Skip to main content
SpringerLink
Log in

Diagnostic Approach to Incidentaloma

  • Chapter
  • First Online:
Adrenocortical Carcinoma

  • 631 Accesses

Abstract

Adrenal incidentalomas (AI) are masses of the adrenal gland discovered inadvertently during diagnostic imaging for other conditions unrelated to adrenal disease. Incidentally found adrenal tumors were first described more than 25 years ago [1–3]. Improvements in imaging technologies, their increasing availability and use have led to increasing recognition of AI as a public health problem in the aging population [4–6]. Prevalences of AI discovered by CT vary in an age-dependent manner from as low as 0.2% in the young (<30 years) to 6.9% or more in the elderly (50–80 years) [6–9]. AI seems to be more frequent in female subjects [6]. However, they comprise a heterogeneous group of diseases, including primary and secondary tumors, benign and malignant lesions, and endocrine masses with or without clinically relevant autonomous hormone secretion [10]. Patients with an AI have a decreased life expectancy, and evidence-based clinical management is cost-effective [11].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Copeland PM (1983) The incidentally discovered adrenal mass. Ann Intern Med 98:940–945

    PubMed  CAS  Google Scholar 

  2. Geelhoed GW, Druy EM (1982) Management of the adrenal “incidentaloma”. Surgery 92:866–874

    PubMed  CAS  Google Scholar 

  3. Prinz RA et al (1982) Incidental asymptomatic adrenal masses detected by computed tomographic scanning. Is operation required? JAMA 248:701–704

    CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. Grumbach MM et al (2003) Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 138:424–429

    PubMed  Google Scholar 

  6. Mansmann G et al (2004) The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 25:309–340

    Article  PubMed  Google Scholar 

  7. Granger P, Genest J (1970) Autopsy study of adrenals in unselected normotensive and hypertensive patients. Can Med Assoc J 103:34–36

    PubMed  CAS  Google Scholar 

  8. Mantero F et al (2000) A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 85:637–644

    Article  PubMed  CAS  Google Scholar 

  9. Young WF Jr (2007) The incidentially discovered adrenal mass. N Eugl J Med 356:601–610

    Article  CAS  Google Scholar 

  10. Kloos RT et al (1995) Incidentally discovered adrenal masses. Endocr Rev 16:460–484

    PubMed  CAS  Google Scholar 

  11. Kievit J, Haak HR (2000) Diagnosis and treatment of adrenal incidentaloma. A cost-effectiveness analysis. Endocrinol Metab Clin North Am 29:69–90

    Article  PubMed  CAS  Google Scholar 

  12. Bornstein SR et al (1999) Adrenocortical tumors: recent advances in basic concepts and clinical management. Ann Intern Med 130:759–771

    PubMed  CAS  Google Scholar 

  13. Ambrosi B et al (1995) Abnormalities of endocrine function in patients with clinically “silent” adrenal masses. Eur J Endocrinol 132:422–428

    Article  PubMed  CAS  Google Scholar 

  14. Corsello SM et al (1993) Incidentally discovered adrenal masses: a functional and morphological study. Exp Clin Endocrinol 101:131–137

    Article  PubMed  CAS  Google Scholar 

  15. Gaboardi F et al (1991) Adrenal incidentalomas: what is the role of fine needle biopsy? Int Urol Nephrol 23:197–207

    Article  PubMed  CAS  Google Scholar 

  16. Guerrero LA (1985) Diagnostic and therapeutic approach to incidental adrenal mass. Urology 26:435–440

    Article  PubMed  CAS  Google Scholar 

  17. Kasperlik-Załuska AA et al (2008) Incidentally discovered adrenal tumors: a lesson from observation of 1444 patients. Horm Metab Res 40:338–341

    Article  PubMed  CAS  Google Scholar 

  18. Latronico AC, Chrousos GP (1997) Extensive personal experience: adrenocortical tumors. J Clin Endocrinol Metab 82:1317–1324

    Article  PubMed  CAS  Google Scholar 

  19. Osella G et al (1994) Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J Clin Endocrinol Metab 79:1532–1539

    Article  PubMed  CAS  Google Scholar 

  20. Terzolo M et al (1995) Adrenal incidentaloma, a five year experience. Minerva Endocrinol 20:69–78

    PubMed  CAS  Google Scholar 

  21. Schteingart DE (2000) Management approaches to adrenal incidentalomas. A view from Ann Arbor, Michigan. Endocrinol Metab Clin North Am 29:127–139

