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Askani E, Rospleszcz S, Lorbeer R, Wintergerst C, Müller-Peltzer K, Kiefer LS, Kellner E, Reisert M, Rathmann W, Peters A, Schlett CL, Bamberg F, Storz C. Associations between adrenal gland volume and adipose tissue compartments - a whole body MRI study. Nutr Metab (Lond) 2024; 21:45. [PMID: 38982517 PMCID: PMC11234623 DOI: 10.1186/s12986-024-00823-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Obesity is associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis. Effects of glucocorticoids on adipose tissues appear to depend on the specific adipose depot, in which they take place. In this study, we aimed to investigate the role of MRI-based adrenal gland volume as an imaging marker in association with different adipose tissue compartments. METHODS The study cohort derives from the population-based research platform KORA (Cooperative Health Research in the Augsburg Region, Germany) MRI sub-study, a cross-sectional sub-study investigating the interactions between subclinical metabolic changes and cardiovascular disease in a study sample of 400 participants. Originally, eligible subjects underwent a whole-body MRI. MRI-based segmentations were performed manually and semi-automatically for adrenal gland volume, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epi- and pericardial fat and renal sinus fat. Hepatic and pancreatic lipid content were measured as pancreatic proton density fraction (PDFF) and MR-spectroscopic hepatic fat fraction (HFF). Multivariable linear regression analyses were performed. RESULTS A number of 307 participants (56.2 ± 9.1 years, 60.3% male, 14.3% with type 2 diabetes (T2DM), 30.6% with obesity, 34.2% with hypertension) were included. In multivariable analyses, strong positive associations between adrenal gland volume and VAT, total adipose tissue (TAT) as well as HFF persisted after extensive step-wise adjustment for possible metabolic confounders (VAT: beta = 0.31, 95%-CI [0.71, 0.81], p < 0.001; TAT: beta = 0.14, 95%-CI [0.06, 0.23], p < 0.001; HFF: beta = 1.17, 95%-CI [1.04, 1.31], p = 0.009). In contrast, associations between adrenal gland volume and SAT were attenuated in multivariate analysis after adjusting for BMI. Associations between pancreatic PDFF, epi- and pericardial fat and renal sinus fat were mediated to a great extent by VAT (pancreatic PDFF: 72%, epicardial adipose tissue: 100%, pericardial adipose tissue: 100%, renal sinus fat: 81.5%). CONCLUSION Our results found MRI-based adrenal gland volume as a possible imaging biomarker of unfavorable adipose tissue distribution, irrespective of metabolic risk factors. Thus, adrenal gland volume may serve as a potential MRI-based biomarker of metabolic changes and contributes to an individual characterization of metabolic states and individual risk stratification. Future studies should elucidate in a longitudinal study design, if and how HPA axis activation may trigger unfavorable adipose tissue distribution and whether and to which extent this is involved in the pathogenesis of manifest metabolic syndrome.
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Affiliation(s)
- Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilans-University Hospital, Munich, Germany
| | - Charlotte Wintergerst
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Müller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena S Kiefer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Annette Peters
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Storz
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg, 79106, Germany.
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Paloka R, Gopireddy DR, Virarkar M, Galgano SJ, Morani A, Adimula P, Singareddy A, Montanarella M. Multimodality imaging of adrenal gland pathologies: A comprehensive pictorial review. J Clin Imaging Sci 2022; 12:62. [PMID: 36601600 PMCID: PMC9805616 DOI: 10.25259/jcis_92_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
The assessment of acute abdominal and pelvic emergencies typically involves a multimodal approach consisting of plain radiographs, ultrasound, computed tomography (CT), and rarely magnetic resonance imaging (MRI). Although MRI is not traditionally employed in acute care settings, there are several instances in which MRI provides superior functional and prognostic information. In this manuscript, we highlight multimodal findings of adrenal gland emergencies: Hemorrhage, infarction, and infection. The purpose of our study is to highlight significant findings in various modalities, including CT, MRI, ultrasound, and PET/CT. Due to the scarcity of published data and limited clinical use, primary ultrasound findings are limited in our multimodal review. In conclusion, we find that synergistic use of CT, MRI, and functional imaging provides an effective tool for evaluation and management of adrenal pathology.
