Hormonal evaluation of the patient with an incidentally discovered adrenal mass

Article Abstract:

Recent improvements in medical imaging, including CT scanners and magnetic resonance imaging (MRI), have led to a more frequent incidental (unplanned) detection of adrenal tumors. Autopsy studies have confirmed that 1.9 to 8.7 percent of individuals have adrenal masses (cortical adenoma), but have no clinical record of irregular or elevated production of adrenal hormones. From these data it appears that there will be an incidental finding of an adrenal mass in approximately 2 percent of all patients undergoing CT scanning procedures. Such a discovery presents a clinical dilemma - how should such patients be evaluated and treated? Some of these cases will involve cancers and other disease entities which need aggressive treatment. Should all patients with adrenal masses be subjected to surgical or other invasive procedures to detect these cases? This review suggests that all patients with such masses should undergo a selective analysis of their endocrine system to identify hormone-secreting adrenal tumors. Various tumors such as pheochromocytoma, aldosterone-producing adenoma, glucocorticoid-producing adenoma, and adrenal carcinoma are considered in detail, and the means of obtaining a definitive diagnosis are considered. This analysis shows that extensive hormonal screening is unnecessary, and that a limited panel of endocrine tests coupled with imaging studies and solid clinical judgement yields a reasonable diagnostic result. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Adrenocortical hormones, Abdomen, Endocrine gland tumors

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A 27-year-old woman with Hodgkin's disease and an adrenal mass

Article Abstract:

A 27-year-old woman whose mother had used diethylstilbestrol (DES) during pregnancy was hospitalized with Hodgkin's disease and an abnormal mass on her adrenal gland. The adrenal glands are located on top of the kidneys, and the adrenal cortex secretes the sex hormones. The patient suffered from fatigue, a low-grade fever, and diseased lymph nodes in the cervical area for two to two and one-half months before hospitalization. Biopsy and computed tomographic (CT) scan were performed. A detailed discussion among various physicians was recorded regarding interpretation of the findings, which are especially complicated in such a case because pathologists have no absolute criterion for differentiating between cancerous and noncancerous tumors of the endocrine glands. Adrenalcortical carcinoma, a rare but almost always fatal cancer, was diagnosed, and the treatment was discussed. The choice of treatment was difficult because it is so seldom successful, and it is questionable whether chemotherapy affects the progress of the disease. Out of one group of 47 patients, there were only two survivors, and in another group of 77 patients, results were generally poor for all of them, and only three of the 28 patients receiving systemic chemotherapy responded well. This patient was nevertheless started on chemotherapy, and six months later showed no sign of recurrence of the adrenal tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Hodgkin's disease, Cancer, Chemotherapy, Endocrine gland cancer

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A 23-year-old woman with a painful mass in the right adrenal region

Article Abstract:

A 23-year-old woman was diagnosed with a benign cyst of the adrenal gland that contained a blood clot inside. The patient was admitted to the hospital with abdominal pain that had started suddenly the morning of admission. An ultrasound of the patient's abdomen revealed a rounded mass that was approximately eight centimeters in diameter above the right kidney. A computed tomographic (CT) scan also revealed a mass above the right kidney. A magnetic resonance imaging (MRI) scan of the abdomen showed a cyst in the area of the right adrenal gland that appeared to be bleeding inside. The patient had surgery, and the cyst was removed. The cyst did not contain any cancer cells.

Abnormalities, Cysts, Adrenal glands

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