    Article  PubMed  CAS  Google Scholar 

  22. Virkkala A et al (1989) Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography. Acta Endocrinol (Copenh) 121:67–72

    CAS  Google Scholar 

  23. Kjellman M et al (2001) Genetic background of adrenocortical tumor development. World J Surg 25:948–956

    Article  PubMed  CAS  Google Scholar 

  24. Tadjine M et al (2008) Frequent mutations of beta-catenin gene in sporadic secreting adrenocortical adenomas. Clin. Endocrinol 68:264–270

    CAS  Google Scholar 

  25. Tissier F et al (2005) Mutations of beta-catenin in adrenocortical tumors: activation of the Wnt signaling pathway is a frequent event in both benign and malignant adrenocortical tumors. Cancer Res 65:7622–7627

    PubMed  CAS  Google Scholar 

  26. Jaresch S et al (1992) Adrenal incidentaloma and patients with homozygous or heterozygous congenital adrenal hyperplasia. J Clin Endocrinol Metab 74:685–689

    Article  PubMed  CAS  Google Scholar 

  27. Adams JE et al (1983) Computed tomography in adrenal disease. Clin Radiol 34:39–49

    Article  PubMed  CAS  Google Scholar 

  28. Sutton MG et al (1981) Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc 56:354–360

    PubMed  CAS  Google Scholar 

  29. Bernini GP et al (1997) Frequency of pheochromocytoma in adrenal incidentalomas and utility of the glucagon test for the diagnosis. J Endocrinol Invest 20:65–71

    PubMed  CAS  Google Scholar 

  30. Mannelli M et al (1999) Pheochromocytoma in Italy: a multicentric retrospective study. Eur J Endocrinol 141:619–624

    Article  PubMed  CAS  Google Scholar 

  31. Neumann HP et al (2002) Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med 346:1459–1466

    Article  PubMed  CAS  Google Scholar 

  32. Pacak K et al (2007) International Symposium on Pheochromocytoma. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. Nat Clin Pract Endocrinol Metab 3:92–102

    Article  PubMed  Google Scholar 

  33. Saeger W et al (1998) Hyperplastic and tumorous lesions of the adrenals in an unselected autopsy series. Endocr Pathol 9:235–239

    Article  PubMed  Google Scholar 

  34. Kluglich M et al (1993) Ultrasound of incidental tumors of the adrenal gland and endocrine hypertension. Bildgebung 60:144–146

    PubMed  CAS  Google Scholar 

  35. Masumori N et al (1998) Detection of adrenal and retroperitoneal masses in a general health examination system. Urology 52:572–576

    Article  PubMed  CAS  Google Scholar 

  36. Suzuki K et al (1995) Efficacy of an ultrasonic surgical system for laparoscopic adrenalectomy. J Urol 154:484–486

    Article  PubMed  CAS  Google Scholar 

  37. Kann P et al (1998) Endosonography of the adrenal glands: normal size--pathological findings. Exp Clin Endocrinol Diabetes 106:123–129

    Article  PubMed  CAS  Google Scholar 

  38. Barzon L et al (1999) Risk factors and long-term follow-up of adrenal incidentalomas. J Clin Endocrinol Metab 84:520–526

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  40. Pena CS et al (2000) Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 217:798–802

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  43. Mayo-Smith WW et al (2001) State-of-the-art adrenal imaging. Radiographics 21:995–1012

    PubMed  CAS  Google Scholar 

  44. Francis IR, Korobkin M (1996) Pheochromocytoma. Radiol Clin North Am 34:1101–1112

    PubMed  CAS  Google Scholar 

  45. Chezmar JL et al (1988) Adrenal masses: characterization with T1-weighted MR imaging. Radiology 166:357–359

    PubMed  CAS  Google Scholar 

  46. Reinig JW et al (1986) MRI of indeterminate adrenal masses. AJR Am J Roentgenol 147:493–496

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  48. Tsushima Y (1994) Different lipid contents between aldosterone-producing and nonhyperfunctioning adrenocortical adenomas: in vivo measurement using chemical-shift magnetic resonance imaging. J Clin Endocrinol Metab 79:1759–1762

    Article  PubMed  CAS  Google Scholar 

  49. Outwater EK et al (1996) 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

    PubMed  CAS  Google Scholar 

  50. Gross MD et al (2002) Is there a future for adrenal scintigraphy? Nucl Med Commun 23:197–202

    Article  PubMed  CAS  Google Scholar 

  51. Hahner S et al (2008) [123 I] Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes. J Clin Endocrinol Metab 93:2358–2365

