The indeterminate adrenal mass

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 F-18-FDG PET/CT.