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Contemporary imaging of incidentally discovered adrenal masses

Nature Reviews Urology volume 6, pages 363–373 (2009)Cite this article

Abstract

The incidental discovery of adrenal masses during modern diagnostic imaging is a common occurrence. These masses form part of a long differential diagnostic list; most often, they are benign adrenal adenomas, but their discovery requires a clinical evaluation that is sufficiently broad to exclude clinically silent endocrine disease, metastases to the adrenal gland in patients with suspected or known malignancies, and rare adrenocortical carcinomas. CT, MRI and nuclear medicine approaches have all been used to evaluate incidentally discovered adrenal masses. Each technology provides information that contributes to the noninvasive characterization of the majority of these neoplasms. Understanding of the modalities used to assess an unanticipated adrenal mass allows for more rapid diagnosis and cost avoidance in a condition that has been referred to as a 'disease' of modern imaging technology.

Key Points

  • Incidentally discovered adrenal masses are commonly encountered when modern high-resolution imaging techniques are used

  • The differential diagnostic list of incidentally discovered masses is large; most are benign, adrenal adenomas

  • The first step in the evaluation of an incidentally discovered adrenal mass is a biochemical evaluation that is sufficient to exclude clinically silent endocrine disease (such as hypercortisolism, hypercatecholaminemia, aldosteronism, and so on)

  • Noninvasive imaging techniques can be used to characterize incidentally discovered adrenal masses, and to distinguish adrenal adenomas from metastases to the adrenal glands and other adrenal neoplasms

  • An understanding of the imaging techniques used to distinguish benign from malignant and other incidentally discovered adrenal masses allows for rapid diagnosis, optimal therapy and decreased costs in the evaluation of these neoplasms

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Figure 1: Abdominal CT scan of an incidentally discovered right adrenal mass with several foci of lipid density that are consistent with macroscopic fat characteristic of a myelolipoma.
Figure 2: Abdominal CT scan of a 3 cm incidentally discovered right adrenal cyst.
Figure 3: Abdominal CT scans of a patient with acute myelomonocytic leukemia presenting with thrombocytopenia, neutropenia, hypotension and concern for adrenal insufficiency.
Figure 4: Abdominal CT scan in a patient with nonspecific abdominal pain.
Figure 5: Abdominal MRI scans of a patient with hypertension and hypercatecholaminemia.
Figure 6: A right adrenocortical carcinoma (arrow) with central tumor necrosis and periaortic metastases on abdominal [18F]-FDG PET/CT.
Figure 7: Adrenal metastases.
Figure 8: Abdominal MRI and CT scans of adrenal masses.
Figure 9: Abdominal CT and PET scans of adrenal masses.

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References

  1. Kloos, R. T., Gross, M. D., Francis, I. R., Korobkin, M. & Shapiro, B. Incidentally discovered adrenal masses. Endocr. Rev. 16, 460–484 (1995).

    CAS  PubMed  Google Scholar 

  2. Aron, D. C. The adrenal incidentaloma: disease of modern technology and public health problem. Rev. Endocr. Metab. Disord. 2, 335–342 (2001).

    Article  CAS  PubMed  Google Scholar 

  3. Bivio, S. et al. Prevalance of adrenal incidentaloma in a contemporary computerized tomography series. J. Endocrinol. Invest. 29, 298–302 (2006).

    Article  Google Scholar 

  4. Beuschlein, F. Adrenal incidentalomas: presentation and clinical workup. Horm. Res. 68 (Suppl. 5), 191–194 (2007).

    PubMed  Google Scholar 

  5. Young, W. F. Jr. Clinical practice: the incidentally discovered adrenal mass. N. Engl. J. Med. 356, 601–610 (2007).

    Article  CAS  PubMed  Google Scholar 

  6. Jossart, G. H., Burpee, S. E. & Gagner, M. Surgery of the adrenal glands. Endocrinol. Metab. Clin. N. Am. 29, 57–68 (2003).

    Article  Google Scholar 

  7. No authors listed. NIH state-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH Consens. State. Sci. Statements 19, 1–25 (2002).

  8. Boland, G. W., Blake, M. A., Hahn, P. F. & Mayo-Smith, W. W. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 249, 756–775 (2008).

