Adrenal Incidentalomas: Functionality and Follow-Up Care

Q: Adrenal Incidentalomas: Functionality and Follow-Up Care

The initial test results may be influenced by oral steroids (false positives). <br>It is usually recommended to monitor the values regularly. <br>If the second test results are still abnormal, further examinations will be suggested. <br>For detailed answers, please consult your a

Adrenal incidentaloma

Dear Doctor,
Last year in June and July, I consulted you regarding an adrenal gland tumor.
Later, I went to the hospital and saw an endocrinologist who confirmed through a CT scan that I have a 2.56 cm tumor.
The doctor arranged for blood tests and urine tests, and later informed me that this is just a benign mass, non-functional, referred to as an incidental adrenal adenoma, and advised me to follow up in six months.

At that time, the 24-hour urine test showed elevated levels of catecholamines: epinephrine was 86 µg, which is high (reference value <22.4 µg/24h), and norepinephrine was 114 µg, also high (reference value 12.1-85.5).
During the follow-up, the doctor mentioned that I had taken a quarter of a steroid, which could cause the plasma renin activity (PRA) to be low, and cortisol levels to be low as well.
A low level is good, indicating that the tumor is non-functional.
In January of this year, I underwent an abdominal ultrasound for follow-up, and the tumor size was 2.58 cm.
The doctor also conducted blood and urine tests, but I did not take any medication this time.
The 24-hour urine test results showed that epinephrine was 84 µg, still high (reference value <22.4 µg/24h), and norepinephrine was 115 µg, also high (reference value 12.1-85.5).
This time, the doctor mentioned that the values were slightly elevated and indicated some functionality, and recommended an MRI to check if the tumor is active.
(1) Why do similar values indicate non-functionality at one point and then suggest some functionality at another? I would greatly appreciate your clarification on this matter.
Thank you very much.

Er Mao, 50~59 year old female. Ask Date: 2018/03/27

Dr. Hu Ziren reply Oncology

The initial test results may be influenced by oral steroids (false positives).
It is usually recommended to monitor the values regularly.
If the second test results are still abnormal, further examinations will be suggested.
For detailed answers, please consult your attending physician.
Thank you!

Reply Date: 2018/03/27

More Info

Adrenal incidentalomas are adrenal masses that are discovered incidentally during imaging studies performed for other reasons. The management of these incidentalomas largely depends on their size, imaging characteristics, and functional status. In your case, it appears that you have undergone a series of evaluations that have raised some important questions regarding the functionality of the adrenal tumor.

1. Understanding Functionality: The adrenal glands produce several hormones, including catecholamines (epinephrine and norepinephrine), cortisol, and aldosterone. When a tumor is found in the adrenal gland, it can either be functional (producing hormones) or non-functional (not producing hormones). In your initial evaluations, the levels of catecholamines were significantly elevated, which suggested that the tumor might be functional. However, subsequent tests indicated that the tumor might not be producing hormones, leading to confusion regarding its functionality.

2. Variability in Hormone Levels: The fluctuation in catecholamine levels can be attributed to several factors. Stress, medications, and even the timing of the tests can influence hormone levels. For instance, if you were under stress or had consumed caffeine before the test, it could lead to elevated catecholamine levels. Additionally, the use of steroids can suppress cortisol production, which may affect the overall hormonal balance and lead to variations in test results.

3. Follow-Up and Monitoring: Given that your tumor is stable in size (2.56 cm to 2.58 cm) and that there are fluctuations in hormone levels, the recommendation for an MRI is prudent. An MRI can provide more detailed information about the tumor's characteristics, including whether it is hypervascular (which may indicate functionality) or if there are any changes that suggest malignancy.
4. Management Recommendations: If the MRI indicates that the tumor is indeed functional, further evaluation may be necessary to determine the best course of action. This could include additional imaging, biochemical tests, or even surgical intervention if the tumor is causing significant hormonal imbalances or symptoms. If the tumor is confirmed to be non-functional, regular follow-up with imaging and hormone level assessments is typically recommended to monitor for any changes.

5. Consultation with Specialists: It is essential to maintain open communication with your endocrinologist regarding your concerns and the implications of the test results. They can provide personalized advice based on your specific situation, including the need for further testing or potential treatment options.

In summary, adrenal incidentalomas require careful evaluation and monitoring, especially when there are fluctuations in hormone levels. The variability in your catecholamine levels could be influenced by various factors, and further imaging studies will help clarify the functionality of the tumor. Regular follow-up is crucial to ensure that any changes in the tumor's behavior are promptly addressed.

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