most common unexpected findings revealed by CT, MRI, or ultrasonography is an incidental adrenal mass or incidentaloma. Improvements in imaging modalities and their increasing use have led to the increased discovery of unexpected pathological findings. Therefore, approximately 80 million CT scans are performed each year in the US ( 2), and in the UK over 5 million CT scans were performed in 2018 ( 3). For magnetic resonance imaging (MRI) the figures were 1 population in the US and in other countries ( 1). ![]() According to estimates from the Organisation for Economic Co-operation and Development, in 2016, the United States performed 245 computed tomography (CT) scans per 1000 population compared with a mean of 1 population across 11 other high-income countries ( 1). The use of diagnostic imaging has increased dramatically over the last 3 decades, driven by several factors, including technological advancement in imaging modalities, growing awareness of preventive care, the rising number of diagnostic imaging centers, and increasing prevalence of chronic disease driven in large part by an aging population. Most patients with AI can be discharged once malignancy and hormone hypersecretion have been excludedĪ causative link between cortisol hypersecretion and age-related comorbidities should be firmly established before recommending surgical excision Pheochromocytoma and autonomous cortisol secretion should be excluded in every case and aldosteronism in patients with underlying hypertension and/or hypokalemia The initial investigation of choice is an unenhanced computed tomography scan of both adrenal glands Up to 10% of patients with AI have autonomous secretion of adrenal hormones ![]() ~2% of patients with AI have adrenocortical cancer It is rare in subjects below 40 years of age Adrenal incidentaloma (AI) is a common endocrine diagnosis affecting ~2% of the general population, but over 7% of those over 70 years.
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