Medicines for Adrenal incidentaloma

What it is

An adrenal incidentaloma is a lump (mass) on one of the adrenal glands — the small glands that sit on top of the kidneys and produce important hormones — that is discovered by chance ("incidentally") on a scan (such as a CT or MRI) done for another reason, in a person who has no symptoms pointing to an adrenal problem. With the increasing use of scans, adrenal incidentalomas are found quite commonly, particularly in older people. The great majority are benign (non-cancerous) and do not produce excess hormones, and cause no problems. However, because a small proportion either produce excess hormones or, rarely, are cancerous, adrenal incidentalomas are assessed in two ways to sort out which need attention. First, they are checked for whether they are "functioning" — that is, producing too much of an adrenal hormone (such as cortisol, aldosterone, or the hormones of a phaeochromocytoma) — even if the excess is mild and not causing obvious symptoms, as this can still affect health (for example blood pressure or blood sugar). Second, the appearance and size of the lump on the scan are assessed to judge how likely it is to be benign or to need concern about cancer. Based on this assessment, most adrenal incidentalomas turn out to be harmless and non-functioning, needing little or no further action, while the minority that produce excess hormone or have concerning features are treated.

How it is treated

An adrenal incidentaloma is assessed in a structured way, usually guided by an endocrine specialist, to determine whether it produces excess hormone and whether its appearance is reassuring. Hormone tests are carried out to check for excess cortisol, aldosterone (particularly if there is high blood pressure), and phaeochromocytoma hormones (which is important to identify, as a phaeochromocytoma can cause dangerous blood pressure surges and needs specific management). The scan characteristics and size of the lump are assessed to judge how likely it is to be benign (most have reassuring features). Based on these results, the approach is decided: a lump that is non-functioning (not producing excess hormone) and has clearly benign features on the scan often needs little further action, sometimes with a repeat scan or hormone check after an interval to confirm stability. Lumps that are found to produce excess hormone, or that are large or have concerning features suggesting they could be cancerous, are treated — typically with surgery to remove the affected adrenal gland, and any hormone excess is managed. Any phaeochromocytoma is managed carefully (with specific preparation before any surgery). Where excess cortisol is found (even if mild), its effects (such as on blood pressure, blood sugar and bones) are considered. The reassuring message is that adrenal incidentalomas are common and usually harmless and non-functioning, and that they are assessed to identify the minority that produce excess hormone or need concern about cancer, which can then be treated appropriately.