Adrenal masses are found on approximately 1% of abdominal CT or MRI scans. If the scan was done for a reason other than to look for an adrenal mass, then the term ‘incidentaloma’ is applied to the mass that is found.
The first step if such a mass is found is to perform specialised blood and urine tests to make sure the mass is not producing too much hormone. This can lead to Conn’s or Cushing’s syndrome, or be associated with a phaeochromocytoma, as discussed in the previous sections.
If the mass is not producing hormones, and the person has had a previous cancer, then a needle biopsy of the mass may be indicated, to see if the mass could have resulted from spread of the previously treated cancer. If this is the case, and there are no other signs of tumour spread, then removal of the affected adrenal gland may be curative.
If the mass is not producing hormones, and the person has not had a previous cancer, then the decision whether to surgically remove the adrenal gland depends on its size and appearance on the scan. If the mass is bigger than 4cm, or looks concerning on the scan, then operation to remove the affected gland should be considered. This is because the mass is more likely to be a cancer arising from the adrenal gland itself if it is bigger than 4cm in size. It should be emphasised, however, that cancer arising from the adrenal gland is very rare, and affects only 1-2 people per million per year. Most masses larger than 4cm, therefore, turn out to be non-cancerous (benign), but often the only way to tell this for sure is for a pathologist to examine the entire mass under a microscope after removal.
Masses up to around 10cm can be removed using a laparoscopic (minimally invasive) technique, but for masses greater than 10cm, or in those where the scan is very suspicious of cancer, then the operation should be performed through a larger scar across the abdomen (belly) or flank.