Adrenal Adenoma

Unilateral non-functional adrenal adenoma with imaging features consistent with a benign lesion

Discharge Criteria:

1. Structural
   1. Imaging characteristics of adrenal lesion are clearly in keeping with a benign etiology
      1. Size < 4cm
      2. HU < 10 on unenhanced CT/non-contrast phase
      3. Imaging criteria is consistent with a myelolipoma (with macroscopic fat)
   2. No growth on follow-up imaging at 6-12 months (< 5mm in greatest diameter)
      1. If size > 2cm and younger individual (< 40 years), consider another scan at 24 months
   3. No history of germline disease associated with ACC, pheochromocytoma or adrenal adenoma (i.e. family history of hereditary adrenal disease, < 40 years, and bilateral nodules)
2. Baseline Hormonal Assessment
   1. Plasma/urine metanephrine negative if CT HU >= 10
   2. Aldosterone: Renin Ratio (ARR) < screening threshold (lab assay dependent) if patient has HTN or hypokalemia
   3. Cortisol < 50mmol/L on 1mg overnight dexamethasone suppression test

Resources:

• Letter to primary care provider
• Letter to patient

Reviewed by topic experts Jeannette Goguen, Kenneth Pace and Jessie Pasternak