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Coscia K, Verrienti M, Di Dalmazi G, Zatelli MC. Who and how to screen for endogenous hypercortisolism in adrenal and pituitary incidentaloma. J Endocrinol Invest 2024:10.1007/s40618-024-02456-6. [PMID: 39395117 DOI: 10.1007/s40618-024-02456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 08/20/2024] [Indexed: 10/14/2024]
Abstract
PURPOSE Adrenal incidentalomas (AIs) and pituitary incidentalomas (PIs) have become frequent findings in the last two decades due to the widespread use of cross-sectional imaging in clinical practice. This review investigates the prevalence of endogenous hypercortisolism in patients with AIs and PIs. We aim to underscore the importance of early detection and management of endogenous hypercortisolism in this subset of patients to mitigate associated cardiometabolic complications and reduce mortality. METHODS We performed a PubMed literature search to provide updates regarding the prevalence of endogenous hypercortisolism in patients with AIs and PIs, the demographic and clinical characteristics of the studied populations, and the diagnostic test accuracy for early identification of endogenous hypercortisolism. RESULTS Hypercortisolism, especially mild autonomous cortisol secretion (MACS), was identified in a notable proportion of patients with AIs. MACS was associated with increased cardiometabolic risks, contributing to an elevated overall mortality rate in this cohort. Furthermore, PIs were found to be linked with Cushing's disease in a subset of patients, emphasizing the need for thorough evaluation and monitoring. CONCLUSION Early diagnosis and appropriate management of endogenous hypercortisolism are essential in preventing complications and improving patient outcomes. As the presence of undetected hypercortisolism is associated with clinical complications over time, the accurate identification of high-risk populations to screen remains crucial.
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Affiliation(s)
- Kimberly Coscia
- Division of Endocrinology and Diabetes Prevention and Care, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martina Verrienti
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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2
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Li M, Duan X, You D, Liu L. Construction of a novel clinical nomogram to predict cancer-specific survival in patients with primary malignant adrenal tumors: a large population-based retrospective study. Front Med (Lausanne) 2023; 10:1184607. [PMID: 37305122 PMCID: PMC10249662 DOI: 10.3389/fmed.2023.1184607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background Primary malignant adrenal tumors were rare and had a poor prognosis. This investigation aimed to create a useful clinical prediction nomogram to anticipate cancer-specific survival (CSS) of patients with a primary malignant adrenal tumor. Method This study included 1748 patients with malignant adrenal tumor diagnoses subjects from 2000 to 2019. These subjects were allocated randomly into training (70%) and validation (30%) cohorts. Patients with adrenal tumors underwent univariate and multivariate Cox regression analyses to identify the CSS-independent predictive biomarkers. Therefore, a nomogram was created depending on those predictors, and calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were used to assess the calibration capacity of the nomogram, discriminative power, and clinical efficiency, respectively. Afterward, a risk system for categorizing patients with adrenal tumors was established. Result The univariate and multivariate Cox analysis demonstrated the CSS-independent predictive factors, including age, tumor stage, size, histological type, and surgery. As a result, a nomogram was developed using these variables. For the 3-, 5-, and 10-year CSS of this nomogram, the values of the area under the curve (AUC) of the ROC curves were 0.829, 0.827, and 0.822, respectively. Furthermore, the AUC values of the nomogram were higher than those of the individual independent prognostic components of CSS, indicating that the nomogram had stronger prognostic prediction reliability. A novel risk stratification method was created to further improve patient stratification and give clinical professionals a better reference for clinical decision-making. Conclusion Through the developed nomogram and risk stratification method, the CSS of patients with malignant adrenal tumors could be predicted more precisely, assisting physicians to differentiate patients better and creating personalized treatment strategies to optimize patient benefits.
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Affiliation(s)
- Mingzhen Li
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaoying Duan
- Department of Acupuncture and Moxibustion, Second Hospital of Jilin University, Changchun, China
| | - Di You
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Linlin Liu
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
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3
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Kandasamy D, Gulati A, Simon B, John R, Goyal A. Imaging Recommendations for Diagnosis, Staging, and Management of Adrenal Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractAdrenal glands are affected by a wide variety of tumors apart from infective and inflammatory lesions and their noninvasive characterization on imaging is important for the management of these patients. Incidentalomas form the major bulk of adrenal tumors and differentiation of benign adenomas from other malignant lesions, especially in patients with a known malignancy, guide further management. Imaging is an integral part of management along with clinical and biochemical features. The cornerstone of clinical and biochemical evaluation of adrenal tumors is to determine whether the lesion is functional or nonfunctional. Computed tomography (CT) is considered as the workhorse for imaging evaluation of adrenal lesions. CT densitometry and CT contrast washout characteristics are quite reliable in differentiating adenomas from malignant lesions. CT is also the modality of choice for the evaluation of resectability and staging of primary adrenal tumors. Magnetic resonance imaging (MRI) has superior contrast resolution compared to other morphological imaging modalities and is generally used as a problem-solving tool. MRI chemical shift imaging can also be used to reliably detect adrenal adenomas. Ultrasonography (USG) is used as a screening tool that is usually followed by either CT or MRI to better characterize the tumor and it is not routinely used for assessing the resectability, staging, and characterization of adrenal tumors. Another important role of USG is in image-guided sampling of tumors. Fluorodeoxyglucose positron emission tomography-computed tomography and other nuclear medicine modalities are a valuable addition to morphological imaging modalities. Image-guided interventions also play an important role in obtaining tissue samples where diagnostic imaging is not able to characterize adrenal tumors. In the functioning of adrenal tumors, adrenal venous sampling is widely used to accurately lateralize the secreting tumor.
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Affiliation(s)
- Devasenathipathy Kandasamy
- Department of Radiodiagnosis & Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gulati
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Betty Simon
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reetu John
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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4
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Riedmeier M, Decarolis B, Haubitz I, Reibetanz J, Wiegering A, Härtel C, Schlegel PG, Fassnacht M, Wiegering V. Assessment of prognostic factors in pediatric adrenocortical tumors: a systematic review and evaluation of a modified S-GRAS score. Eur J Endocrinol 2022; 187:751-763. [PMID: 36193775 DOI: 10.1530/eje-22-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pediatric adrenocortical carcinoma (pACC) is rare and prognostic stratification remains challenging. We summarized the clinical prognostic factors of pACC and determined the prognostic value of the pediatric scoring system (pS-GRAS) in adaption to the recommendation (S-GRAS) of the European Network for the Study of Adrenal Tumors for the classification of adult ACC. DESIGN Analysis of pACC patients of 33 available retrospective studies in the literature. METHODS We searched the PubMed and Embase databases for manuscripts regarding pACC. The pS-GRAS score was calculated as a sum of tumor stage (1 = 0; 2-3 = 1; 4 = 2 points), grade (Ki67 index/rate of mitosis 0-9%/low = 0; 10-19%/intermediate = 1; ≥20%/high = 2 points), resection status (R0 = 0; RX = 1; R1 = 2; R2 = 3 points), age (<4 years = 0; ≥4 years = 1 point), hormone-related symptoms (androgen production = 0; glucocorticoid/mixed/no hormone production = 1 point) generating 10 scores and 4 groups (1: 0-2, 2: 3-4, 3: 5, 4: 6-9). The primary endpoint was overall survival (OS). RESULTS We included 733 patients. The median age was 2.5 years and >85% of pACC showed hormone activity (mixed 50%, androgen 29%, glucocorticoid 21%). Androgen production was associated with a superior OS. Increasing age correlated with higher rates of inactive or only glucocorticoid-producing tumors, advanced tumor stage, and case fatality. Especially infants < 4 years showed more often low-risk constellations with an increased OS for all tumor stages. The pS-GRAS score correlated with clinical outcome; median OS was 133 months (95% CI: 36-283) in group 1 (n = 49), 110 months (95% CI: 2.9-314) in group 2 (n = 57), 49 months (95% CI: 5.8-278) in group 3 (n = 18), and 16 months (95% CI: 2.4-267) in group 4; (n = 11) P < 0.05). CONCLUSION The pS-GRAS score seems to have a high predictive value in the pACC patients, may serve as a helpful tool for risk stratification in future studies, and should be evaluated prospectively in an international context.
