[Incidentally discovered adrenal tumors. Apropos of 20 cases]

According to Glazer, the term of incidentaloma describes an adrenal tumor discovered incidentally during acomputed tomographyscan and by extension to all masses discovered whatever the imaging process. Twenty patients have been operated during the last 10 years. The discovering circumstances are not specific, except the ecography and CT Scan. Complementary examinations include biological tests aiming at showing a possible hormonal secretion and more specific examinations MIBG scintygraphy and magnetic resonance imaging. The tumors often large (80% more than 5 cm long) and solid (75%) have all been removed by transperitoneal approach (13) or lombotomy. Post operative course was approach unevertful. The histological study showed 6 metastasis, 5 benign kystic lesions, 3 hematomas, 3 adenomas, 2 adrenalcortical carcinoma and 1 ganglioneuroma. A review of the literature series leads us to evaluate the frequency and risk of incidentalomas and to consider the necessary examination and the strategy to be adopted in front of such lesions. The evaluation of hormone status, the recourse to specific imaging seems necessary whereas the guided needle biopsy does not present any risk and should be reserved for very special cases. A decisional scheme is proposed, which ains at removing all voluminous and/or secreting tumors. Small lesions behind 35 mm will have to be examined closely and will be removed if they grow larger or persist.