    Article  PubMed  Google Scholar 

  9. Dunnick, N. R. & Korobkin, M. Imaging of adrenal incidentalomas. Am. J. Roentgenol. 179, 559–568 (2002).

    Article  Google Scholar 

  10. Gross, M. D., Avram, A., Fig, L. M. & Rubello, D. Contemporary adrenal scintigraphy. Eur. J. Nucl. Med. Mol. Imaging 34, 547–557 (2007).

    Article  PubMed  Google Scholar 

  11. Inan, N. et al. Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses. Eur. J. Radiol. 65, 154–162 (2008).

    Article  PubMed  Google Scholar 

  12. Gross, M. D. et al. Adrenal Gland Imaging. In Endocrinology, 5th edn (Eds Degroot, L. J. & Jameson, J. L.) 2425–2453 (W. B. Saunders, Philadelphia, 2005).

    Google Scholar 

  13. Beierwaltes, W. H., Lieberman, L. M., Ansari, A. N. & Nishiyama, H. Visualization of human adrenal glands by in vivo scintillation scanning. JAMA 216, 275–277 (1971).

    Article  CAS  PubMed  Google Scholar 

  14. Thrall, J. H., Freitas, J. E. & Beierwaltes, W. H. Adrenal scintigraphy. Semin. Nucl. Med. 18, 23–41 (1978).

    Article  Google Scholar 

  15. Shapiro, B., Britton, K. E., Hawkins, L. A. & Edwards, C. R. Clinical experience with 75Se-selenomethylnorcholesterol adrenal imaging. Clin. Endocrinol. 15, 19–27 (1981).

    Article  CAS  Google Scholar 

  16. Beierwaltes, W. H., Wieland, D. M., Yu, T., Swanson, D. P. & Mosley, S. T. Adrenal imaging agents: rationale, synthesis, formulation and, metabolism. Semin. Nucl. Med. 8, 5–21 (1978).

    Article  CAS  PubMed  Google Scholar 

  17. Minn, H. et al. Imaging of adrenal incidentalomas with PET using 11C-metomidate and 18F-FDG. J. Nucl. Med. 45, 972–979 (2004).

    CAS  PubMed  Google Scholar 

  18. Zettinig, G. et al. Positron emission tomography imaging of adrenal masses: 18F-fluorodeoxyglucose and the 11β-hydroxylase tracer 11C-metomidate. Eur. J. Nucl. Med. Mol. Imaging 31, 1224–1230 (2004).

    Article  PubMed  Google Scholar 

  19. Wadsak, W. et al. [18F]FETO for adrenocortical PET imaging: a pilot study in healthy volunteers. Eur. J. Nucl. Med. Mol. Imaging 33, 669–672 (2006).

    Article  PubMed  Google Scholar 

  20. Gross, M. D. et al. PET in the diagnostic evaluation of adrenal tumors. QJ Nucl. Med. Mol. Imaging 51, 272–283 (2007).

    CAS  Google Scholar 

  21. Sisson, J. C. et al. Scintigraphic localization of pheochromocytoma. N. Engl. J. Med. 305, 12–17 (1981).

    Article  CAS  PubMed  Google Scholar 

  22. Shapiro, B. et al. 131I-meta-iodobenzylguaindine (MIBG) adrenal medullary scintigraphy: interventional studies. In Interventional Nuclear Medicine (Ed. Spencer, R. P.) 451–481 (Grune & Stratton, New York, 1983).

    Google Scholar 

  23. Rosenspire, K. C. et al. Synthesis and preliminary evaluation of (11C) metahydroxyephedrine: a false neurotransmitter agent for heart neuronal imaging. J. Nucl. Med. 31, 1328–1334 (1990).

    CAS  PubMed  Google Scholar 

  24. Nilsson, O. et al. Importance of vesicle proteins in the diagnosis and treatment of neuroendocrine tumors. Ann. NY Acad. Sci. 1014, 280–283 (2004).

    Article  CAS  PubMed  Google Scholar 

  25. Ilias, I. & Pacak, K. Anatomical and functional imaging of metastatic pheochromocytoma. Ann. NY Acad. Sci. 1018, 495–504 (2004).

    Article  CAS  PubMed  Google Scholar 

  26. Eriksson, B. et al. The role of PET in the localization of neuroendocrine and adrenocortical tumors. Ann. NY Acad. Sci. 970, 159–169 (2002).