    Article  PubMed  CAS  Google Scholar 

  52. Rubello D et al (2002) Functional scintigraphy of the adrenal gland. Eur J Endocrinol 147:13–28

    Article  PubMed  CAS  Google Scholar 

  53. Shapiro B et al (1985) Iodine-131 metaiodobenzylguanidine for the locating of suspected pheochromocytoma: experience in 400 cases. J Nucl Med 26:576–585

    PubMed  CAS  Google Scholar 

  54. Tenenbaum F et al (1995) Comparison of radiolabeled octreotide and meta-iodobenzylguanidine (MIBG) scintigraphy in malignant pheochromocytoma. J Nucl Med 36:1–6

    PubMed  CAS  Google Scholar 

  55. van der Harst E et al (2001) [(123)I]metaiodobenzylguanidine and [(111)In]octreotide uptake in benign and malignant pheochromocytomas. J Clin Endocrinol Metab 86:685–693

    Article  PubMed  Google Scholar 

  56. Groussin L et al (2009) 18F-FDG PET for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients. J Clin Endocrinol Metab, PMID: 19190108

    Google Scholar 

  57. Boland GW et al (1995) Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-[18F]-fluoro-2-deoxy-D-glucose. Radiology 194:131–134

    PubMed  CAS  Google Scholar 

  58. Hoegerle S et al (2002) Pheochromocytomas: detection with 18F-DOPA whole body PET – initial results. Radiology 222:507–512

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  60. Pacak K et al (2001) 6-[18F]fluorodopamine positron emission tomographic (PET) scanning for diagnostic localization of pheochromocytoma. Hypertension 38:6–8

    PubMed  CAS  Google Scholar 

  61. Pacak K et al (2001) Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med 134:315–329

    PubMed  CAS  Google Scholar 

  62. Pacak K et al (2004) Functional imaging of endocrine tumors: role of positron emission tomography. Endocr Rev 25:568–580

    Article  PubMed  Google Scholar 

  63. Shulkin BL et al (2006) Current trends in functional imaging of pheochromocytomas and paragangliomas. Ann N Y Acad Sci 1073:374–382

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  65. Bergström M et al (2000) PET imaging of adrenal cortical tumors with the 11 beta-hydroxylase tracer 11C-metomidate. J Nucl Med 41:2752–2782

    Google Scholar 

  66. Weiss LM (1984) Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol 8:163–169

    Article  PubMed  CAS  Google Scholar 

  67. Lachenmayer A et al (2009) Nestin as a Marker in the Classification of Adrenocortical Tumors. Horm Metab Res 41:397–401

    Article  PubMed  CAS  Google Scholar 

  68. Marx C et al (1996) MHC class II expression – a new tool to assess dignity in adrenocortical tumours. J Clin Endocrinol Metab 81:4488–4491

    Article  PubMed  CAS  Google Scholar 

  69. Sasano H et al (1995) Transcription factor adrenal 4 binding protein as a marker of adrenocortical malignancy. Hum Pathol 26:1154–1156

    Article  PubMed  CAS  Google Scholar 

  70. Thompson LD (2002) Pheochromocytoma of the adrenal gland scaled score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol 26:551–566

    Article  PubMed  Google Scholar 

  71. Kopf D et al (2001) Clinical management of malignant adrenal tumors. J Cancer Res Clin Oncol 127:143–155

    Article  PubMed  CAS  Google Scholar 

  72. Mody MK et al (1995) Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr 19:434–439

    Article  PubMed  CAS  Google Scholar 

  73. Welch TJ et al (1994) Percutaneous adrenal biopsy: review of a 10-year experience. Radiology 193:341–344

    PubMed  CAS  Google Scholar 

  74. Harisinghani MG et al (2002) Predictive value of benign percutaneous adrenal biopsies in oncology patients. Clin Radiol 57:898–901

    Article  PubMed  CAS  Google Scholar 

  75. Saboorian MH et al (1995) Fine needle aspiration cytology of primary and metastatic lesions of the adrenal gland. A series of 188 biopsies with radiologic correlation. Acta Cytol 39:843–851