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Affiliation(s)
- Rinald Paloka
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States,Corresponding author: Rinald Paloka, Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States.
| | - Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Samuel Joseph Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, United States
| | - Ajaykumar Morani
- Department of Radiology, University of Texas MD Anderson, Houston, Texas, United States
| | - Padma Adimula
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Anastasia Singareddy
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Matthew Montanarella
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
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3
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Askani E, Rospleszcz S, Lorbeer R, Kulka C, von Krüchten R, Müller-Peltzer K, Hasic D, Kellner E, Reisert M, Rathmann W, Peters A, Schlett CL, Bamberg F, Storz C. Association of MRI-based adrenal gland volume and impaired glucose metabolism in a population-based cohort study. Diabetes Metab Res Rev 2022; 38:e3528. [PMID: 35303389 DOI: 10.1002/dmrr.3528] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess adrenal gland volume by using magnetic resonance imaging (MRI) and to study its role as an indirect marker of impaired glucose metabolism and hypothalamic-pituitary-adrenal (HPA) axis activation in a population-based cohort. METHODS Asymptomatic participants were enrolled in a nested case-control study and underwent a 3-T MRI, including T1w-VIBE-Dixon sequences. For the assessment of adrenal gland volume, adrenal glands were manually segmented in a blinded fashion. Impaired glucose metabolism was determined using fasting glucose and oral glucose tolerance test. Cardiometabolic risk factors were also obtained. Inter- and intrareader reliability as well as univariate and multivariate associations were derived. RESULTS Among 375 subjects included in the analysis (58.5% male, 56.1 ± 9.1 years), 25.3% participants had prediabetes and 13.6% had type 2 diabetes (T2DM). Total adrenal gland volume was 11.2 ± 4.2 ml and differed significantly between impaired glucose metabolism and healthy controls with largest total adrenal gland volume in T2DM (healthy controls: 10.0 ± 3.9 ml, prediabetes: 12.5 ± 3.8 ml, T2DM: 13.9 ± 4.6 ml; p < 0.001). In the multivariate analysis, association of T2DM and increased adrenal gland volume was independent of age, sex, hypertension, triglycerides and body mass index (BMI), but was attenuated in subjects with prediabetes after adjustment for BMI. CONCLUSIONS T2DM is significantly associated with increased adrenal gland volume by MRI in an asymptomatic cohort, independent of age, sex, dyslipidaemia, hypertension and BMI. Adrenal gland volume may represent an indirect marker of impaired glucose metabolism and HPA axis dysfunction.
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Affiliation(s)
- Esther Askani
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilans-University Hospital, Munich, Germany
| | - Charlotte Kulka
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Katharina Müller-Peltzer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dunja Hasic
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Annette Peters
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK e.V.), Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Corinna Storz
- Department of Neuroradiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. Adrenal incidentaloma. Part 2. Modern concepts of computed tomography semiotics of adrenal gland incidentalomas: algorithm of differential diagnosis. TERAPEVT ARKH 2021; 93:1381-1388. [DOI: 10.26442/00403660.2021.11.201169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
While accidentally detecting an adrenal gland lesion (incidentaloma) during a routine computed tomography (CT) scan, the radiologist should correctly interpret revealed changes. The most common lesion is adenoma with high lipid content, but a lipid poor adenoma, pheochromocytoma, adrenocortical cancer, metastasis and other less common adrenal diseases are also worth of attention and require detailed knowledge of their CT semiotics. The article presents criteria of differential diagnosis of the adrenal incidentalomas on the basis of which an algorithm of differential diagnosis was proposed for the most common adrenal lesions.
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. [Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis]. TERAPEVT ARKH 2020; 92:185-194. [PMID: 33720593 DOI: 10.26442/00403660.2020.12.200451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
The adrenal incidentaloma is a lesion of a different etiology and found incidentally in patients who underwent a diagnostic study not about the disease of this organ. Lesions can be both hormonally inactive and hormonally active, can arise from different zones of the adrenal gland or have non-specific organ affiliation, can be benign or malignant. Computed tomography characterization of these lesions, especially the differential diagnosis of benign and malignant, is extremely important for the correct diagnosis in order to provide adequate management of the patient. The article presents the key computed tomography criteria that allow radiologist to characterize the lesion most accurately and consider appropriate diagnosis.
