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NIH CONFERENCE

Management of the Clinically Inapparent Adrenal Mass ("Incidentaloma")

Melvin M. Grumbach, MD; Beverly M.K. Biller, MD; Glenn D. Braunstein, MD; Karen K. Campbell; J. Aidan Carney, MD, PhD; Paul A. Godley, MD, MPP; Emily L. Harris, PhD, MPH; Joseph K.T. Lee, MD; Yolanda C. Oertel, MD; Mitchell C. Posner, MD; Janet A. Schlechte, MD; and H. Samuel Wieand, PhD

4 March 2003 | Volume 138 Issue 5 | Pages 424-429

The National Institutes of Health Consensus Development Program convened surgeons, endocrinologists, pathologists, biostatisticians, radiologists, oncologists, and other health care professionals, as well as members of the general public, to address the causes, prevalence, and natural history of clinically inapparent adrenal masses, or "incidentalomas"; the appropriate evaluation and treatment of such masses; and directions for future research. Improvements in abdominal imaging techniques have increased detection of adrenal incidentalomas, and because the prevalence of these masses increases with age, appropriate management of adrenal tumors will be a growing challenge in our aging society. To address six predetermined questions, the 12-member nonfederal, nonadvocate state-of-the-science panel heard presentations from 21 experts in adrenal incidentalomas and consulted a systematic review of medical literature on the topic provided by the Agency for Healthcare Research and Quality and an extensive bibliography developed by the National Library of Medicine. The panel recommended a 1-mg dexamethasone suppression test and measurement of plasma-free metanephrines for all patients with an adrenal incidentaloma; additional measurement of serum potassium and plasma aldosterone concentration–plasma renin activity ratio for patients with hypertension; and surgery for patients with biochemical evidence of pheochromocytoma, patients with tumors greater than 6 cm, and patients with tumors greater than 4 cm who also meet other criteria. The panel also advocated a multidisciplinary approach to managing adrenal incidentalomas. The statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the federal government.

Author and Article Information

From University of California, San Francisco, San Francisco, California; Massachusetts General Hospital, and Cushing's Support and Research Foundation, Boston, Massachusetts; Cedars-Sinai Medical Center and University of California, Los Angeles, School of Medicine, Los Angeles, California; Mayo Clinic, Rochester, Minnesota; University of North Carolina School of Medicine, Chapel Hill, North Carolina; Kaiser Permanente Center for Health Research, Portland, Oregon; Washington Hospital Center, Washington, DC; University of Chicago, Chicago, Illinois; University of Iowa Hospital, Iowa City, Iowa; and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.

An edited summary of a State-of-the-Science Conference held on 4–6 February 2002 at the National Institutes of Health, Bethesda, Maryland.

Requests for Single Reprints: Kelli Marciel, MA, Office of Medical Applications of Research, National Institutes of Health, Building 31, Room 1B03, 31 Center Drive MSC 2082, Bethesda, MD 20892; e-mail, marcielk{at}od.nih.gov.

Current Author Addresses: Dr. Grumbach: Department of Pediatrics, University of California, San Francisco, 513 Parnassus Avenue, S677, San Francisco, CA 94143-0434.

Dr. Biller: Neurondicrine Unit, Massachusetts General Hospital, Bulfinch 457 B, 55 Fruit Street, Boston, MA 02114.

Dr. Braunstein: Department of Medicine, Cedars-Sinai Medical Center, University of California, Los Angeles, School of Medicine, North Plaza Room 2119, 8700 Beverly Boulevard, Los Angeles, CA 90048.

Ms. Campbell: Cushing's Support and Research Foundation, 65 East India Row, Suite 22B, Boston, MA 02110.

Dr. Carney: Department of Laboratory Medicine and Pathology, Mayo Clinic, Plummer North 10, 200 SW 1st Street, Rochester, MN 55905.

Dr. Godley: Division of Hematology/Oncology, University of North Carolina School of Medicine, 3009 Old Clinic Building, CB 7305, Chapel Hill, NC 27599-7305.

Dr. Harris: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.

Dr. Lee: Department of Radiology, University of North Carolina, 2006 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7510.

Dr. Oertel: Pathology Department, Washington Hospital Center, 110 Irving Street NW, C-1219, Washington, DC 20010-2975.

Dr. Posner: University of Chicago, MC-5031, 5841 South Maryland Avenue, Chicago, IL 60637.

Dr. Schlechte: Department of Medicine, University of Iowa Hospital, 200 Hawkins Drive, Room 157 MRF, Iowa City, IA 52242.

Dr. Wieand: Biostatistics Center, University of Pittsburgh Cancer Institute, Sterling Building, Suite 325, 201 North Craig Street, Pittsburgh, PA 15213.

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