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Li Y, Li P, Tao FK, Li JM. Adrenocortical oncocytic carcinoma misdiagnosed as adrenal cortical adenoma. Asian J Surg 2024; 47:2475-2476. [PMID: 38302362 DOI: 10.1016/j.asjsur.2024.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Yang Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374 Dian-Mian Avenue, Kunming, 650101, China.
| | - Pei Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374 Dian-Mian Avenue, Kunming, 650101, China.
| | | | - Jiong-Ming Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374 Dian-Mian Avenue, Kunming, 650101, China.
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Dölek R, Saraydaroğlu Ö, Taşar P. Adrenocortical Adenoma Arising from Adrenohepatic Fusion: A Mimic of Hepatocellular Carcinoma-Case Report. Ann Ital Chir 2024; 95:13-16. [PMID: 38469607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
AIM We present a case of adrenocortical adenoma originating from the adrenohepatic fusion (AHF) region, accompanied by advanced hepatosteatosis in the liver tissue, and discuss its distinction from hepatocellular carcinoma. Case Experience: A 68-year-old male patient was admitted to the hospital following a fall from a height. He was referred to our hospital after an incidental discovery of a liver mass during an abdominal ultrasound examination. Subsequently, magnetic resonance imaging (MRI) imaging was conducted, followed by segmental liver resection with right adrenalectomy, and histological analysis of a biopsy from the lesion. Results: Upon histologic examination, the case was determined to be an adrenocortical adenoma originating from the AHF. Discussion: Adrenohepatic fusion (AHF) denotes the histological amalgamation of cells from the right adrenal cortex and right hepatic parenchyma. Only a limited number of cases of neoplasia originating from this region have been documented. These rare instances often present a diagnostic challenge, with preoperative imaging frequently misidentifying them as primary malignancies of either hepatic or adrenal origin, potentially leading to unnecessary extensive resections. The integration of immunohistochemical staining alongside clinical and radiological data proves helpful for accurately diagnosing this condition. Conclusion: Awareness among clinicians, radiologists, and pathologists regarding the tumors that may arise from this region can mitigate the risk of performing extensive resections unnecessarily.
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Affiliation(s)
- Rabia Dölek
- Department of Surgical Pathology, Uludag University, Faculty of Medicine, 16059 Bursa, Turkey
| | - Özlem Saraydaroğlu
- Department of Surgical Pathology, Uludag University, Faculty of Medicine, 16059 Bursa, Turkey
| | - Pınar Taşar
- Department of General Surgery, Uludag University, Faculty of Medicine, 16059 Bursa, Turkey
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Wang SR, Morris R, Taraif S, Aneja A. Adrenal cortical adenoma arising in the setting of renal-adrenal fusion: a case report and review of the literature. J Med Case Rep 2023; 17:533. [PMID: 38151746 PMCID: PMC10753841 DOI: 10.1186/s13256-023-04287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Renal-adrenal fusion is a rare entity resulting from incomplete encapsulation of the adrenal gland and kidney. Only 18 cases have been reported in English literature to date. CASE PRESENTATION Our patient is a 77-year-old African American female who presented with a systolic blood pressure of 200 mmHg. Computed tomography showed an enhancing 9 × 6 cm mass anterior and medial to the left kidney. The patient underwent a left adrenalectomy with partial nephrectomy. Gross and histologic examinations revealed an adrenal cortical adenoma and renal-adrenal fusion. CONCLUSION Renal-adrenal fusion may pose a diagnostic challenge, particularly when there is a concurrent adrenal adenoma. It is important to be aware of this uncommon anomaly to avoid misdiagnosis and overtreatment.
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Affiliation(s)
- Samuel R Wang
- School of Arts and Sciences, Rutgers University, New Brunswick, NJ, 08854, USA.
| | - Richard Morris
- Office of The Chief Medical Examiner of The State of Maryland, Baltimore, MD, 21223, USA
| | - Suad Taraif
- Department of Pathology, Cooper University Health Care, Camden, NJ, 08103, USA
| | - Amandeep Aneja
- Department of Pathology, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, USA
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Kim CK, Kang KA, Oh YL, Park SY. Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion. Br J Radiol 2023; 96:20221032. [PMID: 37393525 PMCID: PMC10461282 DOI: 10.1259/bjr.20221032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/16/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVES To investigate performance of adrenal CT-derived multivariate prediction models in differentiating adenomas with cortisol hypersecretion from the other subtypes. METHODS This retrospective study included 127 patients who underwent adrenal CT and had a surgically proven adrenal adenoma. Adenoma subtypes were defined according to biochemical test results: Group A, overt cortisol hypersecretion; Group B, mild cortisol hypersecretion; Group C, aldosterone hypersecretion; and Group D, non-function. Two independent readers analyzed size, attenuation, and washout properties of adenomas, and performed quantitative and qualitative analyses for assessing contralateral adrenal atrophy. Actual and internally validated areas under the curves (AUCs) of adrenal CT-derived multivariate prediction models for differentiating adenomas with cortisol hypersecretion from the other subtypes were assessed. RESULTS In differentiating Group A from the other groups, the actual and internally validated AUCs of the prediction model were 0.856 (95% confidence interval [CI]: 0.786, 0.926) and 0.847 (95% CI: 0.695, 0.999) for Reader 1, respectively, and 0.901 (95% CI: 0.845, 0.956) and 0.897 (95% CI: 0.783, 1.000) for Reader 2, respectively. In differentiating Group B from groups C and D, the actual and internally validated AUCs of the prediction model were 0.777 (95% CI: 0.687, 0.866) and 0.760 (95% CI: 0.552, 0.969) for Reader 1, respectively, and 0.783 (95% CI: 0.690, 0.875) and 0.765 (95% CI: 0.553, 0.977) for Reader 2, respectively. CONCLUSION Adrenal CT may be useful in differentiating adenomas with cortisol hypersecretion from the other subtypes. ADVANCES IN KNOWLEDGE Adrenal CT may benefit in adrenal adenoma subtyping.
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Affiliation(s)
- Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Wang YL, Liu XL, Liao ZB, Lu XM, Chen LL, Lei Y, Zhang HW, Lin F. Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components? Front Endocrinol (Lausanne) 2023; 13:998154. [PMID: 36686431 PMCID: PMC9854128 DOI: 10.3389/fendo.2022.998154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
Background and objectives Pheochromocytoma and adrenal adenoma are common space-occupying lesions of the adrenal gland, and incorrect surgery may lead to adrenal crisis. We used a new method, dual-energy spectral detector computed tomography (SDCT), to differentiate between the two. Materials and methods We analysed the imaging images of patients with SDCT scans and pathologically confirmed adrenal adenomas (n=70) and pheochromocytomas (n=15). The 40, 70, and 100 KeV virtual monoenergetic images (VMIs) were reconstructed based on the SCDT arterial phase, and the correlation between the arterial/venous phase iodine concentration (AP-IC/VP-IC), the effective atomic number (Z-effect), the slope of the Hounsfield unit attenuation plot (VMI slope) and the pathological results was tested. The Shapiro-Wilk test was used to determine whether the above data conformed to a normal distribution. For parameters with P greater than 0.05, Student's t test was used, and the Mann-Whitney test was used for the remaining parameters. A ROC curve was drawn based on the results. Results Student's t test showed that the 40 KeV VMI and the VMI slope were both statistically significant (P<0.01). The Mann-Whitney U test showed that ID-A was statistically significant (P=0.004). ROC curve analysis showed that 40 keV VMI (AUC=0.818), AP-IC (AUC=0.736), difference (AUC=0.817) and VMI-Slope (0.817) could be used to differentiate adrenal adenoma from pheochromocytoma. Conclusion The effect of lipid components on SDCT parameters can be used to differentiate adrenal adenoma from pheochromocytoma.
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Affiliation(s)
- Yu-li Wang
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Xiao-lei Liu
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Ze-bing Liao
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Xiao-mei Lu
- CT Clinical Science, Philips Healthcare, Shenyang, China
| | - Ling-lin Chen
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Yi Lei
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Han-wen Zhang
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Fan Lin
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
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Jiang Y, Liu Q, Zhu Z. 68Ga-DOTATATE PET/CT of ACTH-Independent Cushing Syndrome Due to Ectopic Adrenocortical Adenoma. Clin Nucl Med 2023; 48:83-84. [PMID: 36469068 DOI: 10.1097/rlu.0000000000004380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT Adrenocorticotropic hormone-independent Cushing syndrome due to ectopic adrenocortical adenoma is a very rare entity. We herein present a case of a 57-year-old woman who was referred to our hospital with persistent Cushing syndrome after undergoing unnecessary laparoscopic left adrenalectomy. 68Ga-DOTATATE PET/CT revealed increased uptake in the nodule in the right hilum, which was histologically confirmed to be ectopic adrenocortical adenoma. Removal of the tumor was followed by the disappearance of clinical symptoms of Cushing syndrome. In this case, 68Ga-DOTATATE PET/CT contributed to the diagnosis of ectopic adrenocortical adenoma.
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Affiliation(s)
- Yuanyuan Jiang
- From the Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
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Affiliation(s)
- Norikazu Toi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Satoru Noda
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
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Olmos R, Mertens N, Vaidya A, Uslar T, Fernandez P, Guarda FJ, Zúñiga Á, San Francisco I, Huete A, Baudrand R. Discriminative Capacity of CT Volumetry to Identify Autonomous Cortisol Secretion in Incidental Adrenal Adenomas. J Clin Endocrinol Metab 2022; 107:e1946-e1953. [PMID: 35020922 PMCID: PMC9272424 DOI: 10.1210/clinem/dgac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 01/12/2023]
Abstract
CONTEXT Incidentally discovered adrenal adenomas are common. Assessment for possible autonomous cortisol excess (ACS) is warranted for all adrenal adenomas, given the association with increased cardiometabolic disease. OBJECTIVE To evaluate the discriminatory capacity of 3-dimensional volumetry on computed tomography (CT) to identify ACS. METHODS Two radiologists, blinded to hormonal levels, prospectively analyzed CT images of 149 adult patients with unilateral, incidentally discovered, adrenal adenomas. Diameter and volumetry of the adenoma, volumetry of the contralateral adrenal gland, and the adenoma volume-to-contralateral gland volume (AV/CV) ratio were measured. ACS was defined as cortisol ≥ 1.8 mcg/dL after 1-mg dexamethasone suppression test (DST) and a morning ACTH ≤ 15. pg/mL. RESULTS We observed that ACS was diagnosed in 35 (23.4%) patients. Cortisol post-DST was positively correlated with adenoma diameter and volume, and inversely correlated with contralateral adrenal gland volume. Cortisol post-DST was positively correlated with the AV/CV ratio (r = 0.46, P < 0.001) and ACTH was inversely correlated (r = -0.28, P < 0.001). The AV/CV ratio displayed the highest odds ratio (1.40; 95% CI, 1.18-1.65) and area under curve (0.91; 95% CI, 0.86-0.96) for predicting ACS. An AV/CV ratio ≥ 1 (48% of the cohort) had a sensitivity of 97% and a specificity of 70% to identify ACS. CONCLUSION CT volumetry of adrenal adenomas and contralateral adrenal glands has a high discriminatory capacity to identify ACS. The combination of this simple and low-cost radiological phenotyping can supplement biochemical testing to substantially improve the identification of ACS.
