CUA GUIDELINEUROpediaCANADAPRIOR TO PUBLICATION,THIS GUIDELINE UNDERWENT REVIEW BY THE CUA GUIDEUINES COMMITTEE,TOPIC EXPERTS,AND THE CUA EXECUTIVE BOARDCanadian Urological Association guideline:Diagnosis,management,and followup ofthe incidentally discovered adrenal massNeal E.Rowe",Ravi M.Kumar2,Nicola Schieda Ferhan Siddiqi,April 2021,Mclnnes et al suggested an important revi-Thomas McGregor5,Kristen McAlpines,Philippe D.Violette?,sion to the current CUA guideline0Varun Bathin,Michael Eng,Jason IzardThe purpose of this guideline is to provide anupdated approach to the diagnosis,management,andDivision of Urology.University of Ottawa.Ottawa ON.CanadaDivision of Urology.Universityfollowup of adrenal incidentalomas,with a special focusof Toronto.Toronto.ON.Canada Department of Radiology.University of Ottawa.Ottawa ONCanada "Department of Endocrnology.Dahousie University.Halifax,NS.Canada Departmenton the areas of discrepancy/controversy existing amongU693.59the published guidelines from other associations.University of Saskatchewan.Saskatoon,SK.Canada:"Department of Urologic Scences University ofBritish Columbia Vancouver.BC.CanadaMETHODSJoint frst authorThis guideline was developed by a working group com-prised of urologists,endocrinologists,and radiologistsREVIEWERS:across Canada.The working group met virtually on mul-nf气kthotiple occasions to discuss the priorities for the guidelinePhiladelphia.PA.United Statesand to review the manuscript and recommendations.Wesley Mayer.Department of Urology Baylor College of Medicine.Houston.TX.United StatesThe recommendations and the evidence used to infommGte as:Rowe NE Kumar RM Schieda N et al Canadian Urological Association guideine:each recommendation were reviewed and agreed upon3元器ai684atally discovered adrenal mass.Can Ural Assocby the working group.When required,consensus wasreached by discussion among group members.The tar-get audience of this guideline is healthcare providerswho manage patients with adrenal incidentalomas(e.g.INTRODUCTIONfamily physicians,endocrinologists,intemists,urologists,Adrenal incidentalomas are adrenal masses greaterendocrine surgeons,etc.),as well as patients with adre-than I cm in size that are detected on cross-sectionalnal incidentalomas.imaging performed for an unrelated indication.'TheseThe Grading of Recommendations Assessment,lesions are common,estimated to be present in 4%ofDevelopment and Evaluation (GRADE)frameworkpatients on imaging series,and up to 10%ofthe elderlywas used as a methodological basis for this guideline.population.3 Most of these lesions are benign non-Our evidence synthesis was completed using PubMed,functioning adrenocortical adenomas,with a minorityMedline,and Cochrane Library databases.being hormonally active or malignant.The first step was defining clinical questions.A list ofThe evaluation and management of adrenal inciden-12 clinical questions were compiled and are displayedtalomas is a multidisciplinary process,relying on thein Table I.Next
