LAUSR

i n C fi fi c n i m 1 w v [ r c f t s n r d a s o t a m New guidelines recommendations on the management of drenal incidentalomas (AI) (nodules >1 cm) were published in 016 by the European Society of Endocrinology (ESE) in partership with the European Network for the Study of Adrenal umors (ENSAT) [1]. Other recommendations guidelines had een published previously as reviews [2] or as consensus of edical associations notably by the French Endocrine Society SFE) in 2008 [3] and the American Association of Clinial Endocrinologists and American Association of Endocrine urgeons (AACE/AAES) in 2009 [4]. These new ESE recomendations have already received criticism [5], and differences ith the previous recommendations need to be highlighted, hich is the aim of this letter. AI is defined as an adrenal mass detected on an imaging test rdered for a problem unrelated to adrenal disease. AI are found n 1% to 5% of abdominal CT scans and this frequency increases ith age (< 1% before 30 years, 7% after 70 years) [6]. When n AI is discovered, two standard questions are asked: (1) is the I functional? and (2) is the AI malignant? However, a third rucial question concerns the follow-up of these patients, takng into account the natural progression of AI. In this context, he new ESE recommendations have tried to address two other practical” questions: (3) when does surgery need to be considred? and (4) how should patients who do not undergo surgery e followed? Firstly, the decision tree for imaging proposed by ESE is preented in Fig. 1. A recent meta-analysis was done on 19 studies