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Affiliation(s)
| | | | - Anand Vaidya
- Center for Adrenal Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas Uslar
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, 8330077, Chile
- Program for Adrenal Disorders, CETREN UC, Pontificia Universidad Catolica de Chile, Santiago, 8330077, Chile
| | - Paula Fernandez
- Program for Adrenal Disorders, CETREN UC, Pontificia Universidad Catolica de Chile, Santiago, 8330077, Chile
| | - Francisco J Guarda
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, 8330077, Chile
| | - Álvaro Zúñiga
- Department of Urology, Pontificia Universidad Catolica de Chile, Santiago 8330077, Chile
| | - Ignacio San Francisco
- Department of Urology, Pontificia Universidad Catolica de Chile, Santiago 8330077, Chile
| | | | - René Baudrand
- Correspondence: René Baudrand, M.D., Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th FL, RM, Santiago, Chile, 8330077, USA.
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Han Z, Wu M, Wei P, Zhu H, Zhang X, Ding Z, Zhang M. Differential diagnostic value of plain CT scan in adrenal adenoma and non-adenoma: A two-center control study of mean attenuation value, minimum attenuation value, and CT histogram. Front Endocrinol (Lausanne) 2022; 13:1007870. [PMID: 36440234 PMCID: PMC9683380 DOI: 10.3389/fendo.2022.1007870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To investigate the value of mean attenuation value (AVmean), minimum attenuation value (AVmin), and CT histogram (CTH) for the differential diagnosis of adrenal adenoma and non-adenoma in two medical centers. METHODS The plain CT data of 403 cases of adrenal adenoma and 141 cases of non-adenoma in center A were retrospectively analyzed, and compared with data of 86 cases of adenoma and 71 cases of non-adenoma in center B. All cases were confirmed by pathology or clinical follow-up. The diagnostic efficacy of AVmean ≤ 10 Hounsfield units (HU), AVmin ≤ 0 HU, and CTH negative pixels ≥ 10% for adrenal adenoma, and AVmin and CTH for adenoma with AVmean > 10Hu were compared between the two medical centers. RESULTS In medical centers A and B, the AUC of AVmean for the differential diagnosis of adenoma and non-adenoma was 0.956 and 0.956, respectively, and the corresponding sensitivity, specificity, and accuracy were, 0.591 and 0.663, 1.000 and 1.000, 0.697, and 0.815, respectively, when the threshold was ≤ 10 HU. The AUC of AVmin was 0.941 and 0.958, respectively, and the corresponding sensitivity, specificity, and accuracy were 0.869 and 0.826, 0.986, and 0.972, 0.899, and 0.892, respectively, when the threshold was ≤ 0 HU. The AUC of CTH negative pixels was 0.948 and 0.952, respectively, and the corresponding sensitivity, specificity, and accuracy were 0.759 and 0.674, 1.000 and 1.000, 0.822, and 0.822, respectively, when the threshold was ≥ 10%. Among adenoma with AVmean >10 HU, the best threshold of AVmin in center A and center B were -0.250HU and 2.375HU, and the corresponding AUC, sensitivity and specificity were 0.858 and 0.846, 0.691 and 0.586, 0.986 and 0.958; the best threshold of CTH in center A and center B were 0.895% and 0.775%, and the corresponding AUC, sensitivity and specificity were 0.873 and 0.822, 0.818 and 0.724, 0.837 and 0.915. CONCLUSION AVmean, AVmin, and CTH are all important parameters for differentiating adrenal adenoma from non-adenoma. Even for adenomas with AVmean > 10 HU, AVmin and CTH still had high diagnostic efficiency. The three parameters are complementary, assisting clinicians to develop personalized treatments.
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Affiliation(s)
- Zhijiang Han
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengwei Wu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Peiying Wei
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hanlin Zhu
- Department of Radiology, Hangzhou Ninth People’s Hospital, Hangzhou, China
| | - Xiaohan Zhang
- Department of Radiology, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Zhongxiang Ding, ; Ming Zhang,
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhongxiang Ding, ; Ming Zhang,
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Schloetelburg W, Ebert I, Petritsch B, Weng AM, Dischinger U, Kircher S, Buck AK, Bley TA, Deutschbein T, Fassnacht M. Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses. Eur J Endocrinol 2021; 186:183-193. [PMID: 34813495 PMCID: PMC8679842 DOI: 10.1530/eje-21-0650] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/23/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Reliable results of wash-out CT in the diagnostic workup of adrenal incidentalomas are scarce. Thus, we evaluated the diagnostic accuracy of delayed wash-out CT and determined thresholds to accurately differentiate adrenal masses. DESIGN Retrospective, single-center cohort study including 216 patients with 252 adrenal lesions who underwent delayed wash-out CT. Definitive diagnoses based on histopathology (n = 92) or comprehensive follow-up. METHODS Size, average attenuation values of the adrenal lesions in all CT scan phases, and absolute and relative percentage wash-out (APW/RPW) were determined by an expert radiologist blinded for clinical data. Adrenal lesions with unenhanced attenuation values >10 Hounsfield units (HU) built a subgroup (n = 142). Diagnostic accuracy was calculated. RESULTS The study group consisted of 171 adenomas, 32 other benign tumors, 11 pheochromocytomas, 9 adrenocortical carcinomas, and 29 other malignant tumors. All (potentially) malignant and 46% of benign lesions showed unenhanced attenuation values >10 HU. In this most relevant subgroup, the established thresholds of 60% for APW and 40% for RPW misclassified 35.9 and 35.2% of the masses, respectively. When we applied optimized cutoffs (APW >83%; RPW >58%) and excluded pheochromocytomas, we missed only one malignant tumor by APW and none by RPW. However, only 11 and 15% of the benign tumors were correctly identified. CONCLUSIONS Wash-out CT with the established thresholds for APW and RPW is insufficient to reliably diagnose adrenal masses. Using the proposed cutoff of 58% for RPW, malignant tumors will be correctly identified, but the added value is limited, namely 15% of patients with benign tumors can be prevented from additional imaging or even unnecessary surgery.
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Affiliation(s)
- Wiebke Schloetelburg
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Department of Nuclear Medicine, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ines Ebert
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Andreas Max Weng
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ulrich Dischinger
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Kircher
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Andreas Konrad Buck
- Department of Nuclear Medicine, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Correspondence should be addressed to M Fassnacht;
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Delivanis DA, Andrade Hurtado MD, Cortes T, Athimulam S, Khanna A, Atkinson E, McKenzie T, Takahashi N, Moynagh MR, Bancos I. Abnormal body composition in patients with adrenal adenomas. Eur J Endocrinol 2021; 185:653-662. [PMID: 34406976 PMCID: PMC8511231 DOI: 10.1530/eje-21-0458] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/18/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Increased visceral fat and sarcopenia are cardiovascular risk factors that may explain increased cardiovascular morbidity and frailty in patients with adrenal adenomas. Our objective was to compare body composition measurement of patients with adrenal adenomas to referent subjects without adrenal disease. DESIGN Cross-sectional study, 2014-2018. METHODS Participants were adults with nonfunctioning adrenal tumor (NFAT), mild autonomous cortisol secretion (MACS), and Cushing syndrome (CS) and age, sex, and BMI 1:1 matched referent subjects without adrenal disorders. Main outcome measures were body composition measurements calculated from abdominal CT imaging. Intra-abdominal adipose tissue and muscle mass measurements were performed at the third lumbar spine level. RESULTS Of 227 patients with adrenal adenomas, 20 were diagnosed with CS, 76 with MACS, and 131 with NFAT. Median age was 56 years (range: 18-89), and 67% were women. When compared to referent subjects, patients with CS, MACS, and NFAT demonstrated a higher visceral fat (odds ratio (OR): 2.2 (95% CI: 0.9-6.5), 2.0 (1.3-3.2), and 1.8 (1.2-2.7) and a lower skeletal muscle area (OR: 0.01 (95% CI: 0-0.09), 0.31 (0.18-0.49), and 0.3 (1.2-2.7)) respectively. For every 1 µg/dL cortisol increase after overnight dexamethasone, visceral fat/muscle area ratio increased by 2.3 (P = 0.02) and mean total skeletal muscle area decreased by 2.2 cm2 (P = 0.03). CONCLUSION Patients with adrenal adenomas demonstrate a lower muscle mass and a higher proportion of visceral fat when compared to referent subjects, including patients with NFAT. Even a subtle abnormality in cortisol secretion may impact health of patients with adenomas.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria D. Andrade Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Health System, La Crosse, WI, USA
| | - Tiffany Cortes
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Shobana Athimulam
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health System, Detroit, MI, USA
| | - Aakanksha Khanna
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Atkinson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Travis McKenzie
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Suzuki A, Kamata Y, Taguchi T, Takano K, Yamazaki Y, Sasano H, Shichiri M. A case of adrenocortical adenoma harboring venous thrombus mimicking adrenal malignancy. Endocr J 2021; 68:857-863. [PMID: 33658437 DOI: 10.1507/endocrj.ej20-0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Advances in imaging technology and its widespread use have increased the number of identified patients with bilateral adrenal incidentalomas. The pathology of bilateral adrenal incidentalomas is gradually elucidated by its increased frequency. Although there is no consensus regarding the optimal management of bilateral adrenal lesions, adrenal lesions that are a suspected adrenocortical carcinoma on the basis of radiological imaging require surgical resection. We report a clinically interesting case of a 59-year-old female with adrenocortical adenoma harboring venous thrombus that mimicked adrenal malignancy. She was referred for evaluation of asymptomatic asymmetric lesions on both adrenal glands. Abdominal computed tomography and magnetic resonance imaging showed a 4.7-cm-diameter heterogenous lesion with peripheral enhancement in the right adrenal gland and a 2.0-cm-diameter homogenous lesion in the left adrenal gland. Adrenal scintigraphy with 131I-adosterol exhibited marked accumulation in the left lesion and slight accumulation in the middle inferior portion of the right lesion. Endocrine data revealed subclinical Cushing syndrome, and the patient underwent right laparoscopic adrenalectomy. The serum cortisol level was not suppressed on an overnight dexamethasone suppression test after the adrenalectomy. The resected tumor revealed a cortisol-producing adrenocortical adenoma harboring an organized and re-canalized venous thrombus, which was associated with focal papillary endothelial hyperplasia. This case illustrates the difficulty with preoperatively diagnosing this heterogeneously enhanced large benign adrenal lesion and differentiating it from adrenocortical carcinoma or angiosarcoma.