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Affiliation(s)
- S A Buryakina
- Endocrinology Research Centre.,Vishnevsky National Medical Research Centre of Surgery
| | - N V Tarbaeva
- Endocrinology Research Centre.,Vishnevsky National Medical Research Centre of Surgery
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Olson MC, Vietti Violi N, Taouli B, Venkatesh SK. Abbreviated Magnetic Resonance Imaging Protocols in the Abdomen and Pelvis. Magn Reson Imaging Clin N Am 2020; 28:381-394. [PMID: 32624156 DOI: 10.1016/j.mric.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent decades, the clinical applications for which magnetic resonance (MR) imaging is routinely used have expanded exponentially. MR imaging protocols have become increasingly complex, adversely affecting image acquisition and interpretation times. The MR imaging workflow has become a prime target for process improvement initiatives. There has been growing interest in the cultivation of abbreviated MR imaging protocols that evaluate specific clinical questions while reducing cost and increasing access. The overarching goal is to streamline the MR imaging workflow and reduce the time needed to obtain and report examinations by eliminating duplicative or unnecessary sequences without sacrificing diagnostic accuracy.
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Affiliation(s)
- Michael C Olson
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Naïk Vietti Violi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sudhakar Kundapur Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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7
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Shidlovskyi VO, Shidlovskyi OV, Tovkai OA, Sheremet MI, Maksymyuk VV, Tarabanchuk VV, Ivanovych SM, Heryak MS, Andreychyn MS, Hanberher II, Piddubna AA. Topical Diagnosis and Determination of the Primary Hyperaldosteronism Variant. J Med Life 2020; 12:322-328. [PMID: 32025248 PMCID: PMC6993286 DOI: 10.25122/jml-2019-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laboratory diagnosis of primary hyperaldosteronism is based on determining blood levels of aldosterone, renin on request, potassium, and sodium. The results of these studies are significantly influenced by drugs, preparation for the study and blood collection methods, age, gender, and concomitant diseases. The work analyzes the factors influencing the results of the study of aldosterone and identifies the main ways of their exclusion at each stage of the diagnosis. Their neglecting is the determining factor in obtaining false results, diagnostic errors, the selection of ill-treatment tactics, and inadequate treatment. All these diagnostic problems are covered in a variety of ways in the review, which is based on the analysis of results of individual authors' research and practical and clinical recommendations from leading world endocrinological associations. Results of laboratory diagnostics of PHA depend on the influence of many factors. Among them, it is essential to use different medication drugs, the rules for preparing for the study, and the method of conducting it. In assessing the results of research, it is necessary to take into account not only the indicators of the level of aldosterone in the blood but also the features of the clinical course of the disease, its compliance to the drug therapy, age, and gender of the patients.
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Affiliation(s)
- Viktor O Shidlovskyi
- Surgery Department, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Olexandr V Shidlovskyi
- Surgery Department, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Oleksandr A Tovkai
- Ukrainian Scientific and Practical Center of Endocrine Surgery, Endocrine and Tissue Transplantation of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Michael I Sheremet
- First Surgery Department, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Vitaliy V Maksymyuk
- First Surgery Department, Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | - Shved M Ivanovych
- Department of First Emergency Medical Aid and Emergency Medical Treatment, Ternopil, Ukraine
| | - Mykolaivna S Heryak
- Second Department of Obstetrics and Gynecology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Mykhailovych S Andreychyn
- Department of Propaedeutic of Internal Medicine and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Igorivna I Hanberher
- Department of Propaedeutic of Internal Medicine and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Antonina A Piddubna
- Department of Clinical Immunology, Allergology and Endocrinology, Bukovinian State Medical University, Chernivtsi, Ukraine
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8
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Shidlovskyi VO, Shidlovskyi OV, Sheremet M, Zhulkevych IV, Andreychyn SM, Hanberher II, Smachylo II, Dobrorodny VB, Futuima YM. Laboratory Diagnostics of Primary Hyperaldosteronism and its Peculiarities (Literature Review). J Med Life 2019; 12:215-220. [PMID: 31666819 PMCID: PMC6814876 DOI: 10.25122/jml-2019-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The final stage of the diagnostic of primary hyperaldosteronism is to identify the causes of excessive secretion of aldosterone and determination of its variants. Based on the analysis of literature data, the diagnostic value, sensitivity and specificity of the methods of radiation diagnostics for primary hyperaldosteronism were assessed: ultrasound, computed tomography, magnetic resonance imaging, photon emission tomography, magnetic resonance spectroscopy, scintigraphy with iodine radiopharmaceuticals. The causes of false-positive and false-negative evaluations of changes in adrenal glands in the application of these diagnostics have been analyzed. There are many genetic and morphological studies when searching the literature data on the principles and methods of distinguishing the nosological forms of primary hyperaldosteronism based on the results of the aldosterone level estimation in the separated blood from the central veins of both adrenal glands or segmental veins of one gland with subsequent determination of the concentration gradient. It was noted that topical diagnostics and, especially, the determination of nosological forms of primary hyperaldosteronism are complex and expensive, but their results allow choosing an appropriate treatment approach for each particular case.
