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Perm J. 2016 Winter;20(1):13-8. doi: 10.7812/TPP/15-037. Epub 2015 Dec 21.

Evaluation of Small Adrenal Incidental Nodules: Is Imaging Follow-Up Necessary?

Author information

1
Senior at Bryn Mawr College and was a Summer Research Associate in Diagnostic Imaging at the Moanalua Medical Center in HI. tokmyoung@sbcglobal.net.
2
Freshman at Yale College at Yale University and was a Summer Research Associate in Diagnostic Imaging at the Moanalua Medical Center in HI. mwong15@punahou.edu.
3
Resident in Radiology at the University of California, Davis Medical Center in CA. mylesm@hawaii.edu.
4
Associate Chief of Diagnostic Imaging at the Moanalua Medical Center in HI. hyo-chun.yoon@kp.org.

Abstract

INTRODUCTION:

Low incidence of adrenal cortical carcinoma in the general adult population has prompted a reevaluation of current protocol for the assessment of adrenal incidentalomas.

OBJECTIVE:

To determine whether follow-up imaging for small (≤ 4 cm) incidental adrenal nodules is necessary for patients without known cancer.

METHODS:

We performed a retrospective analysis of all patients found to have an incidental adrenal nodule on abdominal computed tomography (CT) scan during a 27-month period. The electronic medical record was reviewed to determine clinical outcomes in all patients with a minimum of 3 years of follow-up (mean follow-up = 6.7 years). Patients with a known primary cancer were excluded from the analysis unless they had a prior CT scan that documented an incidental adrenal nodule. Unenhanced CT attenuation was measured for all nodules, if available.

RESULTS:

A total of 392 patients with an incidental adrenal nodule had a mean (standard deviation [SD]) clinical follow-up of 6.7 (2.7) years. There were 200 men and 192 women with a mean (SD) age of 66.0 (13.2) years. None of these patients developed primary adrenocortical carcinoma during the follow-up period.Two hundred forty of these patients also had a minimum 3 years of imaging follow-up (mean [SD], 6.4 [2.4] years; range, 3.1-13.6 years). There were 173 left-sided and 91 right-sided nodules on index CT scan. There was no significant difference in the mean (SD) rate of growth between left- and right-sided nodules (0.1 [0.8] mm/year vs 0.1 [0.8] mm/year, p = 0.58). Mean unenhanced CT attenuation of adrenal nodules did not affect the likelihood of adrenal malignancy during follow-up.

CONCLUSION:

Patients with small incidental adrenal nodules do not require additional imaging to exclude the possibility of adrenocortical carcinoma.

PMID:
26694019
PMCID:
PMC4732789
DOI:
10.7812/TPP/15-037
[Indexed for MEDLINE]
Free PMC Article
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