Adrenal incidentaloma

Question 1

What is an adrenal incidentaloma?

Answer 1

When a mass on the adrenals is discovered incidentally

I.e. a scan was performed for an unrelated reason, and a mass showed up

Question 2

What 2 things do you need to consider when seeing a patient with adrenal incidentaloma?

Answer 2

Is it functioning or non-functioning? (is it secreting any hormones?)

Is it benign or malignant?

Question 3

How can you tell if the incidentaloma is functioning or not?

Answer 3

Check levels of catecholamines in the urine or plasma

Dexamethasone test: if the tumour is functioning (producing cortisol) cortisol levels will remain high when they should be supressed

Question 4

Differential diagnosis of an adrenal incidentaloma?

Answer 4

Adenoid cystic carcinoma
Metastases
Phaeochromocytoma
Aldosteronism
Congenital adrenal hyperplasia
Lymphoma
Infection
Haemorrhage

Question 5

How can you tell if the incidentaloma is benign or malignant?

Answer 5

Benign = high fat
Malignant = low fat

Washout scans:
Benign = will wash out dye
Malignant = will not

PET scan: will show up cancer brightly

Question 6

Describe the venous drainage of the right and left adrenal?

Answer 6

Right = into IVC
Left = into left renal vein

Question 7

Describe the blood supply to the right and left adrenal?

Answer 7

Superior, middle, inferior adrenal

Question 8

Which cancers metastasise to adrenals?

Answer 8

Liver
Upper GI
Kidney
Lung