The widespread use of abdominal CT/MRI has resulted in a new and common diagnosis for the clinical endocrinologist the management of patients with adrenal incidentalomas. Defined as an adrenal mass discovered incidentally in the work-up or treatment of clinical conditions not related to suspicion of adrenal disease, incidentalomas cover a spectrum of underlying adrenal pathologies with a common pathway of discovery. Because of the risk of malignancy, they raise uncertainty, confusion and concern in doctors and patients alike and consume significant resource.
This presentation will define the scale of the problem, discuss diagnostic challenges as they relate to functionality of the tumours and ascertaining whether the lesions are benign or malignant. It will review the natural history and suggested follow-up and treatment of patients based on published NIH clinical guidelines, but will also suggest that such guidelines perhaps over-inflate the real risk of malignancy and a more risk-averse approach to management is now required.
Finally, new biomarker research based on analyzing the urinary steroid metabolome may improve the diagnosis and follow-up of such cases; in-house data will be presented.