ADRENAL MASS: Malignant

ADRENAL MASS: Malignant Malignant Adrenal Mass Signs of Hormone Excess No Signs of Hormone Excess Androgen Excess Estrogen ExcessAldosterone Excess Positive 24-Hour Metanephrines + Nor- Metanephrines Glucocorticoid Releasing Carcinoma (Positive Dexamethasone Suppression Test) Hypertension +/- Hypokalemia/Alkalosis Aldosterone Releasing Carcinoma (High Aldosterone: Renin Ratio) High DHEAS Androgen Releasing Carcinoma (e.g. Adrenocortical Carcinoma) Suggestive of Malignancy: Inhomogenous Density, Delay in CT Contrast Washout (<50% in 10 minutes), Irregular Shape, Diameter >4cm, Calcification, >20 Hounsfeld Units on CT, Vascularity of Mass, Hypointense to Liver on T1 Weighted MRI - DO NOT Biopsy Normal DHEAS Estrogen Releasing Carcinoma (High Plasma E2 + Clinical Picture)Glucocorticoid Excess Feminization, Early Puberty, Heavy Menses Pheo-chromocytoma (Paroxysmal Hypertension, Headache, Diaphoresis, Palpitations, Anxiety) Silent/Non-Functioning Mass Other Source (e.g. Polycystic Ovarian Syndrome, Congenital Adrenal Hyperplasia)Virilization/ HirsutismCushingoid FeaturesRule of 10's For Pheochromocytoma:10% are Malignant10% are Bilateral10% are Extra-Adrenal10% are Familial10% are not Associated with HypertensionLymphoma Metastases (Often Bilateral) Adrenal Carcinoma