DOI: 10.36347/sjams.2018.v06i03.084

Pages: 1227-1234

The development of medical imaging techniques has increased the accidental diagnosis of numerous silent and ignored tumors. The term "adrenal incidentalomas" refers to an adrenal mass equal to or larger than 1 cm in its main axis discovered by chance during an abdominal imaging examination not motivated by exploration of an adrenal pathology. These incidentalomas can be secreting or not, benign or malignant. These characteristics must be distinguished by the physician to help in choosing the treatment, using biology and imaging, essentially CT without and with injection of a contrast agent. We conducted a two-year prospective study in endocrinology department at Mohamed VI University Hospital of Marrakech, included 19 patients whose average age was 43.42 years with extremes of 31 to 72 years, all admitted for exploration of an adrenal incidentaloma. HBP was found in 6 cases with a rather digestive symptomatology (abdominal pains and / or digestive disorders) initially associating the triad of Menard. The methoxylated urinary derivatives were made in the majority of the cases, making it possible to confirm a pheochromocytoma in 10 patients; dexamethasone test and urinary free cortisol measurement found Adrenal cortical carcinoma (ACC) in 3 cases and shed doubt on subclinical Cushing's syndrome in 2 cases. CT appearance and tumor size suggested malignant ACC in 4 cases. In 16 cases surgery allowed improvement of the clinical symptomatology. Tests must be carefully chosen in order to avoid proposing unnecessary and costly examinations to too many patients and, equally, not to ignore the diagnosis of a malignant or secreting tumor. From these tests, the decision of the type of care management will be made: surgical or monitoring. If simple monitoring, specific criteria and duration must be followed and respected (clinical, imaging and biology).