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Affiliation(s)
- Agena Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Yuji Kamata
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Tomomi Taguchi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University School of Medicine, Sendai, Miyagi 980-8575, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Miyagi 980-8575, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
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Ishiwata K, Suzuki S, Igarashi K, Ruike Y, Naito K, Ishida A, Deguchi-Horiuchi H, Fujimoto M, Koide H, Imamura Y, Sakamoto S, Ichikawa T, Ikeda JI, Yokote K. Characteristics of benign adrenocortical adenomas with 18F-FDG PET accumulation. Eur J Endocrinol 2021; 185:155-165. [PMID: 33960957 DOI: 10.1530/eje-20-1459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/07/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Although 18F-FDG PET was originally developed to evaluate benign and malignant tumors, the frequency of detection of benign adrenocortical adenomas showing FDG-PET accumulation has increased. However, the details of FDG-PET-accumulated benign adrenocortical adenomas have not been elucidated. METHODS To elucidate the pathophysiology of FDG-PET-positive cortisol-producing adrenal tumors, we performed clinicopathological and genetic analyses of adrenocortical adenomas examing FDG-PET in 30 operated patients with unilateral cortisol-producing adrenal tumors (26 adrenal adenomas and 4 adrenal cancers). RESULTS All adrenocortical carcinomas and 17/26 (65%) benign adrenocortical adenomas showed high FDG accumulation (SUVmax ≥ 3). In adrenocortical adenomas with high FDG accumulation (SUVmax ≥ 3), SUVmax showed a positive correlation with the CT Hounsfield units. A higher SUVmax showed a clear black adenoma appearance with predominantly compact cells, which exhibited high T1 and T2 signals, a lack of signal drop on out-of-phase imaging on MRI, and less accumulation on 131-I adsterol scintigraphy. Furthermore, RNA-sequencing analysis revealed significant increases in the lysosomal and autophagy pathways and metabolic pathways, including glycolysis through glucose transporter (GLUT) 1 and 3, in black adenomas with high-level FDG accumulation. DISCUSSION A black adenoma is blackish due to lipofuscin, which accumulates as a result of damaged mitochondria or proteins that escape lysosomal degradation or autophagy. Since FDG in PET is taken up via GLUTs, alteration of the intracellular metabolic dynamics associated with mitochondrial damage in black adenomas may increase PET accumulation. CONCLUSION Black adrenal adenomas should be considered with adrenal tumors showing PET accumulation and low lipid contents.
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Affiliation(s)
- Kazuki Ishiwata
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Sawako Suzuki
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Katsushi Igarashi
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yutaro Ruike
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Kumiko Naito
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Akiko Ishida
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hanna Deguchi-Horiuchi
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masanori Fujimoto
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hisashi Koide
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yusuke Imamura
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun-Ichiro Ikeda
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
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Abstract
ABSTRACT CXC chemokine receptor type 4 as a G-protein-coupled receptor has been confirmed to be highly expressed in functional adrenocortical adenomas. 68Ga-pentixafor, a CXC chemokine receptor type 4-specific ligand, has been reported as a promising tracer to evaluate functional nature of adrenal adenomas. We report intense 68Ga-pentixafor activity of cortisol-producing adrenal adenomas in 2 patients with adrenocorticotropic hormone-independent Cushing syndrome.
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Affiliation(s)
- Jie Ding
- From the Department of Nuclear Medicine and Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
| | - Anli Tong
- Department of Endocrinology and Key Laboratory of Endocrinology, Ministry of Health, and Departments of
| | | | - Hui Zhang
- Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li Huo
- From the Department of Nuclear Medicine and Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
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Kohlenberg J, Chang AY. Diffuse Wide Inflammatory Striae as the Presenting Symptom of Cushing Disease in a Young Adult. Mayo Clin Proc 2021; 96:529-530. [PMID: 33673904 DOI: 10.1016/j.mayocp.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jacob Kohlenberg
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
| | - Alice Y Chang
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Lu CC, Yen RF, Peng KY, Huang JY, Wu KD, Chueh JS, Lin WY. NP-59 Adrenal Scintigraphy as an Imaging Biomarker to Predict KCNJ5 Mutation in Primary Aldosteronism Patients. Front Endocrinol (Lausanne) 2021; 12:644927. [PMID: 33995277 PMCID: PMC8113947 DOI: 10.3389/fendo.2021.644927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/06/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Somatic KCNJ5 mutation occurs in half of unilateral primary aldosteronism (PA) and is associated with more severe phenotype. Mutation status can only be identified by tissue sample from adrenalectomy. NP-59 adrenal scintigraphy is a noninvasive functional study for disease activity assessment. This study aimed to evaluate the predictive value of NP-59 adrenal scintigraphy in somatic KCNJ5 mutation among PA patients who received adrenalectomy. METHODS Sixty-two PA patients who had NP-59 adrenal scintigraphy before adrenalectomy with available KCNJ5 mutation status were included. Two semiquantitative parameters, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON) derived from NP-59 adrenal scintigraphy, of mutated and wild-type patients were compared. Cutoff values calculated by receiver-operating characteristic (ROC) analysis were used as a predictor of KCNJ5 mutation. RESULTS Twenty patients had KCNJ5 mutation and 42 patients were wild type. Patients harboring KCNJ5 mutation had both higher ALR and CON (p = 0.0031 and 0.0833, respectively) than wild-type patients. With ALR and CON cutoff of 2.10 and 1.95, the sensitivity and specificity to predict KCNJ5 mutation were 85%, 57% and 45%, 93%, respectively. Among 20 patients with KCNJ5 mutation, 16 showed G151R point mutation (KCNJ5- G151R) and 4 showed L168R point mutation (KCNJ5-L168R), which former one had significantly lower ALR (p=0.0471). CONCLUSION PA patients harboring somatic KCNJ5 mutation had significantly higher NP-59 uptake regarding to ALR and CON than those without mutation. APAs with KCNJ5-L168R point mutation showed significantly higher ALR than those with KCNJ5-G151R point mutation.
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Affiliation(s)
- Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kang-Yung Peng
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jei-Yie Huang
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kwan-Dun Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeff S. Chueh
- Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Wan-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- *Correspondence: Wan-Yu Lin,
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Wang H, Wang F, Zhang Y, Wen J, Dong D, Chang X, Sun H, Ma X, Cui Y, Chen S, Lu L, Ren W, Tong A, Li Y. Surgical Outcomes of Aldosterone-Producing Adenoma on the Basis of the Histopathological Findings. Front Endocrinol (Lausanne) 2021; 12:663096. [PMID: 34552553 PMCID: PMC8451176 DOI: 10.3389/fendo.2021.663096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Previous studies on the surgical outcomes of aldosterone-producing adenoma (APA) patients were mainly based on the histopathological diagnosis of HE staining or adrenal venous sampling (AVS) instead of the functional pathology. The aim of the present study was to evaluate the surgical outcomes of APA patients based on the functional pathological diagnosis of APA according to HISTALDO (histopathology of primary aldosteronism) consensus. METHODS Clinical data of 137 patients with suspected APA were analyzed retrospectively. All patients had hypertension and spontaneous hypokalemia. In all patients, CT showed a unilateral solitary hypodense adrenal lesion, and a contralateral adrenal gland of normal morphology. Tumors were removed and immunostained for CYP11B2, and their pathology were identified based on HISTALDO consensus. Patients were followed up 6 to 24 months after operation. RESULTS Among 137 cases of presumptive APA diagnosed by CT, 130 (95%) cases were pathologically diagnosed with classical pathology, including 123 APA(90%) and 7 aldosterone-producing nodule (APN) (5%). 7 cases (5%) had non-functioning adenoma (NFA) with aldosterone-producing micronodule (APM) or multiple aldosterone-producing micronodule (MAPM) in the surrounding adrenal tissue. In all 137 patients, hypertension was complete or partial clinical success postoperatively. Complete clinical success was achieved in 73 (53%), and partial clinical success was achieved in 64 (47%) cases. Serum potassium level recovered to normal in all. In 123 patients with APA, complete clinical success was reached in 67 (54%), and partial clinical success was reached in 56 (46%) cases. Gender, duration of hypertension and the highest SBP were significant independent predictors for cure of APA after surgery. A multiple logistic regression model integrating the three predictors was constructed to predict the outcome, which achieved a sensitivity of 72.4% and a specificity of 73.1%. CONCLUSION The specificity of CT in the diagnosis of APA and APN patients with hypokalemia was 95%. All patients achieved complete or partial clinical success after surgery. Gender, duration of hypertension and the highest SBP were independent predictors for the postoperative cure of APA.
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Affiliation(s)
- Huiping Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Department of Endocrinology, The First Affiliated Hospital of North University of Hebei, North University of Hebei, Zhangjiakou, China
| | - Fen Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Wen
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dexin Dong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaosen Ma
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunying Cui
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shi Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Lu
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weidong Ren
- Department of Endocrinology, The First Affiliated Hospital of North University of Hebei, North University of Hebei, Zhangjiakou, China
| | - Anli Tong
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Anli Tong,
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People’s Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Berthon A, Libe R, Bertherat J, Stratakis CA. Letter to the Editor from Berthon: "Cardiac Myxoma Caused by Fumarate Hydratase Gene Deletion in Patient With Cortisol-Secreting Adrenocortical Adenoma". J Clin Endocrinol Metab 2020; 105:5893956. [PMID: 32808982 PMCID: PMC7899563 DOI: 10.1210/clinem/dgaa530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Annabel Berthon
- Inserm U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Université, Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Correspondence and Reprint Requests: Annabel Berthon, PhD, Institut Cochin, 24 rue du faubourg Saint Jacques, 75014 Paris, France. E-mail:
| | - Rossella Libe
- Inserm U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Université, Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Jérôme Bertherat
- Inserm U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Université, Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics, The Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland
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Suda K, Fukuoka H. Response to Letter to the Editor from Berthon: "Cardiac Myxoma Caused by Fumarate Hydratase Gene Deletion in Patients With Cortisol-Secreting Adrenocortical Adenoma". J Clin Endocrinol Metab 2020; 105:5893966. [PMID: 32810276 DOI: 10.1210/clinem/dgaa531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Kentaro Suda
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
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Li S, Yang C, Fan J, Yao Y, Lv X, Guo Y, Zhang S. Pregnancy-induced Cushing's syndrome with an adrenocortical adenoma overexpressing LH/hCG receptors: a case report. BMC Endocr Disord 2020; 20:62. [PMID: 32393232 PMCID: PMC7216527 DOI: 10.1186/s12902-020-0539-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pregnancy-induced Cushing's syndrome (CS) with an adrenocortical adenoma overexpressing luteinizing hormone (LH)/human choriogonadotropin (hCG) receptors (LHCGR) has been rarely reported in the literatures. This peculiar condition challenges the canonical diagnosis and management of CS. CASE PRESENTATION A 27-year-old woman (G2P0A1) presented at 20 weeks gestational age (GA) with overt Cushingoid clinical features. Adrenocorticotropic hormone (ACTH)-independent CS was diagnosed based on undetectable ACTH and unsuppressed cortisol levels by dexamethasone. Magnetic resonance imaging (MRI) scanning without contrast revealed a left adrenal nodule while pituitary MRI scanning was normal. A conservative treatment strategy of controlling Cushingoid comorbidities was conducted. At 36 weeks GA, a caesarean operation was performed and a live female infant was delivered. At 8 weeks after parturition, our patient achieved normalization of blood pressure, blood glucose, serum potassium, and urinary cortisol level spontaneously. During non-pregnancy period, stimulation testing with exogenous hCG significantly evoked a cortisol increase. The woman underwent resection of the adrenal tumor at 6 months after parturition. Immunohistochemistry (IHC) showed the tumor tissue that stained positive for luteinizing hormone (LH)/human choriogonadotropin (hCG) receptor (LHCGR), whereas negative for both melanocortin 2 receptor (MC2R) and G protein-coupled receptor-1 (GPER-1). CONCLUSIONS Stimulation test with exogenous hCG after parturition is necessary for the diagnosis of pregnancy-induced CS. LHCGR plays an essential role in the pathogenesis of this rare condition.
