INCIDENTAL DISCOVERY OF ADRENAL-TUMOR - DIAGNOSTIC AND THERAPEUTIC STRATEGY

Among upper abdominal computed tomography (CT) scans, 0.6 per 1000 fortuitously reveal an adrenal tumour, an "image pathology" now known as "adrenal incidentaloma". Should the clinician avoid useless, iatrogenic surgery or run the risk of failing to identify a malignant adrenocortical tumour? We outline a clinical procedure aimed at distinguishing between solid vs liquid, secreting vs nonsecreting and primary vs metastatic tumour. Nevertheless, in the end the diagnosis may be uncertain, in which case tumour size becomes the deciding factor. For tumours of less than 3 cm close surveillance is advocated, wereas surgery is necessary for tumours larger than 3 cm; for tumours in between these sizes only the individual clinician can decide.