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Review
. 2024 Oct;30(10):987-1002.
doi: 10.1016/j.eprac.2024.06.015. Epub 2024 Aug 3.

Clinical Review: The Approach to the Evaluation and Management of Bilateral Adrenal Masses

Ann T Sweeney  1 , Oksana Hamidi  2 , Prerna Dogra  3 , Shobana Athimulam  4 , Ricardo Correa  5 , Michael A Blake  6 , Travis McKenzie  7 , Anand Vaidya  8 , Karel Pacak  9 , Amir H Hamrahian  10 , Irina Bancos  11
Affiliations
Review

Clinical Review: The Approach to the Evaluation and Management of Bilateral Adrenal Masses

Ann T Sweeney et al. Endocr Pract. 2024 Oct.

Abstract

Objective: This white paper provides practical guidance for clinicians encountering bilateral adrenal masses.

Methods: A case-based approach to the evaluation and management of bilateral adrenal masses. Specific clinical scenarios presented here include cases of bilateral adrenal adenomas, hemorrhage, pheochromocytomas, metastatic disease, myelolipomas, as well as primary bilateral macronodular adrenal hyperplasia.

Results: Bilateral adrenal masses represent approximately 10% to 20% of incidentally discovered adrenal masses. The general approach to the evaluation and management of bilateral adrenal masses follows the same protocol as the evaluation of unilateral adrenal masses, determined based on the patient's clinical history and examination as well as the imaging characteristics of each lesion, whether the lesions could represent a malignancy, demonstrate hormone excess, or possibly represent a familial syndrome. Furthermore, there are features unique to bilateral adrenal masses that must be considered, including the differential diagnosis, the evaluation, and the management depending on the etiology. Therefore, considerations for the optimal imaging modality, treatment (medical vs surgical therapy), and surveillance are included. These recommendations were developed through careful examination of existing published studies as well as expert clinical opinion consensus.

Conclusion: The evaluation and management of bilateral adrenal masses require a comprehensive systematic approach which includes the assessment and interpretation of the patient's clinical history, physical examination, dynamic hormone evaluation, and imaging modalities to determine the key radiographic features of each adrenal nodule. In addition, familial syndromes should be considered. Any final treatment options and approaches should always be considered individually.

Keywords: adrenal adenoma; bilateral; diagnosis; imaging; metastasis; outcome; pheochromocytoma; treatment.

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Conflict of interest statement

Disclosure I.B. reports consulting/advisory board/data safety monitoring board fees to institution from HRA Pharma, Recordati, Corcept, Sparrow, Xeris, NovoNordisk, AstraZeneca, Crinetics, Neurocrine, Diurnal, Adrenas, Spruce, and Adrenas and funding for investigator-initiated research from HRA Pharma and Recordati all unrelated to the current paper. A.V. reports consulting fees from Corcept, Mineralys, and HRA Pharma, all unrelated to the current work. A.H. reports research funding from Corcept, AstraZeneca, and Spruce Biosciences consulting and advisory board fees from Corcept, all unrelated to the current paper. O.H. reports advisory board participation with Corcept Therapeutics, Neurocrine Biosciences, Recordati Rare Diseases, Xeris Pharma, Amryt Pharma, and Lantheus. The remaining authors have no conflicts of interest to disclose.

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