The “incidental” finding of an adrenal gland abnormality is more common that you may think. Scans performed for all sorts of reasons reveal an abnormality within the adrenal gland in up to almost 10% of scans of the abdomen and is one of the more common reasons for referral to an endocrine surgeon. This should not be alarming however given that the majority of incidental adrenal gland abnormalities are not of great significance and will not impact on your well-being.
Despite this, it is necessary for all patients identified to have an adrenal incidentaloma to be reviewed by an expert in adrenal gland pathology. This is primarily because some lesions can be a real problem, not just for the patient but for their family as well. The incidental finding of a lesion in the adrenal gland is an ideal opportunity to investigate the problem while it is typically small and not symptomatic.
Investigation of an incidentaloma begins with taking a history from the patient. A history of high blood pressure, trouble managing blood sugar or changes in weight or skin may all be relevant. Family history is extremely important. Most people with a family who are at risk of developing endocrine organ problems are already aware, but this is not always the case. While there are subtle aspects of the physical examination that can reveal insight into the presence of adrenal disease, most patients will not possess any signs of adrenal disease at all.
The tests involved in assessing whether or not the adrenal gland abnormality is of significance can be simply broken into imaging, blood tests and urine tests. There are generally screening tests done initially and where abnormalities are defined, additional confirmatory tests may be requested. As you can imagine, this can take some time and requires consideration to ensure that the correct tests are completed and interpreted appropriately. Your ANZES recognised endocrine surgeon will be able to guide you through this process and facilitate a diagnosis.
The specifics of the known or suspected diagnosis then guide management. This can range from surgery to excise the lesion (adrenalectomy) through to ongoing surveillance or even discharge if the lesion is clearly benign, not producing any excess hormones and won’t trouble you in future. The specific diagnoses that may be revealed by investigation are discussed briefly below.