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Affiliation(s)
- Maria Riedmeier
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Boris Decarolis
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Imme Haubitz
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Joachim Reibetanz
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Christoph Härtel
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Paul-Gerhardt Schlegel
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Martin Fassnacht
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Verena Wiegering
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
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5
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Riedmeier M, Decarolis B, Haubitz I, Müller S, Uttinger K, Börner K, Reibetanz J, Wiegering A, Härtel C, Schlegel PG, Fassnacht M, Wiegering V. Adrenocortical Carcinoma in Childhood: A Systematic Review. Cancers (Basel) 2021; 13:5266. [PMID: 34771430 PMCID: PMC8582500 DOI: 10.3390/cancers13215266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 01/01/2023] Open
Abstract
Adrenocortical tumors are rare in children. This systematic review summarizes the published evidence on pediatric adrenocortical carcinoma (ACC) to provide a basis for a better understanding of the disease, investigate new molecular biomarkers and therapeutic targets, and define which patients may benefit from a more aggressive therapeutic approach. We included 137 studies with 3680 ACC patients (~65% female) in our analysis. We found no randomized controlled trials, so this review mainly reflects retrospective data. Due to a specific mutation in the TP53 gene in ~80% of Brazilian patients, that cohort was analyzed separately from series from other countries. Hormone analysis was described in 2569 of the 2874 patients (89%). Most patients were diagnosed with localized disease, whereas 23% had metastasis at primary diagnosis. Only 72% of the patients achieved complete resection. In 334 children (23%), recurrent disease was reported: 81%-local recurrence, 19% (n = 65)-distant metastases at relapse. Patients < 4 years old had a different distribution of tumor stages and hormone activity and better overall survival (p < 0.001). Although therapeutic approaches are typically multimodal, no consensus is available on effective standard treatments for advanced ACC. Thus, knowledge regarding pediatric ACC is still scarce and international prospective studies are needed to implement standardized clinical stratifications and risk-adapted therapeutic strategies.
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Affiliation(s)
- Maria Riedmeier
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
| | - Boris Decarolis
- Department of Pediatric Oncology and Hematology, Medical Faculty, University Children’s Hospital of Cologne, 50937 Cologne, Germany;
| | - Imme Haubitz
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
| | - Sophie Müller
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Konstantin Uttinger
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Kevin Börner
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Joachim Reibetanz
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany; (S.M.); (K.U.); (K.B.); (J.R.); (A.W.)
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
| | - Christoph Härtel
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
| | - Martin Fassnacht
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
- Department of Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany
| | - Verena Wiegering
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Wuerzburg, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany; (M.R.); (I.H.); (C.H.); (P.-G.S.)
- Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Centre, Josef-Schneiderstr. 2, 97080 Wuerzburg, Germany;
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6
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Peterkova VA, Alimova IL, Bashnina EB, Bezlepkina OB, Bolotova NV, Zubkova NA, Kalinchenko NU, Kareva MA, Kiyaev AV, Kolodkina AA, Kostrova IB, Makazan NV, Malievskiy OA, Orlova EM, Petryaykina EE, Samsonova LN, Taranushenko TE. [Clinical guidelines «Precocious puberty»]. PROBLEMY ĖNDOKRINOLOGII 2021; 67:84-103. [PMID: 34766494 DOI: 10.14341/probl12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/06/2022]
Abstract
The precocious puberty is an urgent problem of pediatric endocrinology characterized by clinical and pathogenetic heterogeneity. The appearance of secondary sex characteristics before the age of 8 years in girls and 9 years in boys requires timely diagnosis and the appointment of pathogenetically justified treatment in order to achieve the target indicators of final growth and prevent social deprivation. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of рrecocious puberty, methods of its diagnosis and treatment based on the principles of evidence-based medicine.
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Affiliation(s)
| | | | - E B Bashnina
- North-Western State Medical University named after I.I. Mechnikov
| | | | - N V Bolotova
- Saratov State Medical University named after V. I. Razumovsky
| | | | | | | | | | | | - I B Kostrova
- N.M. Kuraev Children's Republican Clinical Hospital
| | | | | | | | - E E Petryaykina
- Russian Children's Clinical Hospital, Pirogov Russian National Research Medical University
| | - L N Samsonova
- Russian Medical Academy of Continuous Professional Education
| | - T E Taranushenko
- Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky
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7
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Hamidi O. Cardiovascular and metabolic consequences in patients with asymptomatic adrenal adenomas. Curr Opin Endocrinol Diabetes Obes 2021; 28:277-282. [PMID: 33764928 DOI: 10.1097/med.0000000000000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The incidence of adrenal tumors has increased over the past 20 years, most of which are incidentally discovered nonfunctioning adenomas (NFA) and tumors with mild autonomous cortisol secretion (MACS). This review aimed to summarize recent progress in understanding cardiometabolic risk in patients with NFA and MACS and to provide updates on the effect of treatment on improving outcomes in this population. RECENT FINDINGS NFA and MACS are associated with adverse cardiovascular risk factors and metabolic derangements, which are likely mediated by excessive glucocorticoid secretion. Recent studies showed significantly higher prevalence of hypertension, impaired glucose metabolism, obesity, and dyslipidemia in patients with NFA and MACS. Adrenalectomy may improve comorbidities in selected patients. SUMMARY Asymptomatic adrenal adenomas are common and are associated with adverse cardiometabolic changes. In selected patients, adrenalectomy may reduce cardiometabolic risk and improve clinical outcomes.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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8
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Zambaiti E, Duci M, De Corti F, Gamba P, Dall'Igna P, Ghidini F, Virgone C. Clinical prognostic factors in pediatric adrenocortical tumors: A meta-analysis. Pediatr Blood Cancer 2021; 68:e28836. [PMID: 33306282 DOI: 10.1002/pbc.28836] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
Pediatric adrenocortical tumors (ACT) are rare and sometimes aggressive malignancies, but there is no consensus on the outcome predictors in children. A systematic search of MEDLINE, SCOPUS, Web of Science, and the Cochrane Library for studies from 1994 to 2020 about pediatric ACT was performed. In 42 studies, 1006 patients, aged 0-18 years, were included. The meta-analyses resulted in the following predictors of better outcome: age <4 years (P < .00001), nonsecreting tumors (P = .004), complete surgical resection (P < .00001), tumor volume (P < .0001), tumor weight (P < .00001), tumor maximum diameter (P = .0009), and Stage I disease (P < .00001). Moreover, patients affected by Cushing syndrome showed a worse outcome (P < .0001). International prospective studies should be implemented to standardize clinical prognostic factors evaluation, together with pathological scores, in the stratification of pediatric ACT.
