Approach to the patient with adrenal incidentaloma. Case series

The formations of the adrenal glands are often detected accidentally during instrumental methods of examination of the abdominal cavity and retroperitoneal space, performed for some other reasons. Over the past 2 decades, the frequency of detection of adrenal gland formations has increased 10-fold, and most of them are diagnosed in old age. The tactics of observation and treatment depend both on hormonal activity and on the malignant potential of the detected formation. Up to 5–8% of patients with adrenal incidentalomas have a malignant nature, with a higher risk in young patients, with a size of more than 4 cm, as well as with a history of other malignant neoplasms. The frequency of detection of the classical clinical and laboratory picture of hypercorticism, hyperaldosteronism or catecholamine-producing tumor is less than 15%, however, the phenomenon of functionally autonomous cortisol production according to the results of studies conducted in the last few years is much more common – up to 30–50% of patients. Despite the absence of vivid clinical symptoms in some cases, autonomous cortisol secretion is associated with increased cardiovascular morbidity and metabolic disorders, therefore, all patients with adrenal incidentalomas need to exclude this condition. This article presents clinical cases of patients with adrenal gland formations, describes in detail the examination algorithm and the choice of treatment tactics, taking into account the results of studies conducted since the release of the latest clinical recommendations for the management of patients with adrenal gland incidentalomas in 2016.