Adrenal lesions are common and usually found incidentally on imaging, appearing in ~3% of abdominal CTs and with increased frequency in older people (~10%). Most adrenal lesions are harmless, but some can produce excessive hormones or become potentially cancerous.
CONDITIONS
Adrenal Lesion
Risk Factors, Symptoms and Signs
• Genetic syndromes – MEN 1, MEN 2, VHL, NF1 and SDH mutations
• A history of cancer elsewhere in the body
• Combination signs of hormone excess – central weight gain, stretch marks, muscle weakness, high blood pressure that is difficult to control or very episodic, sweating and palpitations
• Sex-hormone excess – virilisation or feminisation
How We Diagnose Adrenal Lesions
• Hormonal blood and urine tests to check for hormone excess (Cushing’s, Conn’s, phaeochromocytoma)
• Imaging – adrenal CT, and MRI in certain cases
How We Manage Adrenal Lesions
• If the lesion is non-functioning and has no suspicious features, we monitor it with periodic blood tests and imaging
Surgery is considered when a lesion is:
• Hormonally active
• Suspicious for cancer on imaging
• > 4–6 cm with uncertain features
• Growing by > 20% (and ≥ 5 mm) on follow-up imaging
• A single area of metastasis from another cancer in selected patients
