endocrine and metabolic disorders
Nonfunctional Adrenal Masses
Treatment of Nonfunctional Adrenal Masses
Sometimes excision, depending on size and/or imaging results Periodic monitoring Although some imaging modalities (eg, in-phase and out-of-phase MRI) may be diagnostic, if the tumor is solid, of adrenal origin, and>4 cm, it should usually be excised unless the imaging characteristics are clearly benign. Tumors 2 to 4 cm in diameter are a particularly difficult clinical problem. If scanning does not suggest cancer and hormonal function does not seem altered (eg, normal electrolytes and metanephrines, no evidence of Cushing syndrome), it is reasonable to reevaluate periodically with imaging studies, usually for 1 to 2 years. If no progression occurs by then, further follow-up is unnecessary. However, many of these tumors secretecortisolin quantities too small to cause symptoms, and whether they would eventually cause symptoms and morbidity if untreated is unclear. Most clinicians merely observe patients with these tumors, but clinicians should consider removal of these tumors if there is significantcortisolsecretion. Adrenal adenomas<2 cm require no special treatment but should be observed regularly over a period of time (eg, about every 6 months for 2 years) for both growth or development of secretory function (such as by looking for clinical signs and periodically measuring electrolytes). Nonfunctional adrenal carcinoma that has metastasized is not amenable to surgery, thoughmitotaneplus corticosteroids may help control symptoms of hypercortisolism. 