AttendMe Owl Logo
AttendMe
Sign In
All Pathways
RadiologyDiagnostic

Incidental Adrenal Mass Evaluation (ACR)

Incidental Adrenal Mass Evaluation (ACR): Incidental Adrenal Mass → Known Primary Malignancy? → Staging Workup.

Pathway Overview

11 steps

Algorithm Steps

11 total

  1. 01Start

    Incidental Adrenal Mass

    Discovered on CT/MRI for unrelated indication

  2. 02Decision

    Known Primary Malignancy?

    • Yes - staging workup
    • No - characterize
  3. 03Action

    Staging Workup

    PET/CT, consider biopsy for treatment planning

  4. 04Decision

    CT Attenuation (Unenhanced)?

    • ≤10 HU (lipid-rich)
    • 10-30 HU
    • >30 HU
  5. 05Action

    Likely Benign Adenoma

    ≤10 HU highly specific for lipid-rich adenoma

  6. 06Decision

    Size Assessment

    • <4cm - observe
    • ≥4cm - surgery consult
  7. 07End

    Annual Imaging x 1-2 Years

    Consider biochemical workup

  8. 08End

    Consider Adrenalectomy

    If growth or hormonal symptoms

  9. 09Action

    Washout CT or MRI

    APW >60% or RPW >40% suggests adenoma

  10. Path rejoins step 07Shared downstream outcome
  11. 10Action

    PET/CT or Biopsy

    PET if known malignancy; biopsy if isolated

  12. 11Action

    Suspicious Features

    >30 HU, no washout, irregular margins

  13. Path rejoins step 10Shared downstream outcome

Guideline Source

ACR Appropriateness Criteria: Incidentally Discovered Adrenal Mass

DOI: 10.1016/j.jacr.2017.02.016View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Does not address functional tumors in detail
  • Biochemical workup recommendations vary by institution
  • Size thresholds may differ internationally

Applicable Regions

USAUUKEU

EU: ENSAT guidelines with emphasis on functional screening

US: Endocrine Society recommends biochemical screen for all

Version 1Next review: 2028-01-01

Related Radiology Pathways

Acute Abdomen Imaging Selection (ACR)

Diagnostic

Acute Stroke Imaging Protocol (AHA/ASA)

Diagnostic

Contrast Allergy Management (ACR 2021)

Management

Contrast Extravasation Management (ACR 2024)

Emergency

Next steps

Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.

Calculator

Body Mass Index

Weight classification based on height and weight

Open page

Compare

AttendMe.ai vs UpToDate

See how this pathway workflow compares against UpToDate.

Open page

Commercial

Start free

Run the pathway in a live AttendMe account with citations and tracked usage.

Start free

Related Resources

All Clinical PathwaysClinical CalculatorsAI Chat with Auto-Detection

Frequently Asked Questions

What is the Incidental Adrenal Mass Evaluation (ACR)?

The Incidental Adrenal Mass Evaluation (ACR) is a diagnostic clinical algorithm for Radiology. It provides a structured decision tree to guide clinical decision-making, based on ACR Appropriateness Criteria: Incidentally Discovered Adrenal Mass.

What guideline is the Incidental Adrenal Mass Evaluation (ACR) based on?

This algorithm is based on ACR Appropriateness Criteria: Incidentally Discovered Adrenal Mass (DOI: 10.1016/j.jacr.2017.02.016).

What are the limitations of the Incidental Adrenal Mass Evaluation (ACR)?

Known limitations include: Does not address functional tumors in detail; Biochemical workup recommendations vary by institution; Size thresholds may differ internationally. Individual patient factors may require deviation from these recommendations.

Get AI-Powered Analysis Alongside This Algorithm

In AttendMe.ai, the Incidental Adrenal Mass Evaluation (ACR) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.

Try AttendMe Free