Adrenal Incidentaloma: When to keep suspecting even after good washout time?
PDF (Español (España))
HTML (Español (España))


Adrenocortical Adenoma
Adrenal Gland Neoplasms
Adrenocortical carcinoma
Magnetic Resonance Imaging Tomography
X-Ray Computed

How to Cite

Duque-Ramírez, J., Castro-Pinzón, A., & Díaz-Tribaldos, D. (2021). Adrenal Incidentaloma: When to keep suspecting even after good washout time?. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 7(3), 200–204.


We present the case of a 58-year-old male with an incidental left adrenal mass. The adrenal contrast-enhanced computer tomography protocol showed an absolute washout time of 72 %. An abdomen magnetic resonance imaging was also performed, showing intermediate signal intensity in T2 and low intensity in T1, with poor lipid content in the in-phase and out-of-phase sequences. The biochemistry showed a possible cortisol production with a slightly unsuppressed 1 mg postdexamethasone suppression test, and an elevated 17 hydroxyprogesterone. The diagnostic and therapeutic approach of the adrenal incidentaloma is discussed in this paper.
PDF (Español (España))
HTML (Español (España))


1. Sherlock M, Scarsbrook A, Abbas A, Fraser S, Limumpornpetch P, Dineen R, et al. Adrenal Incidentaloma. Endocr Rev. 2020;41(6):775-820. doi: 10.1210/endrev/bnaa008
2. Ferreira EV, Czepielewski MA, Faccin CS, Accordi MC, Furtado APA. [Prevalence of adrenal incidentaloma at computed tomography (chest and abdominal) in a general hospital in Brazil]. Arq Bras Endocrinol Metabol. 2005;49(5):769–75. doi: 10.1590/s0004-27302005000500017
3. Mantero F, Arnaldi G. Management approaches to adrenal incidentalomas. A view from Ancona, Italy. Endocrinol Metab Clin North Am. 2000;29(1):107-25, ix. doi: 10.1016/s0889-8529(05)70119-5
4. Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol. 1998;171(1):201-4. doi: 10.2214/ ajr.171.1.9648789
5. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1- 34. doi: 10.1530/EJE-16-0467
6. Angelelli G, Mancini ME, Moschetta M, Pedote P, Pignataro P, Scardapane A. MDCT in the differentiation of adrenal masses: comparison between different scan delays for the evaluation of intralesional washout. ScientificWorldJournal. 2013;2013:957680. doi: 10.1155/2013/957680
7. Lee JH, Kim EK, Hong AR, Roh E, Bae JH, Kim JH, et al. Radiographic Characteristics of Adrenal Masses in Oncologic Patients. Endocrinol Metab (Seoul). 2016;31(1):147-52. doi: 10.3803/EnM.2016.31.1.147
8. Schieda N, Siegelman ES. Update on CT and MRI of Adrenal Nodules. AJR Am J Roentgenol. 2017;208(6):1206-17. doi: 10.2214/AJR.16.17758.
9. Platzek I, Sieron D, Plodeck V, Borkowetz A, Laniado M, Hoffmann R-T. Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis. Eur Radiol. 2019;29(2):806-17. doi: 10.1007/ s00330-018-5626-5
10. Kamenicky P, Houdoin L, Ferlicot S, Salenave S, Brailly S, Droupy S, et al. Benign cortisol-secreting adrenocortical adenomas produce small amounts of androgens. Clin Endocrinol. 2007;66(6):778-88. doi: 10.1111/j.1365- 2265.2007.02810.x
11. Cawood TJ, Hunt PJ, O’Shea D, Cole D, Soule S. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur J Endocrinol. 2009;161(4):513-27. doi: 10.1530/EJE-09-0234
12. Lenders JWM, Duh Q-Y, Eisenhofer G, Gimenez-Roqueplo A-P, Grebe SKG, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. doi: 10.1210/jc.2014-1498
13. Vassilatou E, Vryonidou A, Michalopoulou S, Manolis J, Caratzas J, Phenekos C, et al. Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin Endocrinol. 2009;70(5):674-9. doi: 10.1111/j.1365-2265.2008.03492.x
14. Fassnacht M, Dekkers O, Else T, Baudin E, Berruti A, de Krijger R, et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1-46. doi: 10.1530/EJE-18-0608
15. Fassnacht M, Assie G, Baudin E, Eisenhofer G, de la Douchardiere C, Haak H, et al. Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(11):1476-90. doi: 10.1016/j.annonc.2020.08.2099
16. Naranjo J, Dodd S, Martin YN. Perioperative Management of Pheochromocytoma. J Cardiothorac Vasc Anesth. 2017;31(4):1427-39. doi: 10.1053/j. jvca.2017.02.023
17. Fang F, Ding L, He Q, Liu M. Preoperative Management of Pheochromocytoma and Paraganglioma. Front Endocrinol (Lausanne). 2020;11:586795. doi: 10.3389/fendo.2020.586795.

Authors must state that they reviewed, validated and approved the manuscript's publication.  Moreover, they must sign a model release that should be sent.  A copy may be reviewed here




Download data is not yet available.