    Article  CAS  PubMed  Google Scholar 

  27. Ruffini, V., Calcagni, M. L. & Baum, R. P. Imaging of neuroendocrine tumors. Semin. Nucl. Med. 36, 228–247 (2006).

    Article  Google Scholar 

  28. Van der Harst, E. et al. 123I-Metaiodobenzylguanidine and 111In-octreotide uptake in benign and malignant pheochromocytomas. J. Clin. Endocrinol. Metab. 86, 685–693 (2001).

    CAS  PubMed  Google Scholar 

  29. Chen, L. et al. Cardiac pheochromocytomas detected by Tc-99m-hydrazinonicotinyl-tyr3-octreotide (HYNIC-TOC) scintigraphy. Clin. Nucl. Med. 32, 182–185 (2007).

    Article  PubMed  Google Scholar 

  30. Win, Z. et al. 68Ga-DOTATATE PET in neuroectodermal tumours: first experience. Nucl. Med. Commun. 28, 359–363 (2007).

    Article  PubMed  Google Scholar 

  31. Yun, M. et al. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J. Nucl. Med. 42, 1795–1799 (2001).

    CAS  PubMed  Google Scholar 

  32. Metser, U. et al. 18F-FDG PET/CT in the evaluation of adrenal masses. J. Nucl. Med. 47, 32–37 (2006).

    PubMed  Google Scholar 

  33. Russell, C., Goodacre, B. W., van Sonnenberg, E. & Orihuela, E. Spontaneous rupture of adrenal myelolipoma: spiral CT appearance. Abdom. Imaging 25, 431–434 (2000).

    Article  CAS  PubMed  Google Scholar 

  34. Cyran, K. M., Kenney, P. J., Memel, D. S. & Yacoub, I. Adrenal myelolipoma. AJR Am. J. Roentgenol. 166, 395–400 (1996).

    Article  CAS  PubMed  Google Scholar 

  35. Rao, P., Kenney, P. J., Wagner, B. J. & Davidson, A. J. Imaging and pathologic features of myelolipoma. Radiographics 17, 1373–1385 (1997).

    Article  CAS  PubMed  Google Scholar 

  36. Cheema, P., Cartagena, R. & Staubitz, W. Adrenal cysts: diagnosis and treatment. J. Urol. 126, 396–399 (1981).

    Article  CAS  PubMed  Google Scholar 

  37. Rozenblit, A., Morehouse, H. T. & Amis, E. S. Jr. Cystic adrenal lesions: CT features. Radiology 201, 541–548 (1996).

    Article  CAS  PubMed  Google Scholar 

  38. Xarli, V. P. et al. Adrenal hemorrhage in the adult. Medicine (Baltimore) 57, 211–221 (1978).

    Article  CAS  Google Scholar 

  39. Burks, D. W., Mirvis, S. E. & Shanmuganathan, K. Acute adrenal injury after blunt abdominal trauma: CT findings. Am. J. Roentgenol. 158, 503–507 (1992).

    Article  CAS  Google Scholar 

  40. Roubidoux, M. A. MR imaging of hemorrhage and iron deposition in the kidney. Radiographics 14, 1033–1044 (1994).

    Article  CAS  PubMed  Google Scholar 

  41. Kawashima, A. et al. Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics 19, 949–963 (1999).

    Article  CAS  PubMed  Google Scholar 

  42. Korobkin, M. et al. Adrenal adenomas: Relationship between histologic lipid and CT and MR findings. Radiology 200, 743–747 (1996).

    Article  CAS  PubMed  Google Scholar 

  43. Krestin, G. P., Freidmann, G., Fishbach, R., Neufang, K. F. & Allolio, B. Evaluation of adrenal masses in oncologic patients: dynamic contrast-enhanced MR vs CT. J. Comput. Assist. Tomogr. 15, 104–110 (1991).

    Article  CAS  PubMed  Google Scholar 

  44. Korobkin, M. et al. CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR Am. J. Roentgenol. 170, 747–752 (1998).

    Article  CAS  PubMed  Google Scholar 

  45. Reinig, J. W., Doppman, J. L., Dwyer, A. J., Johnson, A. R. & Knop, R. H. Adrenal masses differentiated by MR. Radiology 158, 81–84 (1986).

