Guidelines vary significantly (see Maas JU 2021)

For example, the European Society of Endocrinology recommends no further imaging and no further hormonal testing for these patients in the absence of clinical changes suggestive of hormonal activity, and we believe that this is a reasonable approach.

Based on other guidelines, the most aggressive surveillance that we feel is reasonable in most cases is annual imaging (CT or MRI) and annual repeat hormonal testing for up to a maximum of 5 years.

Guidelines vary significantly (see Maas JU 2021)

See “Imaging Assessment” algorithm for our suggested approach. Surveillance should be tailored to the level of suspicion of the mass and shorter interval scans may be warranted early in the surveillance period. 

We are not aware of any guidelines regarding follow up in this clinical scenario.

Repeat imaging is likely to be of very low utility. 

Repeat hormonal testing is likely only useful in the short term to confirm post-surgical resolution of hormonal abnormalities. Subsequent hormonal testing in the absence of clinical signs/symptoms suggestive of recurrence is likely of very low utility.

Per the European Society of Endocrinology (Fassnacht 2016) we recommend annual clinical reassessment for cortisol-related morbidity and reconsideration of surgical resection based on the results of those assessments. 

Per NCCN guidelines (PHEO-3 1.2021)

After resection:

• At each screening visit

  • H&P, 

  • blood pressure check

  • serum metanephrines 

  • Consider imaging (MRI of abdomen and pelvis, CT of abdomen and pelvis, and/or CT of chest)

• Timing

  • 12 weeks post resection

  • Every 3-6 months for the first year

  • Every 6-12 months from 1 - 5 years

  • Every year from 5-10 years

  • Surveillance is optional after 10 years

See NCCN guidelines for follow up of unresectable, metastatic, or recurrent disease

Per NCCN guidelines (AGT-5 1.2021)

After resection:

• At each screening visit

  • Check hormone levels if tumor was hormonally active prior to resection

  • Consider chest CT and/or CT abdomen or MRI abdomen

• Timing

  • Every 3-12 months for 5 years. Optional thereafter