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Affiliation(s)
- Elisa Zambaiti
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Miriam Duci
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Federica De Corti
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Patrizia Dall'Igna
- Department of Emergencies and Organ Transplantation, Azienda Ospedaliero-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Filippo Ghidini
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Calogero Virgone
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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9
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Abstract
PURPOSE OF REVIEW Adrenocortical tumor (ACT) is a rare disease with an annual worldwide incidence of 0.3-0.38/million children below 15 years old, and Brazilian population presents the highest incidence because of germline mutation in the TP53. Pediatric ACT is associated with virilizing features and hypercortisolism in most cases. Malignancy is defined when local invasion or metastasis is found, and it is associated with a poor prognosis. However, the correct and early diagnosis and treatment may impact on overall and disease-free survival. RECENT FINDINGS A complete understanding of the disease and its singularities facilitates the assistance to the pediatric patient with ACT. The new insights about adrenal tumorigenesis have provided a better understanding of this disease. In this scenario, the era of molecular studies is leading to the refinement of the taxonomy, and it is offering the opportunity to discover new biomarkers and pathways of tumorigenesis, beyond the knowing β-catenin, Insulin-like growth factor-II/IGF-IR, and the p53/Rb signaling. SUMMARY The rarity of this disease makes it a real challenge. Here, we present a review focusing on clinical practice. A methodic approach aiming to clarify the diagnosis and a follow-up are suggested to guide physicians in the assistance of pediatrics patients, improving the prognosis.
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Affiliation(s)
- Vania B Brondani
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo
| | - Maria Candida B V Fragoso
- Unidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo
- Serviço de Endocrinologia da Clínica de Bases do Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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10
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Zekri W, Hammad M, Rashed WM, Ahmed G, Elshafie M, Adly MH, Elborai Y, Abdalla B, Taha H, Elkinaae N, Refaat A, Younis A, Alfaar AS. The outcome of childhood adrenocortical carcinoma in Egypt: A model from developing countries. Pediatr Hematol Oncol 2020; 37:198-210. [PMID: 31971470 DOI: 10.1080/08880018.2019.1710309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare, aggressive endocrine neoplasm. Complete surgical resection is the single most important treatment. Most available information has been learned from experience with its more frequent adult counterpart. In this study, we assessed the features and survival outcome of patients with ACC at Children's Cancer Hospital Egypt (CCHE). Patients diagnosed at CCHE between July 2007 and November 2016 were followed up on until November 2018. Patients with stages I and II were operated upon, while stages III and IV had received combinations of doxorubicin, etoposide, platinol, and mitotane (DEPM) beside the attempt to conduct surgery when feasible. Data belonging to 18 patients (7 men and 11 women) were analyzed; median age at diagnosis was 48.5 months. Sixteen patients had presented with secreting tumors. Six patients were diagnosed with stage I disease; four with stage II; three with stage III; and five with stage IV carcinoma. By the end of this study, 10 patients have survived; five-year overall survival of 66.3%. Surviving patients were all of stage I or II diseases and were all in remission. Seven patients who did not survive died due to tumor progression, while one patient died after chemotherapy. The prognosis of ACC is essentially dependent on a successful complete resection of the tumor and thus on the initial tumor stage. The mitotane and DEP protocols may help control tumor growth in the advanced stages for only short periods. Key pointsInitial stage and resectability are the main indicators of outcomes in adrenocortical carcinoma.Chemotherapeutic agents used in developed countries did not achieve the same outcomes.Further molecular-pharmacology differentiation is needed for various ethnic populations.
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Affiliation(s)
- Wael Zekri
- Pediatric Oncology Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud Hammad
- Pediatric Oncology Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wafaa M Rashed
- Research Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Gehad Ahmed
- Surgery Oncology Department, Faculty of Medicine, Helwan University, Cairo, Egypt.,Surgery Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Maged Elshafie
- Surgery Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Yasser Elborai
- Pediatric Oncology Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Pediatric Hematology-Oncology Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Badr Abdalla
- Gastroenterology Department, Hospital of Llandough, Cardiff, UK
| | - Hala Taha
- Pathology Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Naglaa Elkinaae
- Pathology Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amal Refaat
- Radiodiagnosis Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Radiodiagnosis Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Alaa Younis
- Surgery Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmad S Alfaar
- Experimental Ophthalmology, Department of Ophthalmology, Charité - Universitätsmedizin Berlin, a Corporate Member of Freie Universität, Humboldt University, the Berlin Institute of Health, Berlin, Germany.,Department of Ophthalmology, University of Leipzig, Leipzig, Germany
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11
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Haddad NG, Eugster EA. Peripheral precocious puberty including congenital adrenal hyperplasia: causes, consequences, management and outcomes. Best Pract Res Clin Endocrinol Metab 2019; 33:101273. [PMID: 31027974 DOI: 10.1016/j.beem.2019.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Peripheral precocious puberty results from peripheral production of sex steroids independent of activation of the hypothalamic-pituitary gonadal axis. It is much less common than central precocious puberty. Causes are variable and can be congenital or acquired. In this review, we will discuss the diagnosis and management of the most common etiologies including congenital adrenal hyperplasia, McCune Albright syndrome, familial male-limited precocious puberty, and adrenal and gonadal tumors.
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Affiliation(s)
- Nadine G Haddad
- Riley Hospital for Children, 705 Barnhill Dr, Rm 5960, Indianapolis, IN 46202, USA.
| | - Erica A Eugster
- Riley Hospital for Children, 705 Barnhill Dr, Rm 5960, Indianapolis, IN 46202, USA.
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12
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Araujo-Castro M, Sampedro Núñez MA, Marazuela M. Autonomous cortisol secretion in adrenal incidentalomas. Endocrine 2019; 64:1-13. [PMID: 30847651 DOI: 10.1007/s12020-019-01888-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/28/2019] [Indexed: 02/06/2023]
Abstract
Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3-10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to AI carriers with biochemical evidence of excess cortisol, but without the "specific" clinical signs of Cushing's syndrome. As ACS is associated with an increased risk of diabetes, obesity, high blood pressure (HBP), osteoporosis, cardiovascular events, and global mortality; its correct identification is of great importance. There are different laboratory assays to detect ACS, but all of them have some limitations. The dexamethasone suppression test is the most accepted for screening. However, there is no consensus on the cutoff point that should be used. Low levels of ACTH and DHEA-S and high urinary free cortisol are also associated with ACS, but in isolation they are of little value to establish the diagnosis. Considering its clinical implications and the lack of consensus in the diagnosis and in which is the most appropriate management of these patients, this review offers a quick reference guide of ACS, presenting an exhaustive review of the topic: its definition, epidemiology, diagnosis, clinical implications, treatment, and follow-up.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
| | - Miguel Antonio Sampedro Núñez
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
| | - Mónica Marazuela
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
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13
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Iñiguez-Ariza NM, Kohlenberg JD, Delivanis DA, Hartman RP, Dean DS, Thomas MA, Shah MZ, Herndon J, McKenzie TJ, Arlt W, Young WF, Bancos I. Clinical, Biochemical, and Radiological Characteristics of a Single-Center Retrospective Cohort of 705 Large Adrenal Tumors. Mayo Clin Proc Innov Qual Outcomes 2018; 2:30-39. [PMID: 30225430 PMCID: PMC6124341 DOI: 10.1016/j.mayocpiqo.2017.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To characterize large adrenal tumors (≥4 cm in diameter) and to identify features associated with malignancy. PATIENTS AND METHODS We investigated the clinical, biochemical, and imaging characteristics in a large retrospective single-center cohort of patients with adrenal tumors of 4 cm or more in diameter during the period of January 1, 2000, through December 31, 2014. RESULTS Of 4085 patients with adrenal tumors, 705 (17%) had adrenal masses measuring 4 cm or more in diameter; of these, 373 (53%) were women, with a median age of 59 years (range, 18-91 years) and median tumor size of 5.2 cm (range, 4.0-24.4 cm). Underlying diagnoses were adrenocortical adenomas (n=216 [31%]), pheochromocytomas (n=158 [22%]), other benign adrenal tumors (n=116 [16%]), adrenocortical carcinomas (n=88 [13%]), and other malignant tumors (n=127 [18%]). Compared with benign tumors, malignant tumors were less frequently diagnosed incidentally (45.5% vs 86.7%), were larger (7 cm [range, 4-24.4 cm] vs 5 cm [range, 4-20 cm]), and had higher unenhanced computed tomographic (CT) attenuation (34.5 Hounsfield units [HU] [range, 14.1-75.5 HU] vs 11.5 HU [range, -110 to 71.3 HU]; P<.001). On multivariate analysis, older age at diagnosis, male sex, nonincidental mode of discovery, larger tumor size, and higher unenhanced CT attenuation were all found to be statistically significant predictors of malignancy. CONCLUSION The prevalence of malignancy in patients with adrenal tumors of 4 cm or more in diameter was 31%. Older age, male sex, nonincidental mode of discovery, larger tumor size, and higher unenhanced CT attenuation were associated with an increased risk for malignancy. Clinical context should guide management in patients with adrenal tumors of 4 cm or more in diameter.
