Sonder - Your Local Health News - Jan/Feb 2020

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dexamethasone suppression test
Phaeochromocystoma – 24-hour urinary
metanephrines and normetanephrines
Aldosteronoma – plasma aldosterone:renin
ratio
Sex hormones – very rare. Test only if patient
display virilisation features. If present, be
suspicious for adrenal malignancy.
(Confounders – drugs e.g. steroids, ACE
inhibitors, SSRIs can interfere with test results
and need to be withheld temporarily)
3. How big is the lesion and is it growing?
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Size is an important predictor for malignancy.
Numerous studies have shown that the risk for
adrenal malignancy is approximately 5-10%
for lesions 4-6 cm, and 15-20% for lesions >6
cm. Therefore, any lesions larger than 4cm
should be referred to an endocrine surgeon for
consideration of surgery.
discharged within 24 hours with minimal pain.
EXTERNAL NEWS
As there is no breach of the peritoneal cavity,
issues such as post-operative ileus and adhesion
formation are avoided.
Open adrenalectomy is usually reserved for
adrenocortical carcinoma, metastases, or large
lesion to minimize the risk of breaching the tumour
and causing spillage and seeding of the cancer
cells.
Whilst size is not an independent predictor for
open surgery (factors e.g. location of tumour and
body habitus of the patient play a significant role),
it is usually very challenging to resect an adrenal
tumour endoscopically when larger than 8 cm.
Follow-up
For benign adrenal tumours that are not resected,
it is reasonable to obtain a non-contrast CT in 6-12
months to assess for growth in size.
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If an adrenal incidentaloma is 20% or >5mm per year
should be referred to an endocrine surgeon for
consideration of resection. Lipid rich (Hounsfield unit