HONG KONG EAST CLUSTER

Doc. no. HKEC-MED-EN-GL-015-R0

Effective date 1 Jun 2004

Last review
Department of Medicine 1 Nov 2015
date

Custodian Endocrine Team

Adrenal Incidentaloma
Approver COS (MED)

1. Objective
To investigate adrenal incidentoma

2. Guidelines
(A) Baseline Investigations

i. Hormonal & biochemical Investigations

1. RFT (serum Na/K)

2. Spot PAC/PRA ratio (ARR)
3. 24 hour urine for catecholamines (three specimen)
4. 1mg over-night dexamethasone suppression test
5. testosterone & oestrogen

ii. CXR

iii. Imaging

1. CT Adrenal (with contrast)

i.To determine the phenotype of the incidentaloma
ii.CT attenuation value(Hounsfield Units) – HU < 10 suggest benign lesion
2. MRI
i.Chemical shift MRI
ii.In/Out phase MRI
3. NP59, MIBG or PET as indicated

iv. FNA

1. Must rule out phaeochromocytoma before FNA

2. Indications
i. known extraadrenal primary malignancy with a new adrenal mass, to rule out
metastatic disease
ii. Suspected systemic infectious or infiltrative processes - fungal, TB,
histoplasmosis

(B) Management & Follow Up Plan according to size & function of incidentaloma

i. Surgery - if

1. Size >6cm

2. Any Size - functional / malignant phenotype on imaging

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 HONG KONG EAST CLUSTER
Doc. no. HKEC-MED-EN-GL-015-R0

Effective date 1 Jun 2004

Last review
Department of Medicine 1 Nov 2015
date

Custodian Endocrine Team

Adrenal Incidentaloma
Approver COS (MED)

ii. Size 4-6cm - non-functional / benign phenotype on imaging / patient refuses surgery

1. Interval CT/MRI adrenal at 4, 12 months, 2, 3, 5, 7 year

2. Hormonal / Biochemical screening at 1, 2, 3, 5, 7 year

iii. Size <4cm – non functional / benign / patient refused surgery

1. Interval CT/MRI adrenal at 6, 12 months, 2, 4, 6 year

2. Hormonal & Biochemical screening at 1, 2, 4, 6 year

3. Attachment

Appendix I - Adrenal Incidentaloma : Investigation Result Sheet

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 HONG KONG EAST CLUSTER
Doc. no. HKEC-MED-EN-GL-015-R0

Effective date 1 Jun 2004

Last review
Department of Medicine 1 Nov 2015
date

Custodian Endocrine Team

Adrenal Incidentaloma
Approver COS (MED)

Appendix I

Adrenal Incidentaloma : Investigation Result Sheet

Baseline 4M 6M 1yr 2yr 3yr 4yr 5yr 6yr 7yr

Date

Serum Na/K

Spot ARR

24 hr urine VMA,
Catecholamines

1mg overnight
Dexa Supp Test
(Cortisol)

Adrenal Imaging
CT/MRI
Size

CT/MRI remarks

Other imagings

FU Plan

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