Incidentally discovered masses in hypertensive patients

Endocrine hypertension is a term used for states in which hormone derangements result in clinically significant hypertension. The adrenal glands are the most likely culprits, due either to an excessive production of mineralocorticoids, catecholamines or glucocorticoids.

The term ‘adrenal incidentaloma’ indicates an adrenal mass discovered accidentally during testing or treatment for other clinical conditions unrelated to any suspicion of adrenal disease. In particular, when an adrenal mass is discovered in a hypertensive subject, physicians must check whether the patient has pheochromocytoma, glucocorticoid excess or primary aldosteronism. Although most adrenal masses are non-hypersecretory adenomas, hormone screening can reveal a significant number of cases of clinically unsuspected hormone-secreting adrenal tumors.

If the clinical history or physical examination of a patient with unilateral incidentaloma shows signs and symptoms suggestive of glucocorticoid, mineralocorticoid, adrenal sex hormone or catecholamine excess, which is confirmed biochemically, the treatment of choice is often adrenalectomy. In cases where surgery is contraindicated or the lesions are unresectable, medical treatment may be an option.

Key words: adrenal incidentaloma, endocrine hypertension, hypersecretion, Conn'syndrome, Cushing's syndrome, pheochromocytoma