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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?

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Senior at Bryn Mawr College and was a Summer Research Associate in Diagnostic Imaging at the Moanalua Medical Center in HI.
Freshman at Yale College at Yale University and was a Summer Research Associate in Diagnostic Imaging at the Moanalua Medical Center in HI.
Resident in Radiology at the University of California, Davis Medical Center in CA.
Associate Chief of Diagnostic Imaging at the Moanalua Medical Center in HI.



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


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


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.


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.


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

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