Imaging Workup of Incidentally Discovered Adrenal Masses in Oncologic Patients

As the use of cross-sectional imaging continues to rise, adrenal masses are more frequently detected incidentally in the daily practice of radiology. The goal of adrenal imaging is to characterize and differentiate the benign leave-alone lesions from those that require treatment without exhaustive workup. Most of incidentally found masses are benign, with adenoma being the most common pathology. However, the adrenal gland is a common site of metastasis. Also, of clinical concern are primary adrenal neoplasms that may require proper management, e.g., pheochromocytoma, aldosteronoma, cortisol-producing adenoma, and adrenal cortical carcinoma. Prior history of malignancy is one of the most important determinants in the workup of incidental adrenal lesions. Differentiating a benign from metastatic adrenal mass in patients in whom the adrenal gland is the only potential site of metastasis would be of more importance, because the diagnosis may alter not only the prognosis but also the treatment options. For example, in a patient with a potentially resectable lung carcinoma and an isolated adrenal mass, differentiating a benign adenoma from a metastasis is critical for accurate staging and determining the most optimal treatment (curative resection vs. chemotherapy). This presentation discusses contemporary adrenal imaging and the optimal algorithm for the workup of incidentally discovered adrenal masses.