    PubMed  CAS  Google Scholar 

  76. Beuschlein F (2007) Adrenal incidentalomas: presentation and clinical work-up. Horm Res 68(Suppl 5):191–194

    Article  PubMed  Google Scholar 

  77. Aso Y, Homma Y (1992) A survey on incidental adrenal tumors in Japan. J Urol 147:147814–147881

    Google Scholar 

  78. Bernini G et al (2002) Primary aldosteronism in normokalemic patients with adrenal incidentalomas. Eur J Endocrinol 146:523–529

    Article  PubMed  CAS  Google Scholar 

  79. Caplan RH et al (1994) Subclinical hormone secretion by incidentally discovered adrenal masses. Arch Surg 129:291–296

    PubMed  CAS  Google Scholar 

  80. Barzon L et al (1998) Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab 83:55–62

    Article  PubMed  CAS  Google Scholar 

  81. Terzolo M et al (1998) Subclinical Cushing’s syndrome in adrenal incidentaloma. Clin Endocrinol (Oxf) 48:89–97

    Article  CAS  Google Scholar 

  82. Valli N et al (2001) Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas. Eur J Endocrinol 144:401–408

    Article  PubMed  CAS  Google Scholar 

  83. Funder JW et al (2008) Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93:3266–3281

    Article  PubMed  CAS  Google Scholar 

  84. Nieman LK et al (2008) The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 93:1526–1540

    Article  PubMed  CAS  Google Scholar 

  85. Reimondo G et al (2005) Evaluation of the effectiveness of midnight serum cortisol in the diagnostic procedures for Cushing’s syndrome. Eur J Endocrinol 153:803–809

    Article  PubMed  CAS  Google Scholar 

  86. Masserini B et al (2009) The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma. Eur J Endocrinol 160:87–92

    Article  PubMed  CAS  Google Scholar 

  87. Tanabe A et al (2001) Autonomy of cortisol secretion in clinically silent adrenal incidentaloma. Horm Metab Res 33:444–450

    Article  PubMed  CAS  Google Scholar 

  88. Montori VM, Young WF Jr (2002) Use of plasma aldosterone concentration-to-plasma renin activity ratio as a screening test for primary aldosteronism: a systematic review of the literature. Endocrinol. Metab Clin North Am 31:619–632

    Article  CAS  Google Scholar 

  89. Willenberg HS et al (2009) The serum sodium to urinary sodium to (serum potassium)2 to urinary potassium (SUSPPUP) ratio in patients with primary aldosteronism. Eur J Clin Invest 39:43–50

    Article  PubMed  CAS  Google Scholar 

  90. Balaş M et al (2010) Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism. Hypertension Res Published online.

    Google Scholar 

  91. Médeau V et al (2008) Clinical and Biochemical Characteristics of Normotensive Patients with Primary Aldosteronism: a Comparison with Hypertensive Cases. Clin Endocrinol 69:20–28

    Article  CAS  Google Scholar 

  92. Lenders JW et al (2002) Biochemical diagnosis of pheochromocytoma: which test is best? JAMA 287:1427–1434

    Article  PubMed  CAS  Google Scholar 

  93. Jaresch S et al (1987) Silent adrenal gland tumors in patients with adrenogenital syndrome. Klin Wochenschr 65:627–633

    Article  PubMed  CAS  Google Scholar 

  94. Seppel T, Schlaghecke R (1994) Augmented 17a-hydroxy-progesterone response to ACTH stimulation as evidence of decreased 21-hydroxylase activity in patients with incidentally discovered adrenal tumours (incidentalomas). Clin Endocrinol 41:445–451

    Article  CAS  Google Scholar 

  95. Mantero F et al (1997) Adrenal incidentaloma: an overview of hormonal data from the National Italian Study Group. Horm Res 47:284–289

    Article  PubMed  CAS  Google Scholar 

  96. Terzolo M et al (1996) Different patterns of steroid secretion in patients with adrenal incidentaloma. J Clin Endocrinol Metab 81:740–744

    Article  PubMed  CAS  Google Scholar 

  97. Willenberg HS et al (2002) The short synacthen test in the evaluation of adrenal masses in patients with malignancies. Endocr Res 4:793–797

    Article  Google Scholar 

  98. Beuschlein F et al (1998) Steroid 21-hydroxylase mutations and 21-hydroxylase messenger ribonucleic acid expression in human adrenocortical tumors. J Clin Endocrinol Metab 83:2585–2588

