3 They include myelolipomas, cysts, and lipid-rich adenomas. This group of adrenal masses can be correctly diagnosed with a high degree of certainty based on their imaging appearance. In these cases, image-guided adrenal biopsy may be performed for definitive diagnosis.

The third category comprises adrenal “conundrums,” which are lesions that remain indeterminate after dedicated adrenal imaging. The ACR White Paper provides a helpful decision tree to determine the most appropriate imaging test to work-up the incidental adrenal lesion. The second category consists of incidentalomas, which cannot be diagnosed on initial discovery, but require further imaging to elucidate their nature. The first category consists of lesions known as “Aunt Minnies.” These lesions can be diagnosed immediately and with high degree of certainty so that no further imaging work-up is necessary. Most adrenal masses can be divided into three broad categories. The purpose of this article is to review the imaging appearance of common adrenal diseases and to provide a diagnostic imaging algorithm for work-up of the “adrenal incidentaloma” based on guidelines published in the ACR White Paper on management of incidental findings. Because masses in the adrenal glands are one of the most commonly encountered incidentalomas, the American College of Radiology (ACR) has developed specific recommendations on how to manage incidentally discovered adrenal masses in the adult population. Imaging now plays a critical role in the work-up and clinical management of adrenal disease.

Visit /SAM2 for full SA-CME information.Īdvances in imaging technology have led to improvements in the detection and diagnosis of adrenal pathology. This article is accredited for one SA-CME credit.

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