    Article  CAS  PubMed  Google Scholar 

  46. Outwater, E. K., Siegelman, E. S., Radecki, P. D., Piccoli, C. W. & Mitchell, D. G. Distinction between benign and malignant adrenal masses: value of T1-weighted chemical-shift MR imaging. Am. J. Roentgenol. 165, 579–583 (1995).

    Article  CAS  Google Scholar 

  47. Sutton, M. G., Sheps, S. G. & Lie, J. T. Prevalence of clinically unsuspected pheochromocytoma: review of a 50-year autopsy series. Mayo Clin. Proc. 56, 354–360 (1981).

    CAS  PubMed  Google Scholar 

  48. Lucon, A. M. et al. Pheochromocytoma: study of 50 cases. J. Urol. 157, 1208–1212 (1997).

    Article  CAS  PubMed  Google Scholar 

  49. Szolar, D. H. et al. Adrenocortical carcinoma and adrenal pheochromocytoma: mass and enhancement loss evalaution at delayed contrast enhanced CT. Radiology 234, 479–485 (2005).

    Article  PubMed  Google Scholar 

  50. Bessell-Browne, R. & O'Malley, M. E. CT of phromocytoma and paraganglioma: risk of adverse events with IV administration of nonionic contrast material. AJR Am. J. Roentgenol. 188, 970–974 (2007).

    Article  PubMed  Google Scholar 

  51. Blake, M. A. et al. Pheochromocytoma: an imaging chameleon. Radiographics 24 (Suppl. 1), S87–S89 (2004).

    Article  PubMed  Google Scholar 

  52. Dunnick, N. R., Heaston, D., Halvorsen, R., Moore, A. V. & Korobkin, M. CT appearance of adrenal cortical carcinoma. J. Comput. Assist. Tomogr. 6, 978–982 (1982).

    Article  CAS  PubMed  Google Scholar 

  53. Fishman, E. K. et al. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. AJR Am. J. Roentgenol. 148, 531–535 (1987).

    Article  CAS  PubMed  Google Scholar 

  54. Dunnick, N. R., Doppman, J. L. & Geelhoed, G. W. Intravenous extension of endocrine tumors. AJR Am. J. Roentgenol. 135, 471–476 (1980).

    Article  CAS  PubMed  Google Scholar 

  55. Wilson, D. A., Muchmore, H. G., Tisdal, R. G., Fahmy, A. & Pitha, J. V. Histoplasmosis of the adrenal gland studied by CT. Radiology 150, 779–783 (1984).

    Article  CAS  PubMed  Google Scholar 

  56. Ferrozzi, F., Tognini, G., Bova, D., Zuccoli, G. & Pavone, P. Hemangiosarcoma of the adrenal glands: CT findings in two cases. Abdom. Imaging 26, 336–339 (2001).

    Article  CAS  PubMed  Google Scholar 

  57. Kawashima, A. et al. Spectrum of CT findings in nonmalignant disease of the adrenal gland. Radiographics 18, 393–412 (1988).

    Article  Google Scholar 

  58. Krebs, T. L. & Wagner, B. J. MR imaging of the adrenal gland: Radiologic-pathologic correlation. Radiographics 18, 1425–1440 (1998).

    Article  CAS  PubMed  Google Scholar 

  59. Radin, R., David, C. L., Goldfarb, H. & Francis, I. R. Adrenal and extra-adrenal retroperitoneal ganglioneuroma: imaging findings in 13 adults. Radiology 202, 703–707 (1997).

    Article  CAS  PubMed  Google Scholar 

  60. Johnson, G. L., Hruban, R. H., Marshall, F. F. & Fishman, E. K. Primary adrenal ganglioneuroma: CT findings in four patients. AJR Am. J. Roentgenol. 169, 169–171 (1997).

    Article  CAS  PubMed  Google Scholar 

  61. Falchook, F. S. & Allard, J. C. CT of primary adrenal lymphoma. J. Comput. Assist. Tomogr. 15, 1048–1050 (1991).

    Article  CAS  PubMed  Google Scholar 

  62. Paling, M. R. & Williamson, B. R. Adrenal involvement in non-Hodgkin lymphoma. AJR Am. J. Roentgenol. 141, 303–305 (1983).

