Pediatric Adrenal Mass Evaluation and Management

Introduction to Adrenal Masses

Adrenocortical carcinoma is a rare but important consideration in pediatric adrenal masses, according to the American Urological Association 1

The European Society for Medical Oncology recommends targeting specific findings during history and physical examination, including signs of catecholamine excess, such as hypertension, headaches, palpitations, sweating, and pallor, to rule out pheochromocytoma before any intervention 2, 3
The American Academy of Pediatrics suggests evaluating signs of cortisol excess, including weight gain, central obesity, moon facies, buffalo hump, purple striae, easy bruising, and proximal muscle weakness 4
The Endocrine Society recommends assessing signs of androgen excess, such as virilization, hirsutism, deepening voice, and precocious puberty in males 4

The American College of Endocrinology advises comprehensive hormonal evaluation before any intervention, including plasma free metanephrines or 24-hour urinary fractionated metanephrines to exclude pheochromocytoma 2, 3, 5
The European Society for Medical Oncology suggests a 1 mg overnight dexamethasone suppression test to screen for autonomous cortisol secretion 5
The American Heart Association recommends assessing the aldosterone-to-renin ratio if hypertension or hypokalemia is present 5

The American College of Radiology recommends non-contrast CT as the first-line imaging modality, with Hounsfield Units (HU) measurement and mass characteristics to assess malignancy risk 6, 7, 3
The Society for Pediatric Radiology suggests MRI as complementary imaging to minimize radiation exposure in pediatric cases 3, 4

The American Academy of Pediatrics advises surgical resection for all pediatric incidental adrenal masses given the 30.8% malignancy rate, regardless of size or imaging characteristics 6, 7, 3

The American Urological Association recommends obtaining immediate multidisciplinary review by pediatric endocrinologists, pediatric surgeons, and radiologists for all pediatric adrenal masses 6, 7, 3