Diagnosis
Evaluation can be limited.

• History
• Physical examination to look for evidence suggesting Cushing's syndrome, hyperaldosteronism, carcinoma, or pheochromocytoma
• Urinary catecholamine studies to diagnose pheochromocytoma
• Renin and aldosterone determinations only if hypertension and hypokalemia are present
• Cortisol studies only if there is a suggestion of Cushing's syndrome on history and physical examination

Management
The management of patients with an incidentally found adrenal mass.

• All solid lesions greater than 5 cm are removed.
• All functional lesions are removed.
• All cystic lesions are observed and only removed when increased size is found.
• Nonfunctional lesions less than 5 cm are studied with MRI and removed by a laparoscopic technique if the MRI is not hypointense with homogeneous findings typical of an adenoma.

References

• Blumenfeld JD, Schlusse, Sealey JE, et al: Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med, 121:877-885, 1994.
• Blumenfeld JD, Vaughan ED Jr.: The adrenals. In: Campbell's Urology. 7th Ed. Philadelphia, Saunders, 1998, pp. 2915-2971.
• Manger WM, Gifford RW Jr.: Pheochromocytoma. A clinical review. In: Hypertension Pathophysiology, Diagnosis, and Management. Laragh JH, Brenner BM, eds. 1995, pp. 2225-2246.
• Orth DN: Cushing syndrome. N Eng J Med 332:791-795, 1995.
• Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC: Successful outcomes in pheochromocytoma surgery in the modern era. J Urol 161:764-767, 1999. Vaughan ED Jr.: Adrenal surgery. F. F. Marshall, Ed. In: Textbook of Operative Surgery. Philadelphia, Saunders, 1996, p 220-230.
• Vaughan ED Jr., (ed): Diagnosis and treatments of adrenal disorders. World J Urol 17:1064, 1999.

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