Diagnosis and management of adrenal masses: 1987 Du Pont lecture

Adrenal enlargements were found in slightly more than 100 patients of approximately 15,000 who underwent abdominal computed tomography. A firm diagnosis was made in 61 patients. Of these, 34 were screened because of suspected metastases from nonadrenal tumours. Major causes of adrenal enlargement were metastases (20 patients), nonfunctioning adenomas (15) and hormonally active masses (9). Fine-needle aspiration biopsy was a useful diagnostic aid in patients with metastases. Surgical treatment was undertaken in 17 patients (three pheochromocytomas, one Cushing's adenoma, three Conn's adenomas, four primary carcinomas, two metastatic carcinomas, three nodular hyperplasias suspected to be part of the multiple endocrine adenopathy syndrome and one myelolipoma). Work-up of an adrenal mass includes a full history and physical examination, search for possible nonadrenal primary malignant lesions, testing for excess adrenal hormone secretion, computed tomography of the abdomen and fine-needle aspiration biopsy in selected patients.