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Affiliation(s)
| | | | - Danae A. Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | | | - Diana S. Dean
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Melinda A. Thomas
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Muhammad Z. Shah
- Department of Endocrinology, Diabetes, and Metabolism, University of Minnesota, Minneapolis, MN
| | - Justine Herndon
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | | | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - William F. Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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14
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Breidbart E, Cameo T, Garvin JH, Hibshoosh H, Oberfield SE. Pubertal outcome in a female with virilizing adrenocortical carcinoma. J Pediatr Endocrinol Metab 2016; 29:503-9. [PMID: 26812773 PMCID: PMC4836965 DOI: 10.1515/jpem-2015-0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022]
Abstract
Adrenocortical tumors are neoplasms that rarely occur in pediatric patients. Adrenocortical carcinoma (ACC) is even more uncommon, and is an aggressive malignancy with 5-year survival of 55% in a registry series. There is a lack of information on long-term endocrine outcome in survivors. We describe a 10-year follow-up in a patient who presented at 3 years 5 months with a 1-year history of axillary odor and 6 months' history of pubic hair development with an increased clitoral size. Androgen levels were increased and a pelvic sonogram revealed a suprarenal mass of the left kidney. The tumor was successfully removed. At 6 years 11 months, androgen levels increased again. Workup for tumor recurrence was negative and the findings likely represented early adrenarche. The patient had menarche at an appropriate time and attained a height appropriate for her family.
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Affiliation(s)
- Emily Breidbart
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, New York, NY, USA
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, New York, NY, USA
| | - James H. Garvin
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, New York, NY, USA
| | - Hanina Hibshoosh
- Division of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Sharon E. Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, New York Presbyterian Hospital-Columbia University Medical Center, 622 West 168th Street PH 5E 522, New York, NY 10032, USA
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15
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Marret JB, Raffoul L, Ribault V, Ravasse P, Rod J. Adrenocortical tumor with precocious puberty in a 2-month-old girl. Pediatr Int 2015; 57:1025-7. [PMID: 26508188 DOI: 10.1111/ped.12702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/14/2015] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
Abstract
Adrenocortical tumor is a rare childhood tumor with a median age at onset of 3.2 years. Virilization is the most common sign. Laparotomy is the reference treatment and has a favorable course. The diagnosis of adrenal tumor can be difficult. The main parameters of malignant tumors are size and metastasis. Analysis of TP53 mutation can facilitate final diagnosis. We report a case of virilizing adrenal tumor that developed in a 2-month-old girl, and which was treated with laparoscopic adrenalectomy.
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Affiliation(s)
| | - Lara Raffoul
- Department of Pediatric Surgery, University of Necker Hospital, Paris, France
| | - Virginie Ribault
- Department of Pediatric Endocrinology, University of Caen Hospital, Caen, France.,University of Caen Hospital, Caen, France.,University of Caen Normandy, UFR Medicine, Caen, France
| | - Philippe Ravasse
- Department of Pediatric Surgery, University of Caen Hospital, Caen, France.,University of Caen Hospital, Caen, France.,University of Caen Normandy, UFR Medicine, Caen, France
| | - Julien Rod
- Department of Pediatric Surgery, University of Caen Hospital, Caen, France.,University of Caen Hospital, Caen, France.,University of Caen Normandy, UFR Medicine, Caen, France
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16
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Gönç EN, Özön ZA, Çakır MD, Alikaşifoğlu A, Kandemir N. Need for comprehensive hormonal workup in the management of adrenocortical tumors in children. J Clin Res Pediatr Endocrinol 2014; 6:68-73. [PMID: 24932598 PMCID: PMC4141578 DOI: 10.4274/jcrpe.1351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Clinical findings do not reflect the excess hormonal status in adrenocortical tumors (ACTs) in children. Identification of abnormal hormone secretion may help provide the tumor marker and delineate those patients with a risk of adrenal suppression following tumor removal. To analyze the impact of complete hormonal assessment regardless of the clinical presentation in hormone-secreting ACTs in childhood. METHODS Association of hormonal workup at diagnosis with the clinical findings and frequency of adrenal suppression postoperatively were analyzed in 18 children with ACT. RESULTS Seventeen of the 18 patients had functional ACT. Clinical findings suggested isolated virilization and isolated Cushing's syndrome in 38.8% and 17.6% of patients, respectively. Hormonal workup revealed a frequency of 83.3% for hyperandrogenism. The majority of the tumors (50%) had mixed type hormonal secretion. Hypercortisolism existed in 28.5% of children with isolated virilization and hyperandrogenism was found in 2/3 of children with isolated Cushing's syndrome. Various androgens other than dehydroepiandrosterone sulfate were also determined to be high in hyperandrogenism. Increased testosterone was a highly prevalent tumor marker. Nine patients (3 with no signs of hypercortisolism) had adrenal suppression following tumor removal which lasted 1-24 months. CONCLUSION Complete hormonal workup showed the predominance of mixed hormone-secreting type of tumor in the patients who lacked the appropriate clinical findings and also showed that patients lacking signs of Cushing's syndrome could have postoperative adrenal suppression. Clinical findings may not reflect the abnormal hormone secretion in all cases and tumor markers as well as risk of postoperative adrenal suppression can best be determined by complete hormonal evaluation at the time of diagnosis.