    Article  CAS  PubMed  Google Scholar 

  63. Abrams, H. L., Spiro, R. & Goldstein, N. Metastases in carcinoma: analysis of 1,000 autopsied cases. Cancer 3, 74–85 (1950).

    Article  CAS  PubMed  Google Scholar 

  64. Lee, M. J. et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology 179, 415–418 (1991).

    Article  CAS  PubMed  Google Scholar 

  65. Korobkin, M. et al. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am. J. Roentgenol. 166, 531–536 (1996).

    Article  CAS  PubMed  Google Scholar 

  66. Boland, G. W. et al. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am. J. Roentgenol. 171, 201–204 (1998).

    Article  CAS  PubMed  Google Scholar 

  67. Hamrahian, A. M. et al. Clinical utility of noncontrast computed tomography attenuation value (Hounsfield Units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience. J. Clin. Endocrinol. Metab. 90, 871–877 (2005).

    Article  CAS  PubMed  Google Scholar 

  68. Mitchell, D. G., Crovello, M., Matteucci, T., Petersen, R. O. & Miettinen, M. M. Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 185, 345–351 (1992).

    Article  CAS  PubMed  Google Scholar 

  69. Outwater, E. K., Siegelman, E. S., Radecki, P. D., Piccoli, C. W. & Mitchell, D. G. Distinction between benign and malignant adrenal masses: Value of T1-weighted chemical-shift MR imaging. AJR Am. J. Roentgenol. 165, 579–583 (1995).

    Article  CAS  PubMed  Google Scholar 

  70. Outwater, E. K., Siegelman, E. S., Huang, A. B. & Birnbaum, B. A. Adrenal masses: correlation between CT attenuation value and chemical shift ratio at MR imaging with in-phase and opposed-phase sequences. Radiology 200, 749–752 (1996).

    Article  CAS  PubMed  Google Scholar 

  71. Szolar, D. H. & Kammerhuber, F. Quantitative CT evaluation of adrenal gland masses: a step forward in the differentiation between adenomas and nonadenomas? Radiology 202, 517–521 (1997).

    Article  CAS  PubMed  Google Scholar 

  72. Szolar, D. H. & Kammerhuber, F. H. Adrenal adenomas and nonadenomas: assessment of washout at delayed contrast-enhanced CT. Radiology 207, 369–375 (1998).

    Article  CAS  PubMed  Google Scholar 

  73. Caoili, E. M., Korobkin, M., Francis, I. R., Cohan, R. H. & Dunnick, N. R. Delayed enhanced CT of lipid-poor adrenal adenomas. AJR Am. J. Roentgenol. 175, 1411–1415 (2000).

    Article  CAS  PubMed  Google Scholar 

  74. Khafagi, F. A. et al. The clinical significance of the large adrenal mass. Br. J. Surg. 78, 828–833 (1991).

    Article  CAS  PubMed  Google Scholar 

  75. Gross, M. D. et al. Scintigraphic evaluation of clinically silent adrenal masses. J. Nucl. Med. 35, 1145–1152 (1994).

    CAS  PubMed  Google Scholar 

  76. Kloos, R. T. et al. Diagnostic dilemma of small incidentally discovered adrenal masses: a role for 131-I-6β-iodomethyl-norcholesterol (NP-59) scintigraphy. World J. Surg. 21, 36–40 (1997).

    Article  CAS  PubMed  Google Scholar 

  77. Maurea, S., Klain, M., Mainolfi, C., Ziviello, M. & Salvatore, M. The diagnostic role of radionuclide imaging in evaluation of patients with nonhypersecreting adrenal masses. J. Nucl. Med. 42, 884–892 (2001).

    CAS  PubMed  Google Scholar 

  78. Maurea, S., Caracò, C., Klain, M., Mainolfi, C. & Salvatore, M. Imaging characterization of non-hypersecreting adrenal masses. Comparison between MR and radionuclide techniques. QJ Nucl. Med. Mol. Imaging 48, 188–197 (2004).

    CAS  Google Scholar 

  79. Vikram, R., Yeung, H. D., Macapinlac, H. A. & Iyer, R. B. Utility of PET/CT in differentiating patients with cancer. AJR Am. J. Roentgenol. 191, 1545–1551 (2008).