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Affiliation(s)
- Shaohua Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Chen Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Jing Fan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Yao Yao
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Xiaomei Lv
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, China.
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Elbanan MG, Javadi S, Ganeshan D, Habra MA, Rao Korivi B, Faria SC, Elsayes KM. Adrenal cortical adenoma: current update, imaging features, atypical findings, and mimics. Abdom Radiol (NY) 2020; 45:905-916. [PMID: 31529204 DOI: 10.1007/s00261-019-02215-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Adrenal adenoma is the most common adrenal lesion. Due to its wide prevalence, adrenal adenomas may demonstrate various imaging features. Thus, it is important to identify typical and atypical imaging features of adrenal adenomas and to be able to differentiate atypical adrenal adenomas from potentially malignant lesions. In this article, we will discuss the diagnostic approach, typical and atypical imaging features of adrenal adenomas, as well as other lesions that mimic adrenal adenomas.
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Affiliation(s)
- Mohamed G Elbanan
- Department of Diagnostic Radiology, Yale New Haven Health System, Bridgeport Hospital, Bridgeport, CT, USA
| | - Sanaz Javadi
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Dhakshinamoorthy Ganeshan
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Brinda Rao Korivi
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Silvana C Faria
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Elson MJ, Wang VL, Sharma J. Management of Conn's Syndrome Associated with Hypokalemic Nonperiodic Paralysis. Am Surg 2020; 86:e33-e34. [PMID: 32077432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Cho YS, Kim JW, Seon HJ, Cho JY, Park JH, Kim HJ, Choi YD, Hur YH. Intrahepatic adrenocortical adenoma arising from adrenohepatic fusion mimicking hepatic malignancy: Two case reports. Medicine (Baltimore) 2019; 98:e15901. [PMID: 31169702 PMCID: PMC6571242 DOI: 10.1097/md.0000000000015901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intrahepatic adrenocortical adenoma (IAA) arising from adrenohepatic fusion (AHF) is rare and its imaging findings are not well established. Moreover, it is easily misdiagnosed as malignant hepatic tumor in patients at risk of malignancy. Its key finding is the connection between the tumor and adrenal gland. When IAA from AHF is suspected, biopsy should be considered to avoid unnecessary surgery. Herein, we report 2 cases of IAA from AHF. PATIENT CONCERNS A 59-year-old woman was admitted due to a 1.5-cm hypoechoic nodule in the right hepatic lobe detected on ultrasound for hepatocellular carcinoma (HCC) surveillance due to chronic hepatitis B. Contrast-enhanced computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) were performed to evaluate the hepatic mass. Another 75-year-old woman was admitted due to rectal adenocarcinoma detected on colonoscopy. Contrast-enhanced CT depicted a 2.5-cm mass in the right hepatic lobe. DIAGNOSIS In case 1, CT and MRI showed a 1.5-cm subcapsular mass in the right hepatic lobe with typical findings of HCC in a patient with chronic hepatitis B. The mass was confirmed as IAA from AHF after the laparoscopic surgery. In case 2, CT showed advanced rectal malignancy and a 2.5-cm poorly enhancing mass in the right hepatic lobe. The tentative diagnosis was hepatic metastasis. However, based on the connection between the tumor and adrenal gland during preoperative review, the presumed diagnosis was changed to IAA from AHF, which was confirmed on biopsy. INTERVENTIONS The hepatic mass connected with the right adrenal gland was laparoscopically resected in case 1. Laparoscopic lower anterior resection for rectal malignancy and percutaneous biopsy for the hepatic mass were performed in case 2. OUTCOMES The first patient had an uneventful recovery, without recurrence on the 3-year follow-up CT. The second patient had an uneventful postoperative course and has been alive for 12 months postoperatively without pathologically proven IAA changes on follow-up CT. LESSONS When hepatic mass is found adjacent to the right adrenal gland on imaging, the connection between the tumor and adrenal gland should be investigated. When IAA arising from AHF is suspected, biopsy should be considered to avoid unnecessary surgery.
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Affiliation(s)
- Yong Soo Cho
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyun Ju Seon
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Ju-Yeon Cho
- Department of Internal Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Jun-Hee Park
- Department of Otolaryngology-Head and Neck Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyung Joong Kim
- Impedance Imaging Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Young Hoe Hur
- Department of Hepato-Biliary-Pancreas Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
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Clark TJ, Hsu LD, Hippe D, Cowan S, Carnell J, Wang CL. Evaluation of diagnostic accuracy: multidetector CT image noise correction improves specificity of a Gaussian model-based algorithm used for characterization of incidental adrenal nodules. Abdom Radiol (NY) 2019; 44:1033-1043. [PMID: 30600378 DOI: 10.1007/s00261-018-1871-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate whether the histogram analysis method of characterizing adrenal nodules as adenomas is affected by increased noise with modern CT technique, and if an extension that allows for noise correction will improve diagnostic performance. MATERIALS AND METHODS This is a HIPAA-compliant, IRB-approved retrospective study performed on 58 total patients. The first group of 29 patients had 33 adrenal lesions that were pathology-proven non-adenomas. The second group had 29 patients with 33 pathology-proven or presumed adenomas based on established imaging criteria. The nodules were evaluated using the histogram method, mean attenuation method, and a Gaussian model-based algorithm without (uncorrected Gaussian algorithm) and with correction (corrected Gaussian algorithm) for image noise. Sensitivity, specificity, and accuracy for identifying adenoma were derived. RESULTS There were no significant differences in identifying adenoma from non-adenoma when using the histogram analysis method and the uncorrected Gaussian algorithm, both of which had low specificities of 42.4% and 47.0%, respectively (p = 0.30). Adding noise correction to the Gaussian algorithm resulted in a statistically significant increase in specificity relative to the histogram method (86.4% vs. 42.4%, p < 0.001). The corrected Gaussian algorithm improved sensitivity compared to the mean attenuation method (71.2% vs. 54.5%, p < 0.001), but had lower specificity (86.4% vs. 100%, p < 0.001), and similar overall accuracy (78.8% vs. 77.3%, p = 0.74). CONCLUSION With modern low-dose CT technique, the specificity scores of the histogram method for discrimination of adrenal adenomas and non-adenomas are lower than with previous higher dose scans. The specificity and accuracy of a histogram-equivalent method can be increased mathematically through image noise correction, and the corrected Gaussian algorithm has improved sensitivity to the mean attenuation with similar accuracy albeit with lower specificity. Although this suggests limited utility for histogram analysis in adrenal nodule characterization, our study demonstrates the potential mathematical application for other noise-dependent CT characterization methods.
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Affiliation(s)
- Toshimasa J Clark
- Abdominal Imaging Division, Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, 12401 E 17th Ave, Mail Stop L954, Aurora, CO, 80045, USA.
| | - Larson D Hsu
- Department of Radiology, Roswell Park Cancer Institute, Body Imaging Section Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Daniel Hippe
- Body Imaging Section, Department of Radiology, University of Washington, Box 358081, 825 Eastlake Ave E, G2-600, Seattle, WA, 98109, USA
| | - Sophie Cowan
- Body Imaging Section, Department of Radiology, University of Washington, Box 358081, 825 Eastlake Ave E, G2-600, Seattle, WA, 98109, USA
| | - Jonathan Carnell
- Body Imaging Section, Department of Radiology, University of Washington, Box 358081, 825 Eastlake Ave E, G2-600, Seattle, WA, 98109, USA
| | - Carolyn L Wang
- Body Imaging Section, Department of Radiology, University of Washington, Box 358081, 825 Eastlake Ave E, G2-600, Seattle, WA, 98109, USA
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Thomas AJ, Habra MA, Bhosale PR, Qayyum AA, Ahmed K, Vicens R, Elsayes KM. Interobserver agreement in distinguishing large adrenal adenomas and adrenocortical carcinomas on computed tomography. Abdom Radiol (NY) 2018; 43:3101-3108. [PMID: 29671009 DOI: 10.1007/s00261-018-1603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Large adrenal masses pose a diagnostic dilemma. The purpose of this study was twofold: first, to assess the degree of interobserver agreement in evaluating the morphology of pathologically proven adrenal adenomas and adrenocortical carcinomas larger than 4 cm in diameter; and second, to identify morphologic characteristics that correlated with the pathologic diagnosis. MATERIALS AND METHODS For this blinded, retrospective study, we collected cases of 25 adrenal adenomas and 33 adrenocortical carcinomas measuring larger than 4 cm. Two radiologists evaluated morphologic characteristics of the lesions on CT. Interobserver agreement was evaluated using kappa statistics, and the correlation of imaging characteristics with the diagnosis was evaluated using a logistic regression model. RESULTS We found the highest interobserver agreement in the assessment of precontrast attenuation (Κ = 0.81) as well as substantial agreement in determining the shape and the presence of calcifications (Κ = 0.69 and 0.74, respectively). Readers agreed less often regarding the presence of fat (Κ = 0.48), as well as regarding the presence of necrosis, heterogeneity, and the overall impression (Κ = 0.15, 0.24, and 0.26, respectively). CT characteristics correlated with benignity included round shape (p = 0.02), an overall radiologic impression of a benign lesion (p < 0.0001), the presence of fat (p = 0.01), and a precontrast attenuation of less than 10 Hounsfield units (p < 0.0001). The latter two of these characteristics were highly specific for benign pathology (93% and 100%, respectively). CONCLUSION Our study suggests that CT has the ability to consistently identify characteristics significantly correlated with benign vs. malignant adrenal tumors.
