Purpose: This paper is a review of the evidence base carried out to provide recommendations to aid the clinical management of patients with a CT/MRI-detected lipid-poor/indeterminate adrenal mass in whom phaeochromocytoma and metastatic adrenal disease are excluded.
Methods: A Medline keyword search of English-language articles led to the production of a draft document and consensus statement containing levels of evidence and grading of recommendations as proposed by the Agency for Healthcare Research and Quality.
Results: Literature review clearly defines the extent and definition of what constitutes a lipid-poor adrenal mass. The ability of MRI to better distinguish adrenocortical adenoma from adrenocortical cancer is increasing, although there is little high-level evidence to confirm this. FDG PET appears promising in its ability to predict that an adrenal lesion is benign.
Conclusions: The management of a patient with an indeterminate adrenal mass in the absence of clear clinical, biochemical, and radiological indications for adrenalectomy may be aided by further assessment using chemical-shift/contrast-enhanced MRI and (18)F-FDG PET/CT.