Malignant Adrenal Mass - Differential Diagnosis Algorithm 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 TI Weighted MRI — DO NOT Biopsy Androgen Excess - Virilization/ Hirsutism • High DHEAS - Androgen Releasing Carcinoma (e.g. Adrenocortical Carcinoma) • Normal DHEAS - Other Source (e.g. Polycystic Ovarian Syndrome, Congenital Adrenal Hyperplasia) Estrogen Excess - Feminization, Early Puberty, Heavy Menses • Estrogen Releasing Carcinoma (High Plasma E2 + Clinical Picture) Glucocorticoid Excess - Cushingoid Features • Glucocorticoid Releasing Carcinoma (Positive Dexamethasone Suppression Test) Aldosterone Excess Hypertension +/- Hypokalemia/Alkalosis • Aldosterone Releasing Carcinoma (High Aldosterone: Renin Ratio) Positive 24-Hour Metanephrines + Nor-Metanephrines • Pheochromocytoma (Paroxysmal Hypertension, Headache, Diaphoresis, Palpitations, Anxiety) Silent/Non-Functioning Mass • Lymphoma Metastases (Often Bilateral) Adrenal Carcinoma #AdrenalMass #Malignant #Differential #Diagnosis #Algorithm #Endocrinology