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Affiliation(s)
- Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mouhammed A Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aliya A Qayyum
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem Ahmed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rafael Vicens
- Department of Radiology, Hospital Auxilio Mutuo, San Juan, PR, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Humbert AL, Lecoanet G, Moog S, Bouderraoui F, Bresler L, Vignaud JM, Chevalier E, Brunaud L, Klein M, Cuny T. The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas. Endocrine 2018; 59:529-537. [PMID: 29332161 DOI: 10.1007/s12020-018-1522-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Adrenocortical lesions are characterized through imaging, hormonal and histopathological analysis. Our aim was to compare the radiological features of adrenocortical lesions with their cortisol-secreting status and histopathological Weiss score. METHODS Seventy five patients operated between 2004 and 2016 in the University Hospital of Nancy for either adrenocortical carcinomas (ACC) or adrenocortical adenomas (ACA) were enrolled in this study. We collected cortisol parameters, Computed Tomography (CT) scans (unenhanced density, wash-out (WO) analysis) and 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) datas. The histopathological Weiss score ultimately differentiates ACA (score ≤ 2) from ACC (score ≥ 3). One-way ANOVA, Fisher's exact and unpaired t tests were used for statistical analysis with significancy reached at p < 0.05. RESULTS There were 23 ACC and 52 ACA with 40 patients (53%) who had an autonomous secretion of cortisol. On CT scan, ACC were larger compared to ACA (108 vs. 37 mm, p < 0.0001). A roughly similar proportion of cortisol-secreting (22/25) and non-secreting (15/19) ACA were atypical (i.e., unenhanced density value ≥ 10 Hounsfield Units [HU]), however 85% of cortisol-secreting vs. 40% of non-secreting ACA were classified as benigns by the relative WO analysis (p = 0.08). Likewise, there was a trend for a higher 18F-FDG uptake in cortisol-secreting ACA compared to non-secreting ACA (p = 0.053). CONCLUSIONS The relative adrenal WO analysis consolidates the benign nature of an ACA, especially in case of cortisol oversecretion, a condition known to compromise the diagnostic accuracy of the 10 HU unenhanced CT attenuation threshold.
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Affiliation(s)
- Anne-Laure Humbert
- Department of Endocrinology, University Hospital of Nancy, Nancy, France
| | | | - Sophie Moog
- Department of Endocrinology, University Hospital of Nancy, Nancy, France
| | - Fehd Bouderraoui
- Department of Nuclear Medicine, University Hospital of Nancy, Nancy, France
| | - Laurent Bresler
- Department of Endocrine and General Surgery, University Hospital of Nancy, Nancy, France
| | | | - Elodie Chevalier
- Department of Nuclear Medicine, University Hospital of Nancy, Nancy, France
| | - Laurent Brunaud
- Department of Endocrine and General Surgery, University Hospital of Nancy, Nancy, France
| | - Marc Klein
- Department of Endocrinology, University Hospital of Nancy, Nancy, France
| | - Thomas Cuny
- Department of Endocrinology, University Hospital of Nancy, Nancy, France.
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27
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Delivanis DA, Iñiguez-Ariza NM, Zeb MH, Moynagh MR, Takahashi N, McKenzie TJ, Thomas MA, Gogos C, Young WF, Bancos I, Kyriazopoulou V. Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas. Clin Endocrinol (Oxf) 2018; 88:209-216. [PMID: 29115003 DOI: 10.1111/cen.13512] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/25/2023]
Abstract
CONTEXT Abdominal visceral adiposity and central sarcopenia are markers of increased cardiovascular risk and mortality. OBJECTIVE To assess whether central sarcopenia and adiposity can serve as a marker of disease severity in patients with adrenal adenomas and glucocorticoid secretory autonomy. DESIGN Retrospective cohort study. PATIENTS Twenty-five patients with overt Cushing's syndrome (CS), 48 patients with mild autonomous cortisol excess (MACE) and 32 patients with a nonfunctioning adrenal tumour (NFAT) were included. METHODS Medical records were reviewed, and body composition measurements (visceral fat [VAT], subcutaneous fat [SAT], visceral/total fat [V/T], visceral/subcutaneous [V/S] and total abdominal muscle mass) were calculated based on abdominal computed tomography (CT). RESULTS In patients with overt CS, when compared to patients with NFAT, the V/T fat and the V/S ratio were increased by 0.08 (P < .001) and by 0.3 (P < .001); however, these measurements were decreased by 0.04 (P = .007) and 0.2 (P = .01), respectively, in patients with MACE. Total muscle mass was decreased by -10 cm2 (P = .02) in patients with overt CS compared to patients with NFAT. Correlation with morning serum cortisol concentrations after dexamethasone suppression testing revealed that for every 28 nmol/L cortisol increase there was a 0.008 increase in V/T (P < .001), 0.02 increase in the V/S fat ratio (P < .001) and a 1.2 cm2 decrease in mean total muscle mass (P = .002). CONCLUSIONS The severity of hypercortisolism was correlated with lower muscle mass and higher visceral adiposity. These CT-based markers may allow for a more reliable and objective assessment of glucocorticoid-related disease severity in patients with adrenal adenomas.
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Affiliation(s)
- Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Melinda A Thomas
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Charalambos Gogos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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28
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Lumachi F, Borsato S, Tregnaghi A, Marino F, Fassina A, Zucchetta P, Marzola MC, Cecchin D, Bui F, Iacobone M, Favia G. High Risk of Malignancy in Patients with Incidentally Discovered Adrenal Masses: Accuracy of Adrenal Imaging and Image-Guided Fine-Needle Aspiration Cytology. Tumori 2018; 93:269-74. [PMID: 17679462 DOI: 10.1177/030089160709300307] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Aims and background The incidental finding of nonfunctioning adrenal masses (incidentalomas) is common, but no reliable criteria in differentiating between benign and malignant adrenal masses have been defined. The aim of this preliminary study was to assess the usefulness of adrenal imaging and image-guided fine-needle aspiration cytology in patients with nonfunctioning adrenal incidentalomas with the aim of excluding or confirming malignancy before surgery. Methods Forty-two consecutive patients (18 men and 24 women; median age, 54 years; range, 25-75 years) with incidentally discovered adrenal masses of 3 cm or more in the greatest diameter were prospectively enrolled in the study. All patients underwent helical computerized tomography scan and image-guided fine-needle aspiration cytology, 33 (78.6%) underwent magnetic resonance imaging, and 26 (61.9%) underwent norcholesterol scintigraphy before adrenalectomy. Results The revised final pathology showed 30 (71.4%) benign (26 adrenocortical adenomas, of which 3 were atypical, 2 ganglioneuromas, and 2 nonfunctioning benign pheochromocytomas) and 12 (28.6%, 95% CI = 15-42) adrenal malignancies (8 adrenocortical carcinomas and 4 unsuspected adrenal metastases). The definitive diagnosis of adrenocortical carcinoma was made according to Weiss criteria and confirmed on the basis of local invasion at surgery or metastases. The sensitivity, specificity and accuracy were 75%, 67% and 83% for computerized tomography scan, 92%, 95% and 94% for magnetic resonance imaging, 89%, 94% and 92% for norcholesterol scintigraphy, and 92%, 100% and 98% for fine-needle aspiration cytology. The sensitivity and accuracy of image-guided fine-needle aspiration cytology and magnetic resonance imaging together reached 100%. Immediate periprocedural complications of fine-needle aspiration cytology occurred in 2 (4.7%) patients: self-limited pneumothorax (n = 1), and severe pain (n = 1) requiring analgesic therapy. No postprocedural or late complications were observed. Conclusions With the aim of selecting for surgery patients with a non-functioning adrenal incidentaloma of 3 cm or more in diameter, the combination of magnetic resonance imaging and fine-needle aspiration cytology should be considered the strategy of choice.
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Affiliation(s)
- Franco Lumachi
- Endocrine Surgery Unit, Department of Surgical & Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
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Sapalidis K, Giannakidis D, Laskou S, Karayannopoulou G, Koletsa T, Rafailidis V, Zarampouka K, Sotiriou S, Spyridaki K, Stamenitou I, Kesisoglou I, Păun I. Double unilateral functioning adrenocortical adenomas. Rom J Morphol Embryol 2018; 59:1269-1273. [PMID: 30845311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Double functioning adrenocortical adenomas, occurring in the same gland is an extremely rare condition. This paper presents two cases of double functioning adrenocortical adenomas within the same adrenal gland, causing primary aldosteronism. Diagnosis was set histopathologically in one case since magnetic resonance imaging (MRI) failed to distinguish the two entities. In each case, a laparoscopic adrenalectomy was conducted. When preoperative imaging studies fail to report the presence of double adrenocortical adenomas, histopathology reports should be comprehensive enough so as to reveal such rare lesions.
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Affiliation(s)
- Konstantinos Sapalidis
- 3rd Department of Surgery, "AHEPA" University General Hospital, Medical School, Aristotle University of Thessaloniki, Greece; ,
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30
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Farrugia FA, Martikos G, Surgeon C, Tzanetis P, Misiakos E, Zavras N, Charalampopoulos A. Radiology of the adrenal incidentalomas. Review of the literature. Endocr Regul 2017; 51:35-51. [PMID: 28222025 DOI: 10.1515/enr-2017-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The term "adrenal incidentaloma" is a radiological term. Adrenal incidentalomas are adrenal tumors discovered in an imaging study that has been obtained for indications exclusive to adrenal conditions (Udelsman 2001; Linos 2003; Bulow et al. 2006; Anagnostis et al. 2009). This definition excludes patients undergoing imaging testing as part of staging and work-up for cancer (Grumbach et al. 2003; Anagnostis et al. 2009). Papierska et al. (2013) have added the prerequisite that the size of a tumor must be "greater than 1cm in diameter", in order to be called incidentaloma. Although in the most cases these masses are non-hypersecreting and benign, they still represent an important clinical concern because of the risk of malignancy or hormone hyperfunction (Barzon et al. 2003). Th e adrenal tumors belong to the commonest incidental findings having been discovered (Kanagarajah et al. 2012).
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31
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Noël F, Lacremans P, Liekens E, Geurde B. [Fortuitous discovery of an adrenal mass following spontaneous retroperitoneal hemorrhage]. Rev Med Liege 2017; 72:358-362. [PMID: 28795549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a case of spontaneous retroperitoneal haemorrhage by bleeding of an adrenal adenoma. Retroperitoneal haemorrhages are rarely encountered in practice, but must be rapidly diagnosed due to the life threatening risk. The etiologies, clinical assessment, management and differential diagnosis of spontaneous retroperitoneal haemorrhages are discussed.
