Clinical Review: The Approach to the Evaluation and Management of Bilateral Adrenal Masses
Recommended Citation
Sweeney AT, Hamidi O, Dogra P, Athimulam S, Correa R, Blake MA, McKenzie T, Vaidya A, Pacak K, Hamrahian AH, and Bancos I. Clinical Review: The Approach to the Evaluation and Management of Bilateral Adrenal Masses. Endocr Pract 2024.
Document Type
Article
Publication Date
10-1-2024
Publication Title
Endocrine practice
Abstract
OBJECTIVE: This white paper provides practical guidance for clinicians encountering bilateral adrenal masses.
METHODS: A case-based approach to the evaluation and management of bilateral adrenal masses. Specific clinical scenarios presented here include cases of bilateral adrenal adenomas, hemorrhage, pheochromocytomas, metastatic disease, myelolipomas, as well as primary bilateral macronodular adrenal hyperplasia.
RESULTS: Bilateral adrenal masses represent approximately 10% to 20% of incidentally discovered adrenal masses. The general approach to the evaluation and management of bilateral adrenal masses follows the same protocol as the evaluation of unilateral adrenal masses, determined based on the patient's clinical history and examination as well as the imaging characteristics of each lesion, whether the lesions could represent a malignancy, demonstrate hormone excess, or possibly represent a familial syndrome. Furthermore, there are features unique to bilateral adrenal masses that must be considered, including the differential diagnosis, the evaluation, and the management depending on the etiology. Therefore, considerations for the optimal imaging modality, treatment (medical vs surgical therapy), and surveillance are included. These recommendations were developed through careful examination of existing published studies as well as expert clinical opinion consensus.
CONCLUSION: The evaluation and management of bilateral adrenal masses require a comprehensive systematic approach which includes the assessment and interpretation of the patient's clinical history, physical examination, dynamic hormone evaluation, and imaging modalities to determine the key radiographic features of each adrenal nodule. In addition, familial syndromes should be considered. Any final treatment options and approaches should always be considered individually.
Medical Subject Headings
Humans; Adrenal Gland Neoplasms; Myelolipoma; Pheochromocytoma; Case Reports as Topic
PubMed ID
39103149
ePublication
ePub ahead of print
Volume
30
Issue
10
First Page
987
Last Page
1002