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Affiliation(s)
- Viktor O Shidlovskyi
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Oleander V Shidlovskyi
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Mikhail Sheremet
- 1st Surgery Department of Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Igor V Zhulkevych
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Sergyi M Andreychyn
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Inna I Hanberher
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Ivan I Smachylo
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Volodimir B Dobrorodny
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Yuryi M Futuima
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Starker LF, Prieto PA, Liles JS, Tran Cao HS, Grubbs EG, Lee JE, Perrier ND, Graham PH. Endocrine incidentalomas. Curr Probl Surg 2016; 53:219-46. [DOI: 10.1067/j.cpsurg.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/22/2016] [Indexed: 12/21/2022]
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10
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Lattin GE, Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, Lack EE. From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics 2015; 34:805-29. [PMID: 24819798 DOI: 10.1148/rg.343130127] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advanced imaging often reveals adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients. When adrenal disease is clinically suspected, cross-sectional imaging can be helpful in evaluating the etiology of the patient's symptoms. When adrenal disease is incidentally identified, what the clinician and patient really want to know is whether the findings are benign or malignant, as this ultimately will affect their next step in management. Using radiologic-pathologic correlation, we broadly classify common, uncommon, and rare tumors and tumor-like conditions that can occur in the adrenal as benign or malignant. This classification follows predominant trends in observed biologic behavior while acknowledging those tumors that may behave in the minority in an unpredictable manner. We review the clinical background and presentation of functional adrenal tumors including Conn syndrome, Cushing syndrome, and catecholamine-secreting tumors, as well as their relationship with adrenal anatomy. We discuss a variety of benign tumors, including adrenal cortical adenoma (including oncocytoma) and pheochromocytoma, as well as uncommonly and rarely encountered tumors such as myelolipoma, hemangioma, lymphangioma, schwannoma, ganglioneuroma, and adenomatoid tumor. A variety of tumefactive but nonneoplastic lesions are addressed, including adrenal cortical hyperplasia, adrenal hemorrhage, adrenal cysts, and infections. Malignant tumors discussed include adrenal cortical carcinoma, the rare malignant pheochromocytoma, lymphoma, metastases, and sarcomas. For each tumor and tumor-like lesion, the clinical presentation, epidemiology, key imaging findings, diagnostic differential considerations, and management options are briefly addressed. Finally, an approach to the workup of suspected or incidentally discovered tumors is presented based on a selected literature survey and our clinical experience. Radiologists play an important role in identification and diagnosis of adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients.
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Affiliation(s)
- Grant E Lattin
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (G.E.L., C.A.T., J.M., W.D.C.); American Institute for Radiologic Pathology, Silver Spring, Md (G.E.L., E.D.S., W.D.C.); Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, Va (E.D.S.); Department of Radiology, David Grant USAF Medical Center, Travis AFB, Calif (C.A.T.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.M.); School of Medicine, Georgetown University, Washington, DC (K.W.S.); Department of Radiology, Suburban Hospital, Bethesda, Md (W.D.C.); and Department of Endocrine Pathology, The Joint Pathology Center, Silver Spring, Md (E.E.L.)
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11
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Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiol Clin North Am 2012; 50:219-43, v. [PMID: 22498440 DOI: 10.1016/j.rcl.2012.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The discovery of an incidental adrenal mass (adrenal incidentaloma) continues to rise with the increasing use of cross-sectional imaging. Although most adrenal lesions are benign and asymptomatic, radiologists should guide evaluation of these lesions, whether benign or malignant. This article reviews the various imaging techniques used to evaluate adrenal masses and their relative strengths and weaknesses. It focuses on the most prevalent adrenal pathologies and their typical imaging characteristics, and concludes with a brief discussion of developing techniques, including diffusion-weighted imaging and dual-energy CT.
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Affiliation(s)
- Myles Taffel
- Department of Radiology, George Washington University Medical Center, Washington, DC, USA.