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Affiliation(s)
- F Noël
- Université de Liège, Belgique
| | - P Lacremans
- Service d'Anatomie Pathologique, CHU de Liège, site Sart Tilman, Liège, Belgique
| | - E Liekens
- Service de Chirurgie Digestive, CH Bois de l'Abbaye, Seraing, Belgique
| | - B Geurde
- Service de Chirurgie Digestive, CH Bois de l'Abbaye, Seraing, Belgique
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Pemayun TGD, Naibaho R, Wiyati MW, Santosa A, Amarwati S. Primary Hyperaldosteronism Due to Adrenocortical Adenoma: a Case Report. Acta Med Indones 2017; 49:249-254. [PMID: 29093236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary hyperaldosteronism is an adrenal abnormality in which there is some degree of autonomy of aldosterone secretion. We report a case of thirty three years old Javanese female presented with uncontrolled hypertension, muscular weakness, cramps and progressing shortness of breath during working for 6 years. She had history of hypertension since age 20. Her serum potassium level was always low that associated with inappropriate kaliuresis. Blood gas analysis revealed metabolic alkalosis. Sonography of the adrenal gland showed right hipoechoic architecture; CT scan of the abdomen confirmed an right adrenal tumor measured 4 cm in its greatest dimension. Endocrine evaluation revealed high plasma aldosterone concentration, suppressed plasma renin activity, aldosterone/renin ratio of 112 and confirmed the diagnosis of primary aldosteronism. She underwent unilateral adrenalectomy. Histopathological report from excised adrenal tumor were compatible to benign adrenocortical adenoma. The patient discharge home with well controlled blood pressure and normokalemia. No clinical symptoms was reported in follow-up.
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Affiliation(s)
- Tjokorda Gde Dalem Pemayun
- Department of Internal Medicine Faculty of Medicine, Diponegoro University - Dr. Kariadi Hospital Semarang, Indonesia.
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Carroll R, Gould A, Feltham J, Harper S. A case of confirmed primary hyperaldosteronism diagnosed despite normal screening investigations. N Z Med J 2017; 130:129-132. [PMID: 28494487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary hyperaldosteronism is a common cause of hypertension in the adult population. We report a case of histologically and biochemically confirmed hyperaldosteronism related to an adrenal adenoma, where initial screening and biochemical tests were potentially misleading. The case highlights the importance of clinical suspicion in the current diagnostic approach to primary hyperaldosteronism.
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Affiliation(s)
- Richard Carroll
- Endocrine, Diabetes and Research Centre, Wellington Regional Hospital, Wellington
| | - Alana Gould
- Endocrine, Diabetes and Research Centre, Wellington Regional Hospital, Wellington
| | - Joe Feltham
- Department of Radiology, Wellington Regional Hospital, Wellington
| | - Simon Harper
- Department of Surgery, Wellington Regional Hospital, Newtown, Wellington
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Katabami T, Ishii S, Obi R, Asai S, Tanaka Y. Contralateral adrenal suppression on adrenocortical scintigraphy provides good evidence showing subclinical cortisol overproduction from unilateral adenomas. Endocr J 2016; 63:1123-1132. [PMID: 27616151 DOI: 10.1507/endocrj.ej16-0281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Unilateral and/or predominant uptake on adrenocortical scintigraphy (ACS) may be related to autonomous cortisol overproduction in patients with subclinical Cushing's syndrome (SCS). However, there is no information regarding whether increased tracer uptake on the tumor side or decreased uptake on the contralateral side on ACS is more greatly associated with inappropriate cortisol production. Therefore, we evaluated the relationship between quantitative 131I-6β-iodomethyl-norcholesterol (131I-NP-59) uptake in both adrenal glands and parameters of autonomic cortisol secretion and attempted to set a cut off for SCS detection. The study included 90 patients with unilateral adrenal adenoma who fulfilled strict criteria. The diagnosis of SCS was based on serum cortisol ≥3.0 μg/dL after 1-mg dexamethasone suppression test (DST) with at least 1 other hypothalamus-pituitary-adrenal axis function abnormality. Twenty-two (27.7%) subjects were diagnosed with SCS. The uptake rate on the affected side in the SCS group was comparable to that in the non-functioning adenoma group. In contrast, the uptake rate on the contralateral side was lower and the laterality ratio significantly higher in the SCS group. The two ACS indices were correlated with serum cortisol levels after a 1-mg DST, but uptake on the tumor side was not. Tumor size was also important for the functional statuses of adrenal tumors and NP-59 imaging patterns. The best cut-off point for the laterality ratio to detect SCS was 3.07. These results clearly indicate that contralateral adrenal suppression in ACS is good evidence showing subclinical cortisol overproduction.
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Affiliation(s)
- Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
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Dekkers T, Prejbisz A, Kool LJS, Groenewoud HJMM, Velema M, Spiering W, Kołodziejczyk-Kruk S, Arntz M, Kądziela J, Langenhuijsen JF, Kerstens MN, van den Meiracker AH, van den Born BJ, Sweep FCGJ, Hermus ARMM, Januszewicz A, Ligthart-Naber AF, Makai P, van der Wilt GJ, Lenders JWM, Deinum J. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol 2016; 4:739-746. [PMID: 27325147 DOI: 10.1016/s2213-8587(16)30100-0] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The distinction between unilateral aldosterone-producing adenoma or bilateral adrenal hyperplasia as causes of primary aldosteronism is usually made by adrenal CT or by adrenal vein sampling (AVS). Whether CT or AVS represents the best test for diagnosis remains unknown. We aimed to compare the outcome of CT-based management with AVS-based management for patients with primary aldosteronism. METHODS In a randomised controlled trial, we randomly assigned patients with aldosteronism to undergo either adrenal CT or AVS to determine the presence of aldosterone-producing adenoma (with subsequent treatment consisting of adrenalectomy) or bilateral adrenal hyperplasia (subsequent treatment with mineralocorticoid receptor antagonists). The primary endpoint was the intensity of drug treatment for obtaining target blood pressure after 1 year of follow-up, in the intention-to-diagnose population. Intensity of drug treatment was expressed as daily defined doses. Key secondary endpoints included biochemical outcome in patients who received adrenalectomy, health-related quality of life, cost-effectiveness, and adverse events. This trial is registered with ClinicalTrials.gov, number NCT01096654. FINDINGS We recruited 200 patients between July 6, 2010, and May 30, 2013. Of the 184 patients that completed follow-up, 92 received CT-based treatment (46 adrenalectomy and 46 mineralocorticoid receptor antagonist) and 92 received AVS-based treatment (46 adrenalectomy and 46 mineralocorticoid receptor antagonist). We found no differences in the intensity of antihypertensive medication required to control blood pressure between patients with CT-based treatment and those with AVS-based treatment (median daily defined doses 3·0 [IQR 1·0-5·0] vs 3·0 [1·1-5·9], p=0·52; median number of drugs 2 [IQR 1-3] vs 2 [1-3], p=0·87). Target blood pressure was reached in 39 (42%) patients and 41 (45%) patients, respectively (p=0·82). On secondary endpoints we found no differences in health-related quality of life (median RAND-36 physical scores 52·7 [IQR 43·9-56·8] vs 53·2 [44·0-56·8], p=0·83; RAND-36 mental scores 49·8 [43·1-54·6] vs 52·7 [44·9-55·5], p=0·17) for CT-based and AVS-based treatment. Biochemically, 37 (80%) of patients with CT-based adrenalectomy and 41 (89%) of those with AVS-based adrenalectomy had resolved hyperaldosteronism (p=0·25). A non-significant mean difference of 0·05 (95% CI -0·04 to 0·13) in quality-adjusted life-years (QALYs) was found to the advantage of the AVS group, associated with a significant increase in mean health-care costs of €2285 per patient (95% CI 1323-3248). At a willingness-to-pay value of €30 000 per QALY, the probability that AVS compared with CT constitutes an efficient use of health-care resources in the diagnostic work-up of patients with primary aldosteronism is less than 0·2. There was no difference in adverse events between groups (159 events of which nine were serious vs 187 events of which 12 were serious) for CT-based and AVS-based treatment. INTERPRETATION Treatment of primary aldosteronism based on CT or AVS did not show significant differences in intensity of antihypertensive medication or clinical benefits for patients after 1 year of follow-up. This finding challenges the current recommendation to perform AVS in all patients with primary aldosteronism. FUNDING Netherlands Organisation for Health Research and Development-Medical Sciences, Institute of Cardiology, Warsaw.
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Affiliation(s)
- Tanja Dekkers
- Department of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Leo J Schultze Kool
- Department of Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hans J M M Groenewoud
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke Velema
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Mark Arntz
- Department of Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jacek Kądziela
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anton H van den Meiracker
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bert-Jan van den Born
- Department of Internal and Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ad R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Alike F Ligthart-Naber
- Department of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Makai
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert-Jan van der Wilt
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jacques W M Lenders
- Department of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Jaap Deinum
- Department of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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36
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Chambre C, McMurray E, Baudry C, Lataud M, Guignat L, Gaujoux S, Lahlou N, Guibourdenche J, Tissier F, Sibony M, Dousset B, Bertagna X, Bertherat J, Legmann P, Groussin L. The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas. Eur J Endocrinol 2015; 173:325-32. [PMID: 26243637 DOI: 10.1530/eje-15-0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Computed tomography (CT) unenhanced attenuation value of <10 Hounsfield units (HU) has an excellent specificity (98%) to diagnose lipid-rich adrenocortical adenomas (ACAs) with a weaker sensitivity (71%). OBJECTIVE To determine from a routine clinical perspective if unenhanced attenuation value is influenced by cortisol secretion in ACAs. DESIGN This was a retrospective study of cases collected between 2009 and 2012. SETTING This study was conducted in a tertiary-care university hospital. PATIENTS Seventy-two patients operated on for an ACA (Weiss score ≤ 2) were analysed. Thirty-four patients had an ACA oversecreting cortisol (Cush-ACA). Thirty-eight patients had an ACA without cortisol oversecretion (Non Hyper-ACA). MAIN OUTCOME MEASURE CT unenhanced attenuation value was correlated with the functional status. The Weiss score items were analysed. RESULTS Among the 34 patients with a Cush-ACA a minority (n = 7) had an unenhanced attenuation value under 10 HU. Among the high precontrast density (> 10 HU) Cush-ACAs, washout analysis after contrast administration was consistent with the benign nature of the tumor in ∼ 60% of the cases. Less than 25% clear cells (lipid-rich cells), a Weiss score item, was present in 50% of the Cush-ACAs in favour of a lipid-poor content. CONCLUSIONS Unenhanced attenuation value has a poor sensitivity to diagnose an ACA in case of cortisol oversecretion due to poor lipid content. Nevertheless, the accuracy of washout analysis was preserved in the group of Cush-ACAs.
