Indications for surgery related to high risk of malignancy:
(1) high unenhanced CT attenuation (> 20 HU)
(2) rapid growth
(3) diameter >= 5 cm (>= 4 cm may be used)
(4) delayed washout of contast medium
(5) other reasons to suspect a primary or metastatic carcinoma
Other reasons to consider adrenal surgery:
(1) pheochromocytoma (chromaffin tumor)
(2) endocrine hyperfunction
(3) acute retroperitoneal hemorrhage associated with the adrenal mass
where:
• A benign adrenal tumor tends to have a CT density <= 10 HU.
If bilateral tumors are present in a patient with Cushing's syndrome and if one adrenal gland is to be removed, then the one to remove is selected based on one or more of the following:
(1) larger size
(2) more rapid growth
(3) higher density on CT images