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12
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Abstract
While different generations of assays have played important role in elucidating causes of different endocrine disorders, radiological techniques are instrumental in localizing the pathology. This statement cannot be truer in any disease entity other than endocrine hypertension. This review makes an effort to highlight the role of different radiological modalities, especially ultrasonography, computed tomography and magnetic resonance imaging, in the evaluation of different causes of endocrine hypertension.
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Affiliation(s)
- Chandan J. Das
- Department of Radiology, DCA Imaging Center and Dr. Gulati's Imaging Institute, New Delhi, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Center, Guwahati, Assam, India
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13
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Klein JD, Turner CG, Gray FL, Yu DC, Kozakewich HP, Perez-Atayde AR, Voss SD, Zurakowski D, Shamberger RC, Weldon CB. Adrenal cortical tumors in children: factors associated with poor outcome. J Pediatr Surg 2011; 46:1201-7. [PMID: 21683223 DOI: 10.1016/j.jpedsurg.2011.03.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 03/26/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate recurrence and survival outcomes in pediatric adrenal cortical neoplasms. METHODS A 90-year retrospective review of children with adrenal cortical neoplasms was performed using multivariate Cox regression analysis to identify factors associated with recurrence and tumor-related mortality. RESULTS The evaluable cohort included 29 patients. Twenty-seven underwent resection. Twenty-two (81%) had localized disease, and 5 (19%) had locally advanced disease (all received chemotherapy and 2 of 5 were cured). Two patients presenting with metastatic disease died despite treatment. There were 4 recurrences; all patients died. Tumor-related mortality was 24% (7/29). Kaplan-Meier freedom from recurrence was 85% at 1 year (95% confidence interval, 75%-95%). Multivariate Cox regression revealed that older age (P = .01), higher mitotic rate (P = .005), and necrosis (P < .001) were independent predictors of tumor-related death. Higher mitotic rate (P = .007) and larger tumor size (P = .03) were significant predictors of tumor recurrence. CONCLUSION Risk factors for poor outcomes in patients with adrenocortical tumors include older age, higher mitotic rate, higher percent necrosis, and larger tumor size. Therefore, the presence of these factors may warrant consideration of adjuvant chemotherapy, even in the absence of advanced disease.
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Affiliation(s)
- Justin D Klein
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Abstract
The adrenal gland may be affected by several pathologies, and the detection of an adrenal nodule may occur during the work-up of a biological abnormality, oncologic work-up, or be incidental. Endocrinological and imaging work-up is required in all cases. Cross-sectional imaging has had a great impact on the diagnostic work-up of adrenal nodules. CT, without and with intravenous contrast, is the first line imaging study for evaluation of adrenal nodules. A spontaneous density below 10 HU confirms the benign nature of a nodule. When lesions cannot be characterized, postcontrast CT or MR imaging, including in and out of phase imaging, may allow diagnosis.
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Affiliation(s)
- P Legmann
- Hôpital Cochin, Service de Radiologie A, 27 rue du Faubourg Saint Jacques, 75679 Paris cedex 14, France.
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15
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Jacques AET, Sahdev A, Sandrasagara M, Goldstein R, Berney D, Rockall AG, Chew S, Reznek RH. Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function. Eur Radiol 2008; 18:2885-92. [PMID: 18641999 DOI: 10.1007/s00330-008-1073-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 05/01/2008] [Accepted: 05/14/2008] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to describe the range of appearances of adrenal phaeochromocytomas on T2-weighted MRI, correlate appearances with histopathology, and quantify the incidence of the previously described hyperintense appearance. The appearance and MR characteristics of 44 phaeochromocytomas were reviewed retrospectively. T2-weighted appearances were grouped: (1) 'classical', homogeneous, high signal intensity, isointense to CSF; (2) homogeneous, isointense or minimally hyperintense to spleen, hypointense to CSF; (3) heterogeneous, marbled appearance; (4) heterogeneous, multiple high signal intensity pockets. All 44 adrenal phaeochromocytomas were well circumscribed, 1.2-15 cm in maximum diameter, with no visual or quantitative signal loss on chemical shift imaging. On T2-weighted MRI 5/44 (11%) had group 1 appearance; 15/44 (34%) group 2, 7/44 (16%) group 3; and 17/44 (39%) group 4. Homogeneous group 1 and 2 lesions were smaller (mean 4.5 cm) than heterogeneous group 3 and 4 lesions (mean 6.3 cm). Increasing MRI heterogeneity correlated pathologically with increasing amounts of haemorrhage, necrosis and fibrosis. No MRI features were predictive of malignancy. Non-functioning phaeochromocytomas were larger than functioning lesions. No size difference was seen between syndrome and sporadic lesions. In this large series we report a wide range of appearances of adrenal phaeochromocytomas on T2-weighted MRI. The previously described classical hyperintense phaeochromocytoma is relatively uncommon.
