Dr. Eric Kuo is an endocrine surgeon at Columbia University Medical Center. In light of Adrenal Awareness Month 2023, Dr. Kuo joined Dr. Hyesoo Lowe on an episode of Columbia Surgery’s podcast Conversations and Curbsides. The two doctors discuss the topic of adrenal incidentalomas.
The following is a transcription of the discussion, and is lightly edited for context and clarity.
Jump to a Section:
- ADRENAL INCIDENTALOMA
- DISCOVERING AN ADRENAL MASS, INCIDENTALLY
- HOW COMMON ARE ADRENAL INCIDENTALOMAS?
- FIRST STEPS AFTER DIAGNOSIS
- BLOOD TESTS & IMAGING
- SEEKING A DOCTOR
Dr. Hyesoo Lowe:
I'm here today talking with my colleague, Dr. Eric Kuo, one of our wonderful endocrine surgeons at Columbia University Medical Center. And we're here to talk about the topic of adrenal incidentalomas. Maybe not applicable to the general public always, but it is something that comes up from time to time, and we'd love to learn more about it. Welcome Dr. Kuo.
Dr. Eric Kuo:
Thank you so much for having me.
ADRENAL INCIDENTALOMA
Dr. Hyesoo Lowe:
So, adrenal “incidentaloma” is sort of a funny word. Is it actually a real medical term?
Dr. Eric Kuo:
Yeah. So, when you think about medical names for these things, a lot of things kind of go back to Latin, centuries ago. But “incidentaloma” is a more recent term. I believe the first time it was actually used in the literature was back in 1982. And so, it's relatively recent, and it basically refers to an incidentally found mass.
Whenever you hear a medical term that has the word “-oma” at the end of it, typically refers to some kind of mass or lesion. And so, therefore an incidentaloma is an incidentally found mass or tumor, and that can be in the adrenal gland, it can be in any other organ in the body.
Dr. Hyesoo Lowe:
It's funny because I feel like that term is used for the adrenal gland more than in other organs. So, I wouldn't call a thyroid nodule an incidentaloma, I would just call it a thyroid nodule. But for some reason it really stuck in the adrenal.
DISCOVERING AN ADRENAL MASS, INCIDENTALLY
Dr. Hyesoo Lowe:
How would an adrenal incidentaloma get discovered?
Dr. Eric Kuo:
Usually they're discovered on some kind of imaging. We call it axial imaging. It is basically a three-dimensional image of your abdomen. And so, usually that means a CAT scan, an MRI, a PET scan, and it's usually for some other reason.
For example, let's say you got in a car crash, you went to the hospital, they scanned your belly looking for signs of injury from the trauma. Because they're imaging everything in your belly, if you have an adrenal nodule or incidentaloma, they're going to find it there.
HOW COMMON ARE ADRENAL INCIDENTALOMAS?
Dr. Hyesoo Lowe:
Are these pretty common to have?
Dr. Eric Kuo:
Adrenal incidentalomas, in general, are a little bit more uncommon than, for example, thyroid nodules. We know from studies that as many as 50% of people are going to end up with a thyroid nodule at some point in their lives.
When it comes to adrenal incidentalomas or adrenal nodules, that's more along the lines of five percent. But when you start to think about one in twenty people having one of these, it's actually more significant than you would think.
Dr. Hyesoo Lowe:
That's true. And with so much imaging being done and high-resolution imaging with technology, I'm sure these are found quite a bit more often than what might be expected.
FIRST STEPS AFTER DIAGNOSIS
Dr. Hyesoo Lowe:
So, a person is told “Your CAT scan's okay. But just so you know, you've got a nodule or an incidentaloma on your adrenal gland.”
What should a patient be thinking through? First of all, what's the most dangerous thing this could be?
Dr. Eric Kuo:
The two essential questions that any doctor who's going to see you is going to ask themselves is, number one, is this a functional nodule? Meaning is it a functional tumor that's overproducing a hormone? And number two, is it cancerous?
So, those are the two main questions that your physicians will be seeking to answer. And to do that, they're going to use a variety of blood tests. They may order additional imaging, as well, to help more specifically characterize that lesion.
Dr. Hyesoo Lowe:
Got it. And so, among all of these incidentalomas, are they likely to be cancer, hormone producing, or just a lump?
Dr. Eric Kuo:
By and large, the most common scenario is for this to be a non-functional lump. We call that an “adrenal adenoma.”
These are non-cancerous lesions. Most of the time they aren't overproducing hormones, and most of the time you can just keep an eye on them with either CT scans or MRIs, down the road.
Adrenal cortical cancers actually are quite uncommon and actually represent a small minority of these incidentalomas.
Dr. Hyesoo Lowe:
But if you have one, it should be addressed right away, I think, right?
Dr. Eric Kuo:
Yes, absolutely right.
BLOOD TESTS & IMAGING
Dr. Hyesoo Lowe:
So, what are the next steps patients should think to take when they find out they have an adrenal incidentaloma?
Dr. Eric Kuo:
Number one is going to be blood work. Your physician is going to order some blood tests to see if that lesion is overproducing certain types of hormones that are commonly made by the adrenal glands. That includes cortisol and adrenaline, the hormone that the adrenal gland is named after. It also includes hormones that in medical terminology we call “catecholamines.” Then the other hormone is aldosterone, which helps your body retain salts and fluid.
Those are the main things that your physicians are going to be looking at. And again, they may order additional imaging, as well to help either raise or lower their suspicion that this may be a cancer.
SEEKING A DOCTOR
Dr. Hyesoo Lowe:
And what kind of doctor would a patient need to see?
Dr. Eric Kuo:
Endocrinologists, endocrine surgeons, or urologists all take care of the adrenal gland, and anyone who has training and experience with adrenal nodules should be able to take care of this for you.
Dr. Hyesoo Lowe:
Sounds great. Is there anything that you think patients should know when they find out that they have a lump on their adrenal?
Dr. Eric Kuo:
I think the first thing that I would tell patients is “Don't panic.” Take things one step at a time. Listen to your doctor's advice, get the work-up done, and just take it one step at a time. Your physicians will help guide you through the whole process.
FURTHER READING
- When the Adrenal Gland Causes Hypertension (Adrenal Awareness Month, 2022) | Columbia Surgery
- Columbia Adrenal Center
- Hyperaldosteronism
- Adrenal Surgery