NIH panel outlines strategies for managing tumors of the adrenal glands

A panel convened by the National Institutes of Health issued recommendations to help physicians evaluate a particular class of tumors of the adrenal glands and determine which should be removed and which should be left alone. The tumors are known as "incidentalomas" because they are discovered by chance, as a result of testing for other conditions. Before the advent of sophisticated new imaging technologies, the tumors typically went undetected.

"Incidentalomas present a dilemma for physicians because while many of these masses are harmless, a few can progress into very serious conditions and cause a variety of complications," said panel chair Melvin Grumbach, M.D., Edwin B. Shaw Professor of Pediatrics Emeritus at the University of California in San Francisco. Noting that the prevalence of incidentalomas increases with age, Dr. Grumbach added that "the appropriate management of incidentalomas promises to be an increasingly common challenge for our aging society."

The adrenals are triangular glands that sit atop each kidney. They influence or regulate the body's metabolism, salt and water balance, response to stress, and other important functions by secreting a variety of hormones. Adrenal gland masses are among the most common tumors in humans, and although most cause no symptoms or health problems, a small proportion can lead to serious diseases, and approximately one out of every 4,000 adrenal masses is cancerous.

One type of adrenal tumor, known as a pheochromocytoma, releases hormones that can cause dangerously high blood pressure. Another type, known as an adrenal cortical cancer, has a high mortality rate. The panel recommends surgically removing both types when technically possible, regardless of size.

The panel members concurred with the prevailing view that incidentalomas should be surgically removed if they are greater than 6 cm, and that those under 4 cm, in some circumstances, may be followed to see if they grow

Contact: Kelli Marciel
NIH/Office of the Director

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