Diagnostic approach to incidental adrenal nodules in the cancer patient. Results of a clinical, radiologic, and fine-needle aspiration study.

Twenty-three nonfunctioning adrenal nodules were discovered during computed tomographic (CT) evaluation of the abdomen in 16 patients with a variety of primary extra-adrenal malignant neoplasms. In seven cases the adrenal masses were bilateral. Following percutaneous fine-needle aspiration biopsy, pathologic diagnosis was consistent with benign adenoma in seven patients, and with adrenal metastasis in nine. There was no significant difference in age, sex, or incidence of bilateral distribution among these two groups. Three of the adenomas were calcified, and the size of the benign nodules in all patients was less than 3 cm. No calcification was seen in metastatic adrenal nodules, and their sizes ranged between 2 and 20 cm. The clinical and radiologic features of these two groups of patients are evaluated, and a rational approach for the management of adrenal masses is described. The CT images of adrenal adenoma and adrenal metastasis, along with their corresponding cytopathologic features, are illustrated.