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Affiliation(s)
- Audrey E T Jacques
- Cancer Imaging, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
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16
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Schindera ST, Soher BJ, Delong DM, Dale BM, Merkle EM. Effect of echo time pair selection on quantitative analysis for adrenal tumor characterization with in-phase and opposed-phase MR imaging: initial experience. Radiology 2008; 248:140-7. [PMID: 18566172 DOI: 10.1148/radiol.2481071069] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine the effect of two pairs of echo times (TEs) for in-phase (IP) and opposed-phase (OP) 3.0-T magnetic resonance (MR) imaging on (a) quantitative analysis prospectively in a phantom study and (b) diagnostic accuracy retrospectively in a clinical study of adrenal tumors, with use of various reference standards in the clinical study. MATERIALS AND METHODS A fat-saline phantom was used to perform IP and OP 3.0-T MR imaging for various fat fractions. The institutional review board approved this HIPAA-compliant study, with waiver of informed consent. Single-breath-hold IP and OP 3.0-T MR images in 21 patients (14 women, seven men; mean age, 63 years) with 23 adrenal tumors (16 adenomas, six metastases, one adrenocortical carcinoma) were reviewed. The MR protocol involved two acquisition schemes: In scheme A, the first OP echo (approximately 1.5-msec TE) and the second IP echo (approximately 4.9-msec TE) were acquired. In scheme B, the first IP echo (approximately 2.4-msec TE) and the third OP echo (approximately 5.8-msec TE) were acquired. Quantitative analysis was performed, and analysis of variance was used to test for differences between adenomas and nonadenomas. RESULTS In the phantom study, scheme B did not enable discrimination among voxels that had small amounts of fat. In the clinical study, no overlap in signal intensity (SI) index values between adenomas and nonadenomas was seen (P < .05) with scheme A. However, with scheme B, no overlap in the adrenal gland SI-to-liver SI ratio between adenomas and nonadenomas was seen (P < .05). With scheme B, no overlap in adrenal gland SI index-to-liver SI index ratio between adenomas and nonadenomas was seen (P < .05). CONCLUSION This initial experience indicates SI index is the most reliable parameter for characterization of adrenal tumors with 3.0-T MR imaging when obtaining OP echo before IP echo. When acquiring IP echo before OP echo, however, nonadenomas can be mistaken as adenomas with use of the SI index value.
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Affiliation(s)
- Sebastian T Schindera
- Department of Radiology, Duke University Medical Center, Duke North, Erwin Rd, Durham, NC 27710, USA
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17
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Martins DL, Baroni RH, Blasbalg R, Viana PCC, Bezerra ROF, Donato Jr. F, Mattedi RL, Lucon AM, Leite CDC, Cerri GG. Avaliação por ressonância magnética dos tumores de adrenal com correlação histológica. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A ressonância magnética é ferramenta importante para a detecção e caracterização dos tumores adrenais. O conhecimento das diferentes apresentações dos tumores primários e secundários à ressonância magnética e sua correlação com dados da histologia são essenciais para o correto raciocínio diagnóstico. Este artigo revisa os aspectos que podem estreitar o diagnóstico diferencial dos tumores adrenais, dando ênfase à correlação histológica daqueles mais comuns.
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Abstract
MR imaging at 1.5T is considered the prime cross-sectional imaging modality for characterization of adrenal lesions. This is of utmost clinical importance, because non-functioning adenoma and adrenal metastasis are fairly common. The differentiation of these two tumor entities primarily is based on chemical shift imaging, also known as dual echo in-phase and opposed-phase imaging. At 3.0 T, the echo time pairs for in-phase and opposed-phase MR imaging need to be adjusted because the frequency difference is double that of standard 1.5T MR systems. Unfortunately, the acquisition of the first opposed-phase echo at 1.1 milliseconds and the first in-phase echo at 2.2 milliseconds within the same breath-hold requires unacceptably high receiver bandwidths at 3.0 T. Therefore, alternative data collection schemes have been implemented. This article reviews the current literature regarding adrenal imaging at 3.0 T with a focus on the chemical shift technique.
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Affiliation(s)
- Elmar M Merkle
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA.
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19
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Affiliation(s)
- William F Young
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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