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Affiliation(s)
- E. Nazlı Gönç
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
,* Address for Correspondence: Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 312 305 11 24 E-mail:
| | - Zeynep Alev Özön
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Meltem Didem Çakır
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayfer Alikaşifoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Nurgün Kandemir
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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17
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Sakoda A, Mushtaq I, Levitt G, Sebire NJ. Clinical and histopathological features of adrenocortical neoplasms in children: retrospective review from a single specialist center. J Pediatr Surg 2014; 49:410-5. [PMID: 24650467 DOI: 10.1016/j.jpedsurg.2013.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 09/14/2013] [Accepted: 09/14/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Adrenocortical tumors (ACTs) are rare in children and the extent to which histopathological features can predict clinical behavior remains uncertain. The aim of this study was to investigate the relationship between histopathological features (Weiss score), surgical approach, tumor size, underlying genetic predisposition syndrome, and outcome. METHODS Twenty-nine ACTs treated at our institution between 1987 and 2011 were identified from a histopathology database. The histological features were categorized using the Weiss scoring system. For tumor staging, the UKCCSG staging system was utilized. RESULTS At a median follow-up of 25 months, 19 patients (65.5%) survived without evidence of disease and 10 patients (35.5%) had died. There was a strong association between high Weiss score and both large tumor size (P<0.01) and adverse outcome (P<0.01). Outcome for stage I and IIA disease was significantly better compared to higher stage disease and/or tumor rupture (P<0.01). CONCLUSION There is an association between high Weiss score, large tumor size, underlying genetic predisposition syndrome and an adverse outcome for pediatric ACTs. Regardless of histopathological findings, complete surgical resection, without tumor spillage, is optimal for survival. Genetic evaluation is recommended in patients with ACTs, particularly those with a high Weiss score.
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Affiliation(s)
- Akiko Sakoda
- Department of Paediatric Urology, Great Ormond Street Hospital for Children and Institute of Child Health, London WC1N 3JH, UK
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital for Children and Institute of Child Health, London WC1N 3JH, UK
| | - Gill Levitt
- Department of Oncology, Great Ormond Street Hospital for Children and Institute of Child Health, London WC1N 3JH, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children and Institute of Child Health, London WC1N 3JH, UK.
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18
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Hossain MR, Alam MM, Nabi J, Kibria M. Endogenous Cushing's Syndrome with Precocious Puberty in an 8-Year-Old Boy due to a Large Unilateral Adrenal Adenoma. Case Rep Endocrinol 2013; 2013:706989. [PMID: 23533838 PMCID: PMC3603619 DOI: 10.1155/2013/706989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/13/2013] [Indexed: 11/24/2022] Open
Abstract
Adrenocortical tumors (ACTs) causing Cushing's syndrome are extremely rare in children and adolescents. Bilateral macronodular adrenocortical disease which is a component of the McCune-Albright syndrome is the most common cause of endogenous Cushing's syndrome. We report the case of a boy with Cushing's syndrome who presented with obesity and growth retardation. The child was hypertensive. The biochemical evaluation revealed that his serum cortisol levels were 25.80 μg/dL, with a concomitant plasma ACTH level of 10.0 pg/mL and nonsuppressed serum cortisol on high-dose dexamethasone suppression test (HDDST) to be 20.38 μg/dL. Computed tomography of the abdomen demonstrated a 8 × 6 × 5 cm left adrenal mass with internal calcifications. Following preoperative stabilization, laparotomy was carried out which revealed a lobulated left adrenal mass with intact capsule weighing 120 grams. Histopathological examination revealed a benign cortical neoplastic lesion, suggestive of adrenal adenoma; composed of large polygonal cells with centrally placed nuclei and prominent nucleoli without capsular and vascular invasion. On the seventh postoperative day, cortisol levels were within normal range indicating biochemical remission of Cushing's syndrome. On followup after three months, the patient showed significant clinical improvement and had lost moderate amount of weight and adrenal imaging was found to be normal.
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Affiliation(s)
- Muhammad Rajib Hossain
- Department of Medicine, Shaheed Suhrawardy Medical College Hospital, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Md. Mashiul Alam
- Department of Pediatrics, Dhaka Medical College Hospital, 100 Ramna, Dhaka 1000, Bangladesh
| | - Junaid Nabi
- Department of Surgery, Shaheed Suhrawardy Medical College Hospital, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Mahzabin Kibria
- Department of Medicine, Shaheed Suhrawardy Medical College Hospital, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
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19
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Mirsaeid Ghazi AA, Mofid D, Salehian MT, Amirbaigloo A, Zare K, Jafari B, Rahimi F. Functioning adrenocortical tumors in children-secretory behavior. J Clin Res Pediatr Endocrinol 2013; 5:27-32. [PMID: 23367496 PMCID: PMC3628389 DOI: 10.4274/jcrpe.835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Adrenocortical tumors are rare childhood neoplasms. More than 95% are functional and present with virilization, Cushing's syndrome, hypertension, or hyperestrogenism. The objective of this paper is to present the clinical, laboratory and pathological findings of this rare disease and to highlight the secretory behavior of these tumors. METHODS Clinical and laboratory data of seven Iranian children and adolescents aged between 2 and 16 years with functioning adrenocortical tumors are presented. Five patients had virilization and two had Cushing's syndrome at the time of diagnosis. In all subjects, the tumors were removed successfully by open surgery, during which a blood sample was drawn from the corresponding adrenal vein for hormonal evaluation. RESULTS Peripheral blood evaluation revealed that in addition to the dominant hormone (testosterone in the cases presenting with virilization and cortisol in those with Cushing's syndrome), significant amounts of other hormones were secreted from these tumors. Adrenal vein evaluation revealed that testosterone, dehydroepiandrosterone sulfate, estradiol, 17(OH) progesterone, and cortisol were directly released from the tumor. The tumors weighed between 36-103 grams. The patients have since been followed for 5 to 20 years, and there have been no signs or symptoms of relapse in any of the patients. CONCLUSIONS The study shows that functioning adrenocortical tumors should be considered in children and adolescents presenting with hyperandrogenism, Cushing's syndrome, or hyperestrogenism. A diagnosis of a functioning adrenocortical tumor requires surgical removal as early as possible to prevent the untoward effects of virilization or corticosteroid excess. Evaluation of adrenal vein hormones showed that the steroids are secreted directly from the tumor and peripheral conversion has little contribution to the serum levels.
