Zhou et al reported the ADRENAL score to evaluate a patient with an adrenal mass. The authors are from The First Affiliated Hospital of Nanchang Hospital, Guangxi Medical University and Temple University.
ADRENAL is an acronym for Aldosterone, Dimension, Relationships, Enhancement, Nearness to major vessels, Adipose and Laterality.
Patient selection: adrenal mass
Parameters:
(1) secretory product (catecholamine, cortisol, catecholamine)
(2) dimensions in cm
(3) relationship to adjacent organs
(4) enhancement on CT scan (highest intratumoral CT numbers on contrast enhanced CT scan in HU)
(5) nearness of the tumor to major vessels in mm
(6) body mass index (BMI) in kg per square meter as measure of adiposity
(7) laterality (not scored; designated left or right adrenal)
|
Parameter
|
Finding
|
Points
|
|
secretory product
|
nonfunctional, cystic, myelolipoma
|
0
|
|
|
suspect primary aldosteronism of Cushing's
|
1
|
|
|
suspect malignancy or pheochromocytoma
|
2
|
|
dimensions
|
<= 4 cm
|
0
|
|
|
4.01 to 6.99
|
1
|
|
|
>= 7 cm
|
2
|
|
relationship to organs
|
clear tumor boundary; no sign of invasion
|
0
|
|
|
< 50% of tumor edge with unclear boundary; no sign local invasion
|
1
|
|
|
>= 50% of tumor edge with unclear boundary; suspect invasion
|
2
|
|
enhancement on CT scan
|
< 10 HU
|
0
|
|
|
>= 10 to 84 HU
|
1
|
|
|
>=85 HU
|
2
|
|
nearness to major vessels
|
>= 7 mm
|
0
|
|
|
< 7 mm but not pressing on vessel
|
1
|
|
|
pressing against major vessel
|
2
|
|
body mass index
|
<= 25
|
0
|
|
|
25.01 to 29.99
|
1
|
|
|
>= 30
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The score is a valid predictor of surgical outcomes and preoperative risk assessment.
|
Total Score
|
Grade
|
|
0
|
0
|
|
1 to 3
|
I
|
|
4 to 7
|
II
|
|
8 to 12
|
III
|