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Affiliation(s)
- Claire Chambre
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Emily McMurray
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Camille Baudry
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Marine Lataud
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Laurence Guignat
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France
| | - Sébastien Gaujoux
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Najiba Lahlou
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Jean Guibourdenche
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Frédérique Tissier
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Mathilde Sibony
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Bertrand Dousset
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Xavier Bertagna
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Jérôme Bertherat
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Paul Legmann
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Lionel Groussin
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
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Petersenn S, Richter PA, Broemel T, Ritter CO, Deutschbein T, Beil FU, Allolio B, Fassnacht M. Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry. Eur J Endocrinol 2015; 172:415-22. [PMID: 25599706 DOI: 10.1530/eje-14-0916] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thresholds of 2-20 hounsfield units (HU) in unenhanced computed tomography (CT) are suggested to discriminate benign adrenal tumors (BATs) from malignant adrenal tumors. However, these studies included only low numbers of adrenocortical carcinomas (ACCs). This study defines a HU threshold by inclusion of a large cohort of ACCs. DESIGN Retrospective, blinded, comparative analysis of CT scans from 51 patients with ACCs (30 females, median age 49 years) and 25 patients with BATs (12 females, median age 64 years) diagnosed during the period of 2005-2010 was performed. METHODS Tumor density was evaluated in unenhanced CT by two blinded investigators. RESULTS Median tumor size was 9 cm (range 2.0-20) for ACCs vs 4 cm (2.0-7.5) for BATs (P<0.0001). In ACCs, the median unenhanced HU value was 34 (range 14-74) in comparison with 5 (-13 to 40) in BATs (P<0.0001). ROC analysis revealed a HU of 21 as threshold with the best diagnostic accuracy (sensitivity 96%, specificity 80%, and AUC 0.89). However, two ACCs that were 5 and 6 cm in size would have been missed. Setting the threshold to 13.9 allowed for 100% sensitivity, but a lower specificity of 68%. CONCLUSIONS This first large study on ACCs confirmed that the vast majority of ACCs have unenhanced HU >21. However, to avoid misdiagnosing an ACC as benign, a threshold of 13 should be used.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Paul-Ajoy Richter
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Thomas Broemel
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Christian O Ritter
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Timo Deutschbein
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Frank-Ulrich Beil
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Bruno Allolio
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
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Zhang Y, Li H, Xiao J, Zhou Y, Zhou Z, Tong A. Bilateral adrenal tumors from different histology: case report and literature review. Cell Biochem Biophys 2014; 71:425-9. [PMID: 25164113 DOI: 10.1007/s12013-014-0216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bilateral adrenal tumors are very uncommon in clinical practice and all originate from the same histology. We presented here a case report and literature review of bilateral adrenal tumors from different histology: pheochromocytoma in one side and adrenocortical adenoma in the other side. The patient was a 37 years old female suffered from Cushing's syndrome form 3 years. One year ago she was diagnosed as ACTH-independent Cushing's syndrome and received Laparoscopic adrenalectomy for right adrenal tumor which diagnosed as a pheochromocytoma by the pathological reports. After the operation, patient's clinical manifestation was not change, then half-year later the lab test showed no improvement in the blood biochemical parameters. Finally, CT detected a mass in left adrenal gland. Thereafter, this patient received Laparoscopic adrenalectomy for left adrenal tumor. The tumor was diagnosed as adrenocortical adenoma by the pathologists. One week after operation, the blood biochemical parameters became normal. In conclusion, bilateral adrenal tumors from different histology are very rare, adrenalectomy for both side tumors and preserving the normal adrenal glands is necessary.
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Affiliation(s)
- Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Qin HY, Sun H, Wang X, Bai R, Li Y, Zhao J. Correlation between CT perfusion parameters and microvessel density and vascular endothelial growth factor in adrenal tumors. PLoS One 2013; 8:e79911. [PMID: 24260316 PMCID: PMC3832505 DOI: 10.1371/journal.pone.0079911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 09/29/2013] [Indexed: 11/19/2022] Open
Abstract
We evaluated the correlation between computed tomography (CT) perfusion parameters and markers of angiogenesis in adrenal adenomas and non-adenomas to determine if perfusion CT can be used to distinguish between them. Thirty-four patients with pathologically-confirmed adrenal tumors (17 adenomas, 17 non-adenomas) received CT perfusion imaging before surgery. CT perfusion parameters (blood flow [BF], blood volume [BV], mean transit time [MTT], and permeability surface area product [PS]) were calculated. Tumor tissue sections were examined with immunohistochemical methods for vascular endothelial growth factor (VEGF) expression and microvessel density (MVD). The mean age of the 34 patients was 43 years. The median BV was significantly higher in adenomas than in non-adenomas [12.3 ml/100 g, inter-quartile range (IQR): 10.4 to 16.5 ml/100 g vs. 8.8 ml/100 g, IQR: 3.3 to 9.4 ml/100 g, p=0.001]. Differences in BF, MTT, and PS parameter values between adenomas and non-adenomas were not significant (p>0.05). The mean MVD was significantly higher in adenomas compared to non-adenomas (98.5 ± 28.5 vs. 53.5 ± 27.0, p<0.0001). Adenomas also expressed significantly higher median VEGF than non-adenomas (65%, IQR: 50 to 79% vs. 45%, IQR: 35 to 67%, p=0.02). A moderately strong correlation between BF and VEGF (r=0.53, p=0.03) and between BV and MVD among adenomas (r=0.57, p=0.02) exist. Morphology, MVD, and VEGF expression in adenomas differ significantly from non-adenomas. Of the CT perfusion parameters examined, both BF and BV correlate with MVD, but only BF correlates with VEGF, and only in adenomas. The significant difference in BV suggests that BV may be used to differentiate adenomas from non-adenomas. However, the small difference in BV shows that it may only be possible to use BV to identify adenomas vs. non-adenomas at extreme BV values.
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Affiliation(s)
- Hai-yan Qin
- Department of Imaging, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Haoran Sun
- Department of Radiology, The General Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Xifu Wang
- Department of Radiology, The First Affiliated Hospital, Jiaotong University, Shanghai, P.R. China
| | - Renju Bai
- Department of Radiology, The General Hospital, Tianjin Medical University, Tianjin, P.R. China
- * E-mail:
| | - Yajun Li
- Department of Radiology, The General Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Jinkun Zhao
- Department of Radiology, The Affiliated Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
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Abbas A, Idriz S, Railton NJ, McGill N, Nasruddin AB, Sandeman DD, Breen DJ. Image-guided ablation of Conn's adenomas in the management of primary hyperaldosteronism. Clin Radiol 2012; 68:279-83. [PMID: 23218647 DOI: 10.1016/j.crad.2012.06.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/25/2012] [Accepted: 06/01/2012] [Indexed: 11/18/2022]
Affiliation(s)
- A Abbas
- Department of Radiology, University Hospital Southampton, Southampton, UK
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Ippersiel V, Rosière A, Michel L, Donckier J. Misleading diagnosis of renal artery stenosis by magnetic resonance angiography in a patient with primary aldosteronism. Acta Chir Belg 2012; 112:302-306. [PMID: 23008996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 24-year-old woman presented with severe hypertension. A diagnostic evaluation for secondary hypertension was undertaken. A duplex ultrasonography followed by a magnetic angiography suspected fibromuscular dysplasia. Unexpectedly, a contrast-enhanced angiography performed for renal angioplasty showed normal renal arteries. Primary aldosteronism was then evoked on the basis of decreased plasma renin and increased plasma aldosterone and aldosterone/renin ratio. After a CT-scan disclosed a left adrenal tumour, the patient underwent a left laparoscopic adrenalectomy. Pathological findings confirmed a benign adrenocortical adenoma. Blood pressure and aldosterone levels were normalized after surgery. Thus, clinicians should be aware of false-positive results of magnetic resonance angiography that could hide other causes of secondary hypertension.
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Affiliation(s)
- V Ippersiel
- Services of Endocrinology, University Hospital of Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
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Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV, Azizan EAB, Aigbirhio F, Gurnell M, Brown MJ. Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn's adenomas. J Clin Endocrinol Metab 2012; 97:100-9. [PMID: 22112805 DOI: 10.1210/jc.2011-1537] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Identification of unilateral aldosterone-producing (Conn's) adenomas has traditionally required lateralization by the invasive and technically difficult procedure of adrenal vein sampling (AVS). (11)C-metomidate, a potent inhibitor of adrenal steroidogenic enzymes, is a positron emission tomography (PET) radiotracer that is selectively accumulated by Conn's adenomas. OBJECTIVE The objective of the study was to compare the sensitivity and specificity of (11)C-metomidate PET-computed tomography (CT) against the current gold standard of AVS. DESIGN The design of the study was within-patient comparison of diagnostic techniques. SETTING The study was conducted at a single center-university teaching hospital. PATIENTS Thirty-nine patients with primary hyperaldosteronism (PHA) and five with nonfunctioning adenomas (incidentalomas) participated in the study. INTERVENTION(S) The first six PHA patients were studied on three occasions to determine whether steroid pretreatment reduced (11)C-metomidate uptake by normal adrenal. Subsequent patients received dexamethasone for 3 d prior to injection of (11)C-metomidate 150-500 MBq. MAIN OUTCOME MEASURE(S) Maximum standardized uptake values (SUV(max)) over regions of interest determined from 35-45 min after injection were measured. RESULTS Dexamethasone increased tumor to normal adrenal SUV(max) ratio by 25.6 ± 5.0% (P < 0.01). PET-CT visualized subcentimeter adenomas and distinguished hot from cold adenomas within a gland. In 25 patients with PHA and AVS lateralization to the side of an adenoma, SUV(max) over tumor (mean ± sem) of 21.7 ± 1.6 was greater than over normal adrenal, 13.8 ± 0.6 (P = 0.00003); this difference was absent in 10 patients without lateralization on AVS (P = 0.28) and in four of five incidentalomas. On receiver-operator characteristics analysis, an SUV(max) ratio of 1.25:1 provided a specificity of 87% [95% confidence interval (69, 104)] and sensitivity of 76% (59, 93); in tumors with SUV(max) greater than 17, the specificity rose to 100%. CONCLUSIONS (11)C-metomidate PET-CT is a sensitive and specific noninvasive alternative to AVS in the management of PHA.
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Affiliation(s)
- Timothy J Burton
- Clinical Pharmacology Unit, Department of Medicine, University of Cambridge, Cambridge CB2 2QQ, UK
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Friedrich-Rust M, Glasemann T, Polta A, Eichler K, Holzer K, Kriener S, Herrmann E, Nierhoff J, Bon D, Bechstein WO, Vogl T, Zeuzem S, Bojunga J. Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound. Ultraschall Med 2011; 32:460-471. [PMID: 21667434 DOI: 10.1055/s-0031-1273408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Adrenal masses can be detected by ultrasound with high sensitivity and specificity. The aim of the present study was to evaluate CEUS in a large patient population using CEUS patterns identified in a previous pilot study. MATERIALS AND METHODS 116 adrenal masses were evaluated by ultrasound, including CEUS with the contrast agent Sonovue®. The dynamic of contrast enhancement (CE) was analyzed using time-intensity curves. The time of the first CE in the adrenal mass was used to define four CEUS patterns: pattern I = early arterial CE, pattern II = arterial CE, pattern III = late CE, pattern IV = no CE. In addition, all patients received CT/MRI and hormonal testing. In suspicious cases biopsy or adrenalectomy was performed. RESULTS CEUS patterns I&II were seen in all patients with primary or secondary malignant lesions of the adrenal gland (n = 16). The sensitivity and specificity of CEUS for the diagnosis of malignant adrenal mass were 100 % (CI [75;100]) and 67 % (CI [56;75]), respectively. Overall histology was available as a reference method for 40 adrenal masses. In 68 % of histologically diagnosed adrenal masses, MRI/CT and CEUS were congruent concerning the characterization of malignant versus benign adrenal mass. CONCLUSION Contrast-enhanced ultrasound may be a useful method in the diagnostic work-up of adrenal mass with excellent sensitivity for the diagnosis of malignancy.