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Affiliation(s)
- Ali Asghar Mirsaeid Ghazi
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Endocrine Research Center, Tehran, Iran
| | - Djafar Mofid
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Department of General Surgery, Tehran, Iran
| | - Mohamad-Taghi Salehian
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Department of General Surgery, Tehran, Iran
| | - Alireza Amirbaigloo
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Endocrine Research Center, Tehran, Iran
,* Address for Correspondence: Shahid Beheshti University of Medical Sciences, Endocrine Research Center, Tehran, Iran Phone: +98-21-22409309 E-mail:
| | - Khandan Zare
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Department of Pathology, Tehran, Iran
| | - Bahar Jafari
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Department of Pathology, Tehran, Iran
| | - Farzaneh Rahimi
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Department of Pathology, Tehran, Iran
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20
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Martínez León M, Romero Chaparro S, Weil Lara B, Domínguez Pinos M, Ceres Ruiz L, Ibáñez Cerrato F, Escobosa Sánchez O. Tumores corticosuprarrenales pediátricos: imagen de adenomas y carcinomas. RADIOLOGIA 2012; 54:342-9. [DOI: 10.1016/j.rx.2011.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 11/26/2022]
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21
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Martínez León M, Romero Chaparro S, Weil Lara B, Domínguez Pinos M, Ceres Ruiz L, Ibáñez Cerrato F, Escobosa Sánchez O. Adrenocortical tumors in children: Imaging adenomas and carcinomas. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Cho MJ, Kim DY, Kim SC, Kim TH, Kim IK. Adrenocortical tumors in children 18 years old and younger. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:246-50. [PMID: 22493766 PMCID: PMC3319779 DOI: 10.4174/jkss.2012.82.4.246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 11/30/2022]
Abstract
Purpose Pediatric adrenocortical tumors (ACTs) are rare. We reviewed findings in 8 children, 18 years of age or younger, diagnosed with ACT in our institution over the past 15 years. Methods We retrospectively reviewed 8 children with ACTs treated between 1996 and 2010. Results Three girls and 5 boys were treated for ACTs; their median age at presentation was 144 months (range, 28 months to 18 years). Seven patients showed signs of endocrine dysfunction, 4 with Cushing syndrome, 2 with virilization, and 1 with hyperaldosteronism. One patient, with symptoms of hematuria, underwent a computed tomography scan, which showed an adrenal mass. The median duration of symptoms prior to resection was 6 months (range, 1 to 24 months). Five patients had adenomas and 3 had carcinomas. All underwent complete resection of the tumor, with laparoscopic adrenalectomy performed on 3 patients with adenoma and 1 with carcinoma. The median tumor weight was 12.5 g (range, 1 to 130 g) and the median tumor volume was 18.3 cm3 (range, 2.2 to 299.2 cm3). At a median follow-up of 5.1 years (range, 4 months to 15 years), all 8 patients remain alive with no recurrence of disease. Conclusion The characteristics of pediatric ACTs vary considerably. Laboratory findings, clinical hormonal features, and tumor size could not distinguish adenomas from carcinomas before surgery. Complete tumor resection was successful, with no tumor recurrence. However, the small number of patients and short follow-up period limit assessments of prognosis.
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Affiliation(s)
- Min Jeng Cho
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Dehner LP, Hill DA. Adrenal cortical neoplasms in children: why so many carcinomas and yet so many survivors? Pediatr Dev Pathol 2009; 12:284-91. [PMID: 19326954 DOI: 10.2350/08-06-0489.1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adrenal cortical neoplasms in children are represented by a disproportionate number of cases that have been diagnosed pathologically as adrenocortical carcinomas (ACCs)-as many as 90% of all cortical tumors in some pediatric series. Like other solid malignancies of childhood, over half of ACCs present in the first 4 years of life in over 50% of cases. Most are sporadically occurring neoplasms, but ACCs are a manifestation of Beckwith-Wiedemann and Li-Fraumeni syndromes. Despite the fact that the microscopic features are often quite atypical and identical in many respects to ACCs in adults, the clinical outcome is favorable in 70% or more of cases. Tumor weight is seemingly a significant determinant in prognosis at a threshold of greater than 400 g. A risk assessment system is proposed that incorporates tumor weight, localization of tumor to the gland without invasion into the surrounding tissues or organs, and absence of metastasis.
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Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO 63110, USA.
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24
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Abstract
PURPOSE OF REVIEW To guide the clinician in the diagnostic evaluation of endocrine neoplasms, to distinguish between benign and malignant and determine when surgical referral is indicated. RECENT FINDINGS Thyroid nodules are uncommon but malignant in as many as 27% of patients. Fine needle aspiration should be considered in adolescents, in which accuracy is as high as 90%; surgical resection should be undertaken in all preadolescents (<13 years) with a thyroid nodule. Prognosis for most primary thyroid malignancies is favorable. Primary hyperparathyroidism is rare and due to an adenoma in up to 70% of patients. Surgical resection carries a cure rate of 95% with the use of intraoperative parathyroid hormone assays. Adrenal neoplasms cover a wide spectrum of disorder. They are functional in 95% of patients and require a thorough diagnostic evaluation prior to surgical resection. Malignant lesions of the adrenal gland carry a poor prognosis when complete surgical resection cannot be achieved. Carcinoids are rare neuroendocrine neoplasms, primarily of the appendix, associated with carcinoid syndrome in 10% of patients. The indolent course warrants aggressive surgical control. SUMMARY Endocrine neoplasms are unusual in the pediatric population. Their presence should raise concern about a multiple endocrine neoplasia syndrome and appropriate diagnostic and endocrine work-up. Most neoplasms will require surgical resection.
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25
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Bouyahia O, Gharsallah L, Ouederni M, Boukthir S, Mrad SM, El Gharbi AS. Feminizing adrenocortical adenoma in a 5 year-old girl. J Pediatr Endocrinol Metab 2009; 22:79-84. [PMID: 19344078 DOI: 10.1515/jpem.2009.22.1.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adrenocortical adenoma is a rare etiology of isosexual precocious puberty in girls. We report the case of a 5 year-old girl with isosexual precocious puberty. Abdominal ultrasound and magnetic resonance imaging revealed a well-defined mass of 32 x 28 mm situated in the left suprarenal region, but no signs of calcification or metastasis. Estradiol and testosterone levels were elevated, cortisol plasma level was normal, and bolus intravenous injection of GnRH showed unresponsiveness of LH and FSH. Pathological examination after complete surgical resection showed an adrenocortical adenoma. Five years later, there had been no recurrence and abdominal ultrasound examination was normal. The diagnosis of feminizing adrenocortical adenoma was confirmed.
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Affiliation(s)
- Olfa Bouyahia
- Paediatric Department C, Children's Hospital of Tunis, Tunisia.
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26
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Savage MO, Chan LF, Grossman AB, Storr HL. Work-up and management of paediatric Cushing's syndrome. Curr Opin Endocrinol Diabetes Obes 2008; 15:346-51. [PMID: 18594275 DOI: 10.1097/med.0b013e328305082f] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Paediatric Cushing's syndrome presents a diagnostic and therapeutic challenge. Most paediatric endocrinologists have limited experience in managing children or adolescents with Cushing's syndrome and thus benefit from close consultation with adult colleagues. A protocol for investigation of the child with suspected Cushing's syndrome is presented followed by principles of management. RECENT FINDINGS Cushing's syndrome is rare in childhood, but causes serious morbidity. Investigations have evolved and now include new genetic and imaging techniques as well as classical endocrine studies. In Cushing's disease trans-sphenoidal surgery has transformed management, although only a few surgeons have experience in children. Pituitary radiotherapy is effective second-line therapy. SUMMARY Early diagnosis and treatment of Cushing's syndrome is vital for long-term outcome. The overall prognosis for Cushing's syndrome is good but challenges remain to ensure normal postcure growth and body composition.
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Affiliation(s)
- Martin O Savage
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK.
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27
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Abstract
PURPOSE This study reviews adrenocortical tumors in children to determine factors that significantly affect outcome. METHODS An institutional review board-approved retrospective review from 1976 to 2005 identified 23 patients younger than 19 years old with histologic confirmation of adrenocortical carcinoma (ACC) and adenomas. RESULTS The mean age of the 23 children was 9.0 +/- 1.6 years; girls predominated (female-to-male ratio = 1.9:1) as did cancers (ACC 16, adenoma 7); tumor hormone production (74%); and advanced stage for disease (66%). All malignancies were more than 2.5 cm. Adrenalectomy, including en bloc resection of adjacent structures (35%) achieved grossly negative margins in 70% of patients. Three patients received chemotherapy or chemoradiation as primary treatment without surgery. There was no perioperative mortality; morbidity was 10% (pneumothorax, acute renal failure, chylous ascites, and thrombocytosis). Surgical cure without adjuvant therapy was achieved for all adenomas and ACC stages I and II. For ACC stage III and IV, median survival was 21 months, 5-year survival was 0%. All advanced-staged ACC received adjuvant therapy. Surgically negative margins conferred a survival advantage. CONCLUSIONS Children, especially females with ACC present with large advanced-staged tumors. Surgically negative margins with or without en bloc resection improves survival. The high percentage of children with functioning tumors suggests earlier detection is possible.
