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Nonfunctional Adrenal Masses

Space-occupying lesions of the adrenal glands that have no hormonal activity.

Adrenal adenomas, detected by abdominal CT or MRI, are the most common of these masses. In newborns, spontaneous adrenal hemorrhage may produce large adrenal masses, simulating neuroblastoma or Wilms' tumor. In adults, bilateral massive adrenal hemorrhage may result from thromboembolic disease or coagulopathy. Benign adrenal cysts are observed in the elderly and may be due to cystic degeneration, vascular accidents, bacterial infections, or parasitic infestations (Echinococcus). The adrenals may become infected with tuberculosis organisms via the bloodstream, causing adrenal masses. Rare nonfunctional adrenal carcinoma produces a diffuse and infiltrating retroperitoneal process. The most common nonfunctioning adrenal mass in adults is an adenoma (55%), followed by metastatic tumors (30%). Cysts and lipomas make up most of the remainder.

Symptoms, Signs, and Treatment

Nonfunctional adrenal masses are usually found incidentally during tests conducted for other reasons. With any adrenal mass, adrenal insufficiency is rarely observed unless both glands are involved. Small adrenal adenomas ( < 2 cm) usually are nonfunctional, produce no symptoms, and require no special treatment but should be kept under observation for growth or development of secretory function. If metastatic disease is a possibility, fine-needle biopsy can be diagnostic. If the tumor is solid, of adrenal origin, and > 6 cm, it should be excised, because biopsy cannot always distinguish benign from malignant tumors. The major signs of bilateral massive adrenal hemorrhage are abdominal pain, falling Hct, signs of acute adrenal failure, and presence of suprarenal masses on CT or MRI. Tuberculosis of the adrenals may cause calcification and adrenal insufficiency (Addison's disease). Nonfunctional adrenal carcinoma usually manifests as metastatic disease and is not amenable to surgery, though mitotane may afford chemotherapeutic control when used in association with supportive exogenous corticosteroids.

From The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.

The information provided here should not be used for diagnosis or treatment. A licensed physician should be consulted for the diagnosis and treatment of Addison's Disease and all diseases. TELEPLEXUS, Inc. does not warrant that this information meets any particular standard or that it is free from errors.

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