Adrenal masses in the cancer patient: surveillance or excision

An increasing number of patients with a history of solid organ malignancy now undergo surveillance imaging as part of their follow-up or for evaluation of other conditions. This imaging has led to both greater identification of asymptomatic adrenal masses and subsequent confusion among clinicians regarding the evaluation and treatment. Although established algorithms exist for treating such "incidentalomas" in otherwise healthy patients, the most effective way to do so in patients with known prior or concurrent malignancies is unclear. In this review, we explore methods of biochemical testing in such patients and discuss the role of imaging techniques in their ability to differentiate benign versus malignant lesions. In this population, we examine the increasing use of biopsy and discuss current data on both surveillance and resection of lesions based on their identity. Finally, we propose an algorithm to aid the clinician in evaluating and treating these complex patients efficiently.