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Storr HL, Chan LF, Grossman AB, Savage MO. Paediatric Cushing's syndrome: epidemiology, investigation and therapeutic advances. Trends Endocrinol Metab 2007; 18:167-74. [PMID: 17412607 DOI: 10.1016/j.tem.2007.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 03/05/2007] [Accepted: 03/19/2007] [Indexed: 10/23/2022]
Abstract
Cushing's syndrome (CS), which is caused by excessive circulating glucocorticoid concentrations, is rare in the paediatric age range but presents a diagnostic and therapeutic challenge. Most paediatric endocrinologists have limited experience of managing children or adolescents with CS and thus benefit from close consultation with colleagues who treat adult patients. A protocol for investigation is required that broadly follows the model for adult patients. Here, the epidemiology and diagnosis of different causes of CS are discussed according to typical age of presentation. Treatment strategies for adrenocorticotrophic hormone (ACTH)-independent and ACTH-dependent CS are described and critically appraised. The management of paediatric CS patients after cure also presents challenges for optimizing growth, bone health, reproduction and body composition from childhood into and during adult life.
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Affiliation(s)
- Helen L Storr
- Department of Endocrinology, William Harvey Research Institute, Barts and the London, Queen Mary's School of Medicine and Dentistry, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
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Mann MWY, Ellis SS, Mallory SB. Infantile acne as the initial sign of an adrenocortical tumor. J Am Acad Dermatol 2007; 56:S15-8. [PMID: 17097383 DOI: 10.1016/j.jaad.2006.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 04/06/2006] [Accepted: 04/07/2006] [Indexed: 10/24/2022]
Abstract
A 23-month-old boy with persistent acne since 6 months of age had signs of virilization and accelerated growth. Hormone evaluation indicated increased levels of dehydroepiandrosterone (DHEA) and testosterone. Ultrasound and abdominal computed tomographic scan revealed a large adrenal mass consistent with an adrenocortical tumor. The patient underwent surgical excision of the well-encapsulated tumor with normalization of his hormones and no subsequent recurrence. Although rare, childhood adrenocortical tumors have a poor prognosis, with the majority of tumors having regional and metastatic disease. Because early diagnosis and complete surgical excision improve prognosis, children with refractory infantile acne should be evaluated for signs of virilization and accelerated growth. Laboratory evaluation should include luteinizing hormone, follicle-stimulating hormone, total and free testosterone cortisol, DHEA, and its sulfate (DHEA-S). Elevated levels of DHEA and DHEA-S should prompt an aggressive diagnostic evaluation for an adrenocortical tumor.
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Affiliation(s)
- Margaret Wing-Yan Mann
- Department of Internal Medicine, Division of Dermatology, Washington University School of Medicine, St Louis, Missouri 63110, USA
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30
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Ribeiro RC, Figueiredo B. Childhood adrenocortical tumours. Eur J Cancer 2004; 40:1117-26. [PMID: 15110875 DOI: 10.1016/j.ejca.2004.01.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Revised: 01/12/2004] [Accepted: 01/13/2004] [Indexed: 11/22/2022]
Abstract
Childhood adrenocortical tumours (ACT) constitute only about 0.2% of all paediatric malignancies. However, the incidence of ACT varies across geographic regions and is remarkably high in southern Brazil. At presentation, most children show signs and symptoms of virilisation, which may be accompanied by manifestations of the hypersecretion of other adrenal cortical hormones. Fewer than 10% of patients with ACT show no endocrine syndrome at presentation; these are often older children and adolescents. ACT is commonly associated with constitutional genetic abnormalities, particularly mutations of the P53 gene. Histological features are used to classify the tumours as adenomas or carcinomas; however, the distinction between these two subtypes is often difficult. The extent of disease is best evaluated by computed tomography or magnetic resonance imaging; the role of positron-emission tomographic scans has not been defined. Cure of ACT requires complete tumour resection. The role of chemotherapy or radiotherapy has not been established, although definitive responses to several anticancer drugs have been documented. Among patients who undergo complete tumour resection, favourable prognostic factors include age <4 years, smaller tumour size, signs of virilisation alone at presentation, and adenomatous tumour histology. Some children with ACT show abnormalities of growth and development at the time of presentation, but these usually resolve after surgery.
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Affiliation(s)
- R C Ribeiro
- The Department of Hematology-Oncology, St. Jude Children's Research Hospital, and Department of Pediatrics, University of Tennessee College of Medicine, Memphis, US.
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31
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Stewart JN, Flageole H, Kavan P. A surgical approach to adrenocortical tumors in children: the mainstay of treatment. J Pediatr Surg 2004; 39:759-63. [PMID: 15137014 DOI: 10.1016/j.jpedsurg.2004.01.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adrenocortical tumors (ACTs) are rare in the pediatric population. The pathogenesis, prognostic indicators, and management of these tumors are still unclear because of its infrequent occurrence. This case series presents the surgical experience of the authors' center over 29 years. METHODS The medical records of children treated for ACTs between 1974 and 2003 were reviewed. Information on age, sex, presenting symptoms, hormonal levels, pathology, stage, treatment, and outcome was obtained. RESULTS Nine children (5 girls, 4 boys) were treated for ACTs. The median age at presentation was 29 months (range, 5 months to 11 years). Endocrine dysfunction was found in 8 patients. Four presented with virilizing symptoms, 4 presented with both virilizing and Cushing's symptoms, and 1 patient with Beckwith-Wiedemann syndrome was identified during routine screening. One was an adenoma, and 8 were carcinomas. Of the carcinomas, 3 were stage I, and 5 were stage II. The mean tumor weight was 125 g (range, 42 g to 336 g) with a mean volume of 139 cm3 (range, 30 cm3 to 626 cm3). All patients had complete excision of the tumor with spillage occurring in 2 cases. Lymph node biopsies were done in all but 2 patients. Two patients were treated with chemotherapy because of large tumor size and nodal involvement. All patients are doing well including those with tumor spillage. CONCLUSIONS This study shows that surgical excision continues to be the mainstay of treatment for ACTs. Extensive lymph node biopsy in small ACTs can probably be avoided given the generally good outcome with surgery alone. The role of adjuvant chemotherapy remains unclear because most of the children in our series were effectively treated with surgical resection only. Patients should be enrolled in multicenter trials to assess the added value of chemotherapy.
