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Algorithm of Barnett for Evaluation of a Patient with an Isolated, Incidentally Identified Adrenal Mass

Description

Barnett et al recommended an algorithm for evaluating a patient with an incidentally identified mass in the adrenal gland. The authors noted that the size of a mass is an unreliable predictor of whether a mass is benign or malignant, while newer imaging modalities can be helpful in deciding how to manage a particular patient. The authors are from M.D. Anderson Cancer Center in Houston.


 

Parameters:

(1) hormone production

(2) MRI

(3) size in centimeters

(4) comorbid conditions in the patient

 

Decision rules for when to resect an isolated adrenal mass found incidentally:

(1) If the mass is hormonally active.

(2) If the tumor is hormonally inactive and MRI is either indeterminate or malignant.

(3) If the mass is large (>= 4 cm) and the patient does not have significant comorbid conditions.

 

NOTE: It is important to perform laboratory tests to specifically exclude pheochromocytoma prior to surgery.

 

Decision rules for when to observe a patient with an isolated adrenal mass found incidentally:

(1) If the mass is hormonally inactive, the MRI suggests benign and the lesion is small (< 4 cm).

(2) If the mass is hormonally inactive, the MRI suggests benign, the lesion is large (>= 4 cm) and the patient has significant comorbid conditions that make resection hazardous.

 


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