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Affiliation(s)
- M Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe-University Hospital.
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Foti G, Faccioli N, Mantovani W, Malleo G, Manfredi R, Mucelli RP. Incidental adrenal lesions: Accuracy of quadriphasic contrast enhanced computed tomography in distinguishing adenomas from nonadenomas. Eur J Radiol 2011; 81:1742-50. [PMID: 21602008 DOI: 10.1016/j.ejrad.2011.04.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/19/2011] [Accepted: 04/25/2011] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the accuracy in distinguishing adrenal adenomas from nonadenomas by means of quadriphasic CT exam, including unenhanced (UE), arterial enhanced (AE), portal enhanced (PE) and 5-min delayed enhanced (DE) CT scans. METHODS This retrospective study had institutional review board approval; the need for informed consent was waived. From September 2007 to September 2009, 104 adrenal masses were evaluated in 87 patients (49 M, 38 F, mean age 58.4 years) undergoing UE, AE (35-s delay), PE (80-s delay) and DE (5-min delay) CT scans. The mean adrenal attenuation during all imaging phases was measured by two readers. The accuracy values of absolute unenhanced attenuation (UE), absolute wash-out (AWO), relative percentage wash-out (RPWO) and percentage enhancement wash-out (PEW) were assessed by using receiver operator curves (ROC) analysis. The overall accuracy of the quadriphasic protocol and other triphasic protocols were evaluated. A value of p≤0.05 was considered significant. RESULTS The accuracy in characterizing adrenal lesions was 86.5% (90/104) for UE attenuation (≤10 HU threshold), 90.1% (82/91) for RPWO (≥30% threshold), 85.7% (78/91) for AWO (≥12 HU threshold) and 83.5% (76/91) for PEW (≥30% threshold), respectively. Quadriphasic CT (accuracy 97.1%, 101/104) performed better than triphasic CT including only AE scan (efficiency 90.0%, 94/104; p=0.011) and triphasic CT including only PE scan (efficiency 96.1%, 100/104; p=0.025). CONCLUSION Quadriphasic CT protocol including 5-min DE scan may be used to characterize incidentally detected adrenal masses. RPWO represented the best wash-out parameter for characterizing adrenal lesions.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
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Zinnamosca L, Petramala L, Cotesta D, Marinelli C, Sciomer S, Cavallaro G, Ciardi A, Massa R, De Toma G, Filetti S, Letizia C. Primary aldosteronism due to adrenocortical adenoma with concurrent ileum carcinoid tumor: case report. Endocrine 2010; 38:313-9. [PMID: 20972725 DOI: 10.1007/s12020-010-9394-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary aldosteronism (PA) with synchronous carcinoid syndrome is extremely rare occurrence. In this article, we describe a case of PA due to adrenocortical adenoma ("aldosteronoma") and concurrent malignant carcinoid tumor of ileum. The patient was treated with synchronous right adrenalectomy and resection of the ileum. This case is an example of concomitant presence of two types of tumors, effectively managed surgically. We report a case of a nonclassical form of multiple endocrine neoplasia type 1 (MEN 1) syndrome.
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Affiliation(s)
- L Zinnamosca
- Department of Clinical Sciences, University "Sapienza", Policlinico Umberto I, 00165 Rome, Italy
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Yang L, Cui X, Fan T, Wei Q. Two different adrenal adenomas causing Cushing's syndrome. Saudi Med J 2010; 31:578-580. [PMID: 20464053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Yener S, Ertilav S, Secil M, Demir T, Akinci B, Kebapcilar L, Comlekci A, Bayraktar F, Yesil S. Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas. J Endocrinol Invest 2010; 33:32-6. [PMID: 19542759 DOI: 10.1007/bf03346546] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Because of the increased use of imaging interventions, more subjects have been diagnosed with adrenal incidentaloma in recent years. AIM To evaluate the risk of mass enlargement, hormone hypersecretion and development of adrenal carcinomas during short-term followup. SUBJECTS AND METHODS There were 317 subjects with incidentally discovered adrenal tumors in the registry. Forty subjects were excluded because of clinically overt hormone secretion at diagnosis and subjects with complete data were included in radiological (no.=150) and hormonal (no.=150) follow- up. Radiological evaluation was performed with computed tomography (CT) and/or magnetic resonance imaging (MRI). There were 143 subjects with adrenal adenomas and 7 subjects with other tumor types (cyst or myelolipoma). Median follow-up duration was 24 months. RESULTS Increase in tumor size was detected in 25 subjects (17.4%) with adenomas and 1 subject with adrenal myelolipoma (14.3%). Decrease in tumor size was found in 7 subjects (4.8%) with adrenal adenomas. One patient was diagnosed with adrenocortical carcinoma during follow-up. In subjects with non-functioning adrenal adenoma (NFA, no.=120) or subclinical Cushing syndrome (sCS) (no.=30), no subject developed clinically overt hormone hypersecretion, while 8 (6%) subjects in the NFA group developed sCS. Tumor diameter and follow-up duration were significantly higher in subjects who developed sCS. CONCLUSION In conclusion, we demonstrated that, despite being infrequent, adrenal tumors may increase in size, develop overt or subclinical hormone secretion or feature malignant transformation. Therefore, radiological and hormonal follow-up should be recommended to the patients. More investigations are needed for the establishment of long-term follow-up protocols.
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Affiliation(s)
- S Yener
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Inciralti, Izmir, Turkey.
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Louiset E, Gobet F, Libé R, Horvath A, Renouf S, Cariou J, Rothenbuhler A, Bertherat J, Clauser E, Grise P, Stratakis CA, Kuhn JM, Lefebvre H. ACTH-independent Cushing's syndrome with bilateral micronodular adrenal hyperplasia and ectopic adrenocortical adenoma. J Clin Endocrinol Metab 2010; 95:18-24. [PMID: 19915020 PMCID: PMC2805485 DOI: 10.1210/jc.2009-0881] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Bilateral micronodular adrenal hyperplasia and ectopic adrenocortical adenoma are two rare causes of ACTH-independent Cushing's syndrome. OBJECTIVE The aim of the study was to evaluate a 35-yr-old woman with ACTH-independent hypercortisolism associated with both micronodular adrenal hyperplasia and ectopic pararenal adrenocortical adenoma. DESIGN AND SETTING In vivo and in vitro studies were performed in a University Hospital Department and academic research laboratories. INTERVENTION Mutations of the PRKAR1A, PDE8B, and PDE11A genes were searched for in leukocytes and adrenocortical tissues. The ability of adrenal and adenoma tissues to synthesize cortisol was investigated by immunohistochemistry, quantitative PCR, and/or cell culture studies. MAIN OUTCOME MEASURE Detection of 17alpha-hydroxylase and 21-hydroxylase immunoreactivities, quantification of CYP11B1 mRNA in adrenal and adenoma tissues, and measurement of cortisol levels in supernatants by radioimmunological assays were the main outcomes. RESULTS Histological examination of the adrenals revealed nonpigmented micronodular cortical hyperplasia associated with relative atrophy of internodular cortex. No genomic and/or somatic adrenal mutations of the PRKAR1A, PDE8B, and PDE11A genes were detected. 17alpha-Hydroxylase and 21-hydroxylase immunoreactivities as well as CYP11B1 mRNA were detected in adrenal and adenoma tissues. ACTH and dexamethasone activated cortisol secretion from adenoma cells. The stimulatory action of dexamethasone was mediated by a nongenomic effect involving the protein kinase A pathway. CONCLUSION This case suggests that unknown molecular defects can favor both micronodular adrenal hyperplasia and ectopic adrenocortical adenoma associated with Cushing's syndrome.
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Affiliation(s)
- Estelle Louiset
- Institut National de la Santé et de la Recherche Médicale, Unité 982/Equipe Associée 4310, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institut Fédératif de Recherches Multidisciplinaires sur les Peptides 23, University of Rouen, 76821 Mont-Saint-Aignan, France
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Agarwal MD, Trerotola SO. Combined adrenal and ovarian venous sampling to localize an androgen producing tumor. Cardiovasc Intervent Radiol 2009; 33:1266-9. [PMID: 19688363 DOI: 10.1007/s00270-009-9689-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 07/27/2009] [Accepted: 07/31/2009] [Indexed: 11/25/2022]
Abstract
A postmenopausal woman presented with hirsutism and elevated serum testosterone levels. A 1-cm adrenal adenoma was noted on computed tomography. Combined adrenal and ovarian venous sampling was performed to localize an androgen producing tumor to the left ovary. The patient underwent a bilateral salpingo-oophrectomy and was spared an unnecessary adrenalectomy.
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Welsh SJ, Khan S. Radiological localizing techniques in adrenal tumors. MINERVA ENDOCRINOL 2009; 34:161-169. [PMID: 19471240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The characterisation of adrenal lesions is a common radiological dilemma. Incidental adrenal lesions are commonly detected with computed tomography (CT), and lesion characterisation is critical. The prevalence of incidental adrenal lesions has been reported to be 2.3% at autopsy and 0.5-2% with abdominal CT. Such lesions are likely to be seen with increasing frequency given the expanding use of radiological imaging in clinical practice. Although the majority of adrenal lesions are benign, in patients with an extra-adrenal primary cancer the probability of an adrenal mass being a metastasis is 52%. Unfortunately, there may be significant overlap between the imaging appearances of benign lesions such as lipid-poor adenomas and malignant lesions, particularly metastases and small adrenal carcinomas. This review highlights recent advances in radiological imaging of adrenal lesions and we discuss the relative merits of CT and magnetic resonance imaging to aid the identification of benign and malignant adrenal lesions and their roles, in combination with biochemical and clinical data, in recognizing common pathologies such as adrenal adenoma, phaeochromocytoma, carcinoma and metastases. We also discuss the radiological characteristics of rarer adrenal lesions including lymphoma, neuroblastic tumours (neuroblastoma, ganglioneuroblastoma, and ganglioneuroma), lipomatous tumours (myelolipoma, angiolipoma, teratoma, lipoma and liposarcoma), in addition to hemangioma, hemangiosarcoma and leiomyosarcoma.
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Affiliation(s)
- S J Welsh
- Nuclear Medicine, Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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