    Article  PubMed  Google Scholar 

  80. Kumar, R. et al. 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J. Nucl. Med. 45, 2058–2062 (2004).

    PubMed  Google Scholar 

  81. Blake, M. A. et al. Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy—initial experience. Radiology 328, 970–977 (2006).

    Article  Google Scholar 

  82. Khan, T. S. et al. 11C-metomidate imaging of adrenocortical cancer. Eur. J. Nucl. Med. Mol. Imaging 30, 403–410 (2003).

    Article  PubMed  Google Scholar 

  83. Hennings, J. et al. [11C]Metomidate positron emission tomography of adrenocortical tumors in correlation with histopathological findings. J. Clin. Endocrinol. Metab. 91, 1410–1414 (2006).

    Article  CAS  PubMed  Google Scholar 

  84. Caroili, E. M., Korobkin, M., Brown, R. K., Mackie, G. & Shulkin, B. L. Differentiating adrenal adenomas from nonadenomas using 18F-FDG PET/CT: quantitative and qualitative evaluation. Acad. Radiol. 14, 468–475 (2007).

    Article  Google Scholar 

  85. Eriksson, B. et al. The role of PET in the localization of neuroendocrine and adrenocortical tumors. Ann. NY Acad. Sci. 970, 159–169 (2002).

    Article  CAS  PubMed  Google Scholar 

  86. Shulkin, B. L., Ilias, I., Sisson, J. C. & Pacak, K. Current trends in functional imaging of pheochromocytomas and paragangliomas. Ann. NY Acad. Sci. 1073, 374–382 (2006).

    Article  PubMed  Google Scholar 

  87. Ilias, I. et al. Superiority of 6-[18F]-Fluorodopamine positron emission tomography versus [131I]-metaiodobenzylguanidine scintography in the localization of metastatic pheochromocytoma. J. Clin. Endocrinol. Metab. 88, 4083–4087 (2003).

    Article  CAS  PubMed  Google Scholar 

  88. Ilias, I. & Pacak, K. Diagnosis and management of tumors of the adrenal medulla. Horm. Metab. Res. 37, 717–721 (2005).

    Article  CAS  PubMed  Google Scholar 

  89. Ilias, I. et al. Comparison of 6-18F-Fluorodopamine PET with 123I-Metaiodobenzylguanidine and 111In-Pentetreotide scintigraphy in localization of non-metastatic and metastatic pheochromocytoma. J. Nucl. Med. 49, 1613–1619 (2008).

    Article  PubMed  Google Scholar 

  90. Bombardieri, E., Seregni, E., Villano, C., Chiti, A. & Bajetta, E. Position of nuclear medicine techniques in the diagnostic work-up of neuroendocrine tumors. QJ Nucl. Med. Mol. Imaging 48, 150–163 (2004).

    CAS  Google Scholar 

  91. Miyoshi, T. et al. Abrupt enlargement of adrenal incidentaloma: a case of isolated adrenal metastasis. Endocr. J. 52, 785–788 (2005).

    Article  PubMed  Google Scholar 

  92. Kasperlik-Zaluska, A. A. et al. Incidentally discovered adrenal tumors: a lesson from observation of 1,444 patients. Horm. Metab. Res. 40, 338–341 (2008).

    Article  CAS  PubMed  Google Scholar 

  93. Vilar, L. et al. Adrenal incidentalomas: diagnostic evaluation and long-term follow-up. Endocr. Pract. 14, 269–278 (2008).

    Article  PubMed  Google Scholar 

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA

    Milton D. Gross & Mehdi Djekidel

  2. Department of Radiology, Division of Abdominal Imaging, University of Michigan Medical Center, Ann Arbor, MI, USA

    Melvyn Korobkin

  3. Department of Veterans Affairs Health System, Radiology Service, Ann Arbor, MI, USA

    Wessam Bou Assaly

  4. Department of Veterans Affairs Health System, Nuclear Medicine Service, Ann Arbor, MI, USA

    Milton D. Gross & Ben Dwamena

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Gross, M., Korobkin, M., Assaly, W. et al. Contemporary imaging of incidentally discovered adrenal masses. Nat Rev Urol 6, 363–373 (2009). https://doi.org/10.1038/nrurol.2009.100

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