    Article  PubMed  CAS  Google Scholar 

  99. Patócs A et al (2002) Hormonal evaluation and mutation screening for steroid 21-hydroxylase deficiency in patients with unilateral and bilateral adrenal incidentalomas. Eur J Endocrinol 147:349–355

    Article  PubMed  Google Scholar 

  100. Francucci CM et al (2002) Bone metabolism and mass in women with Cushing’s syndrome and adrenal incidentaloma. Clin Endocrinol 57:587–593

    Article  CAS  Google Scholar 

  101. Garrapa GG et al (2001) Body composition and metabolic features in women with adrenal incidentaloma or Cushing’s syndrome. J Clin Endocrinol Metab 86:5301–5306

    Article  PubMed  CAS  Google Scholar 

  102. Midorikawa S et al (2001) The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf) 54:797–804

    Article  CAS  Google Scholar 

  103. Osella G et al (2001) The patients with incidentally discovered adrenal adenoma (incidentaloma) are not at increased risk of osteoporosis. J Clin Endocrinol Metab 86:604–607

    Article  PubMed  CAS  Google Scholar 

  104. Rossi R et al (2000) Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 85:1440–1448

    Article  PubMed  CAS  Google Scholar 

  105. Sereg M et al (2009) Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study. Eur J Endocrinol 160:647–655

    Article  PubMed  CAS  Google Scholar 

  106. Tauchmanova L et al (2001) Bone loss determined by quantitative ultrasonometry correlates inversely with disease activity in patients with endogenous glucocorticoid excess due to adrenal mass. Eur J Endocrinol 145:241–247

    Article  PubMed  CAS  Google Scholar 

  107. Tsagarakis S et al (1998) The low-dose dexamethasone suppression test in patients with adrenal incidentalomas: comparisons with clinically euadrenal subjects and patients with Cushing’s syndrome. Clin Endocrinol 48:627–633

    Article  CAS  Google Scholar 

  108. Barzon L et al (2002) Development of overt Cushing’s syndrome in 386 patients with adrenal incidentaloma. Eur J Endocrinol 146:61–66

    Article  PubMed  CAS  Google Scholar 

  109. Bülow B et al (2006) Adrenal incidentaloma – follow-up results from a Swedish prospective study. Eur J Endocrinol 154:419–423

    Article  PubMed  CAS  Google Scholar 

  110. Charbonnel B et al (1981) Does the corticoadrenal adenoma with “pre-Cushing’s syndrome” exist? J Nucl Med 22:1059–1061

    PubMed  CAS  Google Scholar 

  111. Terzolo M et al (2002) Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab 87:998–1003

    Article  PubMed  CAS  Google Scholar 

  112. Fagour C et al (2009) Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study. Eur J Endocrinol 160:257–264

    Article  PubMed  CAS  Google Scholar 

  113. Reincke M et al (1992) Preclinical Cushing’s syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab 75:826–832

    Article  PubMed  CAS  Google Scholar 

  114. Sippel RS, Chen H (2004) Subclinical Cushing’s syndrome in adrenal incidentalomas. Surg Clin N Am 84:875–885

    Article  PubMed  Google Scholar 

  115. Tauchmanova L et al (2002) Patients with subclinical Cushing’s syndrome due to adrenal adenoma have Increased cardiovascular risk. J Clin Endocrinol Metab 87:4872–4878

    Article  PubMed  CAS  Google Scholar 

  116. Reincke M (2000) Subclinical Cushing’s syndrome. Endocrinol Metab Clin North Am 29:43–56

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Rheumatology, University Hospital Duesseldorf, Moorenstr. 5, D–40225, Duesseldorf, Germany

    Holger S. Willenberg

  2. Department of Medicine, Carl Gustav Carus Medical School, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Stefan R. Bornstein

Authors
  1. Holger S. Willenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan R. Bornstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Holger S. Willenberg .

Editor information

Editors and Affiliations

  1. Zina Pitcher Place 109, Ann Arbor, 48109-2200, Michigan, USA

    Gary D. Hammer

  2. Dept. Internal Medicine, Div. Pulmonary & Critical Care Medicine, University of Michigan Health System, Zina Pitcher Place 109, Ann Arbor, 48109-2200, Michigan, USA

    Tobias Else

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Willenberg, H.S., Bornstein, S.R. (2009). Diagnostic Approach to Incidentaloma. In: Hammer, G., Else, T. (eds) Adrenocortical Carcinoma. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77236-3_5

Download citation

Publish with us

Policies and ethics

Search

Navigation