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Endocrinol Metab > Volume 35(1); 2020 > Article |
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Consensus/Guidelines | Year of publication | Country | Recommendation/Suggestion | Level of evidence |
---|---|---|---|---|
National Institutes of Health (NIH) consensus conference [19] | 2002 | United States | Repeat a CT scan at 6-12 months. If there is not an increase in size, follow-up should be ended. | |
Exploration and management of adrenal incidentalomas. French Society of Endocrinology Consensus [20] | 2008 | France | Repeat a CT scan at 6 months to rule out the very-low risk of overlooking a malignant tumor. Repeat a CT scan at 2 years and at 5 years to checking for long-term malignant risk. | |
American Association of Clinical Endocrinologists/American Association of Endocrine Surgeons (AACE/AAES) guideline [18] | 2009 | United States | Repeat an imaging at 3-6 months and then annually for 1-2 years | Grade C; Evidence Level 3 |
Guidelines for the management of the incidentally discovered adrenal mass [21] | 2011 | Canada | No further imaging in patients with a benign appearing mass <1 cm or in patients with benign etiologies at discovery (myelolipomas, hemorrhages, cysts). | Grade D; Evidence Level 4 |
Recommendation | ||||
Repeat imaging after 12 months (preferably of the same modality used at diagnosis) for masses of 1-2 cm if the clinical picture warrants (consider no follow-up if imaging is stable). | Grade C; Evidence Level 3 | |||
Repeat imaging after 12 months for masses 2-4 cm: if stable, consider no follow-up while if not stable consider surgical removal or close follow-up (3-6 months). If a mass exhibits an increase in size (greater than 0.5-1 cm) consider surgical removal. | Recommendation | |||
Italian Association of Clinical Endocrinologists (AME) position statement [1] | 2011 | Italy | In general, repeat a CT scan at 3-6 months. | |
No further imaging in patients with small tumors (<2 cm). For larger tumors the decision should be based on the characteristics of the mass, patient age and history, results of endocrine work-up. | ||||
Adrenal incidentaloma in adults— management recommendations by the Polish Society of Endocrinology [22] | 2016 | Poland | If the tumor is small (≤3 cm) and resembles a typical lipid-rich adenoma, imaging tests are recommended annually. In the cases of larger tumors, or those with a less characteristic phenotype, consider imaging check-ups every 3-6 months within the first year, and later every 12 months. | |
If the lesion is not oncological suspicious and is stable, stop follow-up after 4 years. | ||||
European Society of Endocrinology/European Network for the Study of Adrenal Tumors (ESE/ENSAT) guideline [2] | 2016 | Europe | No further imaging in patients with an adrenal mass <4 cm with clear benign features on imaging studies. | Weak recommendation; Evidence Level very low |
Repeat a non-contrast CT scan or MRI at 6-12 months in patients with a mass >4 cm or with indeterminate characteristics at the first imaging. | Weak recommendation; Evidence Level very low | |||
If there is growth of the lesion less than 20% of the largest diameter during this period, additional imaging after 6-12 months should be performed (in case of growth >20% and at least a 5 mm increase in maximum diameter, the patient should be evaluated for surgical resection). | ||||
Clinical Guidelines for the Management of Adrenal Incidentaloma [23] | 2017 | Korea | No further imaging in patients with an adrenal mass <4 cm with clear benign features on initial work-up. | Recommendation Level C |
Repeat a CT scan at 3-6 months and then annually for 1-2 years in patients with a mass <4 cm and >10 HU. | ||||
In case of repeated imaging follow-up, no further exams are required if the tumor does not change in size over a period of more than 1 year, but if a mass with indeterminate radiological features increases in size more than 0.8-1 cm during 3-12 months of follow-up or it changes its appearance, consider an adrenalectomy. |
Consensus/Guidelines | Year of publication | Country | Recommendation/Suggestion | Level of evidence |
---|---|---|---|---|
National Institutes of Health (NIH) consensus conference [19] | 2002 | United States | Repeat the hormonal screening (overnight 1 mg DST, urine catecholamines/metabolites) annually, or earlier if clinically indicated, for 4 years. | |
Exploration and management of adrenal incidentalomas. French Society of Endocrinology Consensus [20] | 2008 | France | Repeat the hormonal screening (overnight 1 mg DST, plasma or urinary metanephrines) at 6 months. Then repeat overnight 1 mg DST at 2 years and at 5 years. | |
American Association of Clinical Endocrinologists/American Association of Endocrine Surgeons (AACE/AAES) guideline [18] | 2009 | United States | Repeat the hormonal screening (overnight 1 mg DST, plasma aldosterone concentration and plasma renin activity, plasma free metanephrine and normetanephrine, 24-hour total urinary metanephrines and fractionates catecholamines) annually for 5 years. | Grade C; Evidence Level 3 |
Guidelines for the management of the incidentally discovered adrenal mass [21] | 2011 | Canada | Clinical and hormonal follow-up using screening tests employed at initial evaluation annually for 4 years. Masses exhibiting increasing hyperfunction should be considered for surgery. | Level 3 |
Evidence, Grade C Recommendation | ||||
Italian Association of Clinical Endocrinologists (AME) position statement [1] | 2011 | Italy | Repeat the hormonal screening (i.e., overnight 1 mg DST) in case of development of clinical signs of hormone excess or worsening of the metabolic status and cardiovascular risk profile despite optimal medical treatment. | |
Adrenal incidentaloma in adults— management recommendations by the Polish Society of Endocrinology [22] | 2016 | Poland | Repeat the hormonal screening with the overnight 1 mg DST annually (screening tests for pheochromocytoma may be considered). Stop follow-up after 3-5 years. Patients with suspected subclinical hypercortisolism require more control tests. | |
European Society of Endocrinology/European Network for the Study of Adrenal Tumors (ESE/ENSAT) guideline [2] | 2016 | Europe | No further hormonal screening in patients with normal hormonal work-up at initial evaluation, unless there are new clinical signs of endocrine activity or worsening of comorbidities (i.e., hypertension and type 2 diabetes). | Weak recommendation; Evidence Level very low |
Hormonal re-evaluation at any time during the annual clinical follow-up in patient with ‘autonomous cortisol secretion' and in patients with both ‘possible autonomous cortisol secretion' and potentially associated comorbidities. | ||||
Clinical Guidelines for the Management of Adrenal Incidentaloma [23] | 2017 | Korea | In tumors larger than 2 cm, repeat annual hormone tests for 4-5 years to check the functionality of the tumor. | Recommendation Level C |
Giuseppe Reimondo
https://orcid.org/0000-0001-9489-2094
Soraya Puglisi
https://orcid.org/0000-0002-2883-6139
Adrenal Incidentaloma.1999 September;14(3)
A Case of Adrenal Incidentaloma with a Pituitary Incidentaloma.2006 December;21(6)
The Evaluation and Follow-up of Adrenal Incidentaloma.2007 August;22(4)
The Characteristics and Follow-up of Pituitary Incidentaloma.2008 April;23(2)
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