Incidentalomas of the adrenal glands

If the patient has a known tumor outside the adrenal gland and a lesion in the adrenal gland is detected during staging or dispensarization, This is not a true incident. — it may be metastasis and the procedure is different.

How common are incidentalomas?

• Para personas under the age of 40 Incidentalomas are rare.
• With increasing age The incidence increases significantly — most often occurring between 50 and 80 years of life.
• In persone oltre 80, la frequenza è almeno 10%.
• In the Czech Republic, the incidence of incidental diseases is estimated at 2-5% of the population, i.e., up to 500,000 persone.

A significant proportion of their more frequent capture has wide use of imaging methods in modern medicine.

What is the purpose of the examination?

When accidentally finding a foci of the adrenal gland, it is necessary to answer four basic questions:

1. Is the finding workable?
   (Does it produce hormones that can affect the body?)
2. Is it a benign or malignant tumor?
   (What is the risk of cancer?)
3. Is adrenal dysfunction present?
   (Especially with findings on both sides.)
4. Is it necessary to remove the bearing surgically?

Tipos de tumoras

Benign tumors (benign)

• Adenomas rich in fat — make up 70% of all findings, they usually do not produce hormones.
• Myelolipomas y cystas Uncommon, often without clinical significance.
• Sometimes the adrenal glands can also affect infeccionesthat mimics a tumor.

Malignant tumors (malignant)

• Adrenocortical carcinoma (ACC) — aggressive tumor of the adrenal cortex.
• Pheochromocytoma — can be malignant, often hormonally active.
• Lymphoma Usually part of a systemic disability.
• Sarcomas (leiomyosarcoma, angiosarcoma, liposarcoma) -- very rare.
• Neuroblastoma Typical for children's age, but also possible for adults.
• Metastases — adrenal glands may be affected by tumors from other organs.
• Schwannoma, neurofibroma, ganglioneuroma Usually benign, but may be related to genetic syndromes.

Typische symptomen

En meeste casos patients have no symptoms -- the finding is accidental.

However, some have symptoms that may be related to hormonal activity of the tumor, e.g.:

• increased blood pressure,
• increased levels of sugar and fats in the blood,
• Osteoporosis,
• difficult-to-affect obesity.

Attenção: If they are affected both adrenal glands, the so-called “can” occur. adrenal insufficiency — a condition with a deficiency of vital hormones. Untreated condition can be life threatening.

Diagnostics

Anatomic imaging methods

• CT (computed tomography) — preferido método.
  • <10 HU (native CT) -- probably benign.
  • 10—30 HU — suspicious bearing, requires monitoring.
  • >30 HU — high suspicion of malignancy → specialist examination required.
• MRI (magnetic resonance imaging) — an alternative method, often complementary to CT.

Notes Imaging alone will not reveal the hormonal activity of the bearing.

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