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Affiliation(s)
- Jessica N Stewart
- Division of Pediatric Surgery, The Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
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Abstract
PURPOSE The aim of this study was to review the authors' experience with laparoscopic adrenalectomy in the pediatric age group. METHODS This is a retrospective analysis of laparoscopic adrenalectomies performed in children at King Faisal Specialist Hospital & Research Centre, between June 1997 and March 2003. Ten children had laparoscopic adrenalectomies during this period. They were between 3 weeks to 12 years of age and there was an equal number of boys and girls. Case selection was based mainly on the size of the lesion and its localized nature as seen on the imaging studies. The transperitoneal approach was used in all cases. RESULTS Eleven laparoscopic adrenalectomies were performed in 10 children (1 was bilateral adrenalectomy). Presenting features were virilization (n = 3), Cushing's syndrome (n = 1), antenatally detected adrenal cyst (n = 1), hypertension (n = 1), hepatomegaly (n = 1), loin pain with hematuria (n = 1) and an incidental adrenal mass (n = 1). One was a child with stage IV adrenal neuroblastoma postchemotherapy for resection of the residual tumor. On imaging studies, the tumors were between 2.8 and 7 cm in their largest dimension. Operating time ranged from 118 to 180 minutes in the unilateral resections, whereas the bilateral laparoscopic adrenalectomy required 330 minutes. Two had to be converted to open procedures. Postoperative hospital stay was between 2 and 15 days. Pathologic diagnoses were as follows: adrenal cortical adenoma (n = 3), adrenal medullary hyperplasia (n = 2), adrenal cortical carcinoma (n = 1), ganglioneuroma (n = 1), and neuroblastoma (n = 3). There were no complications. Follow-up ranged from 3 months to 6 years. The only mortality in our study group was in the child with stage IV neuroblastoma who died of disseminated disease 9 months later. In the rest, there has been no local recurrence or metastases, and the biochemical and hormonal parameters have remained normal in the functional tumors. CONCLUSIONS We believe that in a select group of pediatric adrenal lesions, laparoscopic adrenalectomy is a safe and effective procedure with the potential benefits of minimally invasive procedures.
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Affiliation(s)
- P Kadamba
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Misu Y, Jiang SX, Yokota Y, Shibata M, Shinohara O, Kameya T, Matsuura N. Clinicopathological Features of Pediatric Functional Adrenocortical Carcinoma Diagnosed by Weiss Criteria; An Analysis of Four Cases. Clin Pediatr Endocrinol 2001. [DOI: 10.1297/cpe.10.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yoko Misu
- Department of Pediatrics, Kitasato University School of Medicine
- Department of Pathology, Kitasato University School of Medicine
| | - Shi-Xu Jiang
- Department of Pathology, Kitasato University School of Medicine
| | - Yukifumi Yokota
- Department of Pediatrics, Kitasato University School of Medicine
| | - Masahiko Shibata
- The First Department of Pathology, Faculty of Medicine, Hokkaido University
| | - Osamu Shinohara
- Department of Pediatrics, Faculty of Medicine, Tokai University
| | - Toru Kameya
- Department of Pathology, Kitasato University School of Medicine
| | - Nobuo Matsuura
- Department of Pediatrics, Kitasato University School of Medicine
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35
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Abstract
Adrenocortical carcinoma in childhood is a rare potentially fatal disease. Despite its often dramatic presentation, there typically has been a distressingly long delay between the onset of symptoms and the time of diagnosis. This delay undoubtedly has contributed to the historically poor prognosis in these children by permitting the disease to reach an advanced stage before treatment is started. It is imperative that the physician recognizes the endocrine manifestations of these tumors early and has a high index of suspicion. Although biochemical and histologic evaluations are helpful, they often cannot differentiate benign lesions from malignant neoplasms and should not unduly delay intervention. Aggressive complete surgical resection continues to be the mainstay of treatment and is the best prognosticator of overall survival. The role of adjuvant therapy and chemotherapy continues to evolve. Molecular studies have increased understanding of cancer biology and may provide possible novel therapeutic approaches in the future. It is hoped that increased familiarity with this unusual tumor will result in earlier detection, prompt intervention, and improved survival for children with adrenocortical carcinoma.
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Affiliation(s)
- L S Liou
- Department of Urology, Cleveland Clinic Foundation, Ohio, USA
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Wilkin F, Gagné N, Paquette J, Oligny LL, Deal C. Pediatric adrenocortical tumors: molecular events leading to insulin-like growth factor II gene overexpression. J Clin Endocrinol Metab 2000; 85:2048-56. [PMID: 10843195 DOI: 10.1210/jcem.85.5.6589] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
It has been previously shown that adrenocortical tumors (ACT) in adults exhibit structural abnormalities in tumor DNA in approximately 30% of cases. These abnormalities involve chromosome 11p15 and include loss of heterozygosity, paternal isodisomy, and overexpression of the gene for insulin-like growth factor II (IGF2), correlating with DNA demethylation at this locus. It has been hypothesized that these events occur late in the tumorigenic process in adults and seem to correlate with a worse prognosis. We present 4 pediatric cases of ACT diagnosed at 2.5 yr, 10 months, 12 yr, and 2.2 yr. All 4 patients presented with virilization, and 1 patient also showed signs and symptoms of glucocorticoid excess. The youngest patient's maternal aunt had surgical excision of a more than 15-cm ACT 18 yr previously, but the aunt is doing well at age 23 yr. They all had surgical removal of their tumors. The 2.5-yr-old child also received chemotherapy and radiotherapy because of capsular rupture and, after 3 local recurrences, died 3.3 yr after initial presentation. We investigated all 4 tumors for chromosome 11 structural abnormalities (11p15.5 to 11q23), IGF2 and H19 expression by competitive RT-PCR analysis, and IGF2 methylation patterns by Southern analysis. All 4 tumors (100%) showed a combination of structural abnormalities at the 11p15 locus with mosaic loss of heterozygosity involving 11p. All tumors also had significantly increased IGF2 messenger ribonucleic acid levels relative to normal adrenal (up to 36-fold) and significant IGF2 demethylation (mean, 87%). H19 messenger ribonucleic acid levels were undetectable in 3 of 4 tumors, explained in part by mosaic loss of the actively expressed maternal allele for this imprinted gene. By immunohistochemistry we were able to confirm increased IGF-II peptide levels within the tumor tissue in 10 pediatric patients, including the 4 patients described above. Concomitantly, we also observed nuclear accumulation of p53, suggesting somatic mutations. For the 10-month-old patient, sequencing revealed a p53 germline mutation. We therefore conclude that in pediatric ACT, structural abnormalities of tumor DNA and IGF2 overexpression as well as p53 mutations are very common and are therefore less useful for prognosis than in adults. Our findings support the theory that pediatric ACT, whose IGF2 expression and steroidogenesis evoke the phenotype of the fetal adrenal cortex, may arise because of defective apoptosis.
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Affiliation(s)
- F Wilkin
- Sainte-Justine Hospital Research Center, Department of Pediatrics, Université de Montréal, Québec, Canada
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37
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Abstract
Adrenal cancer is a rare neoplasm. Up to 1 in 1500 adrenal incidentalomas, however, may hide a carcinoma, which, if diagnosed late or left untreated, is associated with significant morbidity and mortality. Despite extensive investigation of the molecular mechanisms involved in adrenal carcinogenesis and significant improvements in diagnostic imaging, efforts to cure advanced adrenal cancer remain largely unsuccessful. This article reviews the recent advances in molecular understanding, clinical diagnosis, and treatment of adrenal cancer.
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Affiliation(s)
- C A Stratakis
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
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38
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Baranwal AK, Singhi SC, Narshimhan KL, Jayashree M, Singhi PD, Kakkar N. Aldosterone-producing adrenocortical adenoma in childhood: a case report. J Pediatr Surg 1999; 34:1878-80. [PMID: 10626881 DOI: 10.1016/s0022-3468(99)90339-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aldosterone-producing adrenal tumor is an exceptional cause of hypertension in childhood. The authors describe an 11-year-old girl with hypertension and lower limb weakness who had hyperaldosteronism and left adrenocortical adenoma.
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Affiliation(s)
- A K Baranwal
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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