Adrenal Incidentalomas: Clinical Controversies and Modified Recommendations

Garrett, Robert; Nepute, Jordan C; Hayek, Mireille El; Albert, Stewart G.

doi:10.2214/ajr.15.15475

Cited by 32 publications

(17 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of detail regarding TNM staging, metastatic spread, tumor size, and diagnostic evaluation (imaging, functional testing) precludes any ability to further risk stratify patients within each histologic subtype. It is well established that specific imaging modality findings and functional tests are critical to the diagnosis and management of adrenal malignancies . In addition, no details regarding the treatment provided were available, specifically missing were data on chemotherapy regimens, radiotherapy target and dose, and nature of the surgery.…”

Section: Discussionmentioning

confidence: 99%

The who, when, and why of primary adrenal malignancies: Insights into the epidemiology of a rare clinical entity

Chandrasekar

Goldberg

Klaassen

et al. 2018

Cancer

View full text Add to dashboard Cite

BACKGROUND: Primary malignancies of the adrenal glands are rare. Epidemiologic assessment of primary adrenal malignancies is lacking and has been limited to case reports and series. Population-level data can provide a better understanding of the incidence, distribution, and prognostic factors associated with these rare malignancies. METHODS: The Surveillance, Epidemiology, and End Results database was queried for all patients who were diagnosed with primary adrenal malignancies, categorized in 5 histologic groups: adrenocortical carcinoma (ACC), pheochromocytoma and paraganglioma (PH), neuroblastoma (NE), non-Hodgkin lymphoma (NHL), and sarcoma (SA). Age-adjusted incidence, distribution trends, and cancer-specific survival (CSS) for each group were analyzed. RESULTS: In total, 4695 patients with primary adrenal malignancies were identified, including 2057 with ACC, 512 with PH, 1863 with NE, 202 with NHL, and 61 with SA. The age-adjusted incidence of all 5 histologic subtypes was rising. Age at presentation differed substantially by histologic group: NE was the most prevalent during the first decade of life, whereas ACC predominated after age 30 years, and NHL outnumbered PH after age 70 years. Patient-specific factors were not associated with advanced disease at the time of presentation. The 5-year CSS rate for each histologic subtype was 38% for ACC, 69% for PH, 64% for NE, 38% for NHL, and 42% for SA. Survival outcomes for patients with ACC, NHL, PH and SA remained unchanged over the 40-year study period. Multimodal therapy was associated with higher CSS in patients with NE. CONCLUSIONS: This first populationlevel analysis of all primary adrenal malignancies provides important initial data regarding presentation and clinical outcomes. Notably, except for patients with NE, the survival of patients with these rare cancers has not improved over the past 40 years.

show abstract

Section: Discussionmentioning

confidence: 99%

The who, when, and why of primary adrenal malignancies: Insights into the epidemiology of a rare clinical entity

Chandrasekar

Goldberg

Klaassen

et al. 2018

Cancer

View full text Add to dashboard Cite

show abstract

“…Furthermore, their detection is likely to increase with advances in imaging technology, and approach the rates seen in large autopsy series (up to 10% of the population) [5]. Frequently, such nodules are detected on ‘non-adrenal’ imaging protocols, and further investigation (e.g., dedicated adrenal MRI or contrast ‘washout’ CT) is required to determine whether the lesion can be confidently declared as benign, or requires further assessment to exclude/confirm malignancy [1,6,7,8,9,10,11,12,13]. Adrenal adenomas are the most commonly encountered benign lesion and are readily characterized in about 70% of cases by detecting significant amounts of intracellular lipid on unenhanced CT or chemical-shift MRI [1,9].…”

Section: Introductionmentioning

confidence: 99%

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

et al. 2016

View full text Add to dashboard Cite

Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal ‘incidentalomas’ detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e.g., primary aldosteronism, Cushing’s syndrome, phaeochromocytoma). Here, identifying a causative lesion, or lateralising the disease to a single adrenal gland, is key to effective management, as unilateral adrenalectomy may offer the potential for curing conditions that are typically associated with significant excess morbidity and mortality. This review considers the evolving role of positron emission tomography (PET) imaging in addressing the limitations of traditional cross-sectional imaging and adjunctive techniques, such as venous sampling, in the management of adrenal disorders. We review the development of targeted molecular imaging to the adrenocortical enzymes CYP11B1 and CYP11B2 with different radiolabeled metomidate compounds. Particular consideration is given to iodo-metomidate PET tracers for the diagnosis and management of adrenocortical carcinoma, and the increasingly recognized utility of 11C-metomidate PET-CT in primary aldosteronism.

show abstract

“…Subsequent guidelines have been published supporting routine use of the overnight 1 mg dexamethasone suppression test [ 9 ], which although more sensitive is less specific [ 3 ]. Biochemical evaluation to exclude aldosteronoma would have been of low yield based on lack of hypertension, normal serum potassium levels, and the CT size and appearance of the lesion [ 3 , 10 ]. Similarly, in the absence of clinical manifestations, routine screening for sex hormone-secreting adrenal tumors is not recommended [ 4 ] .…”

Section: Discussionmentioning

confidence: 99%

“…Necrosis, hemorrhage, and calcifications are commonly seen in these lesions, which are often observed to grow rapidly (greater than 2 cm per year) [ 4 ]. In patients with no history of malignancy and a >4 cm adrenal mass which is indeterminate on imaging (as in our patient), there is consensus that surgical resection should be considered [ 3 , 11 ]. FDG-PET/CT may be appropriate as part of preoperative staging [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Adrenal Incidentaloma That Mimics Adrenocortical Carcinoma

Lavingia

Torabi

Kim

et al. 2018

Case Reports in Surgery

View full text Add to dashboard Cite

Objective We present a case of an adrenal hemangioma, an uncommon cause of an adrenal mass, and review the clinical presentation, work-up, and management of adrenal incidentalomas. Background A 64-year-old male was found to have a right adrenal incidentaloma during work-up for elevated liver transaminase levels, later found to be from hepatitis C. The mass was suspicious for adrenocortical carcinoma on CT imaging. Biochemical evaluation revealed no evidence of function. He underwent an open right adrenalectomy. The mass was found to be an adrenal hemangioma on histopathologic analysis. Methods This is a case report with pertinent review of the diagnosis and management of adrenal incidentalomas. Results Adrenal hemangiomas are rare, benign, nonfunctional tumors typically found during imaging for other reasons. As illustrated by this case, they appear similar to adrenocortical carcinoma on CT imaging. The diagnosis is usually not made prior to surgical resection. Conclusion Adrenal hemangioma is a rare nonfunctional adrenal incidentaloma that displays atypical features on CT imaging. The suspicion for adrenocortical carcinoma usually prompts adrenalectomy.

show abstract

Adrenal Incidentalomas: Clinical Controversies and Modified Recommendations

Abstract: An alternative algorithm for the imaging and clinical workup of adrenal incidentalomas is presented in an attempt to bridge sometimes conflicting recommendations.

Cited by 32 publications

References 50 publications

The who, when, and why of primary adrenal malignancies: Insights into the epidemiology of a rare clinical entity

The who, when, and why of primary adrenal malignancies: Insights into the epidemiology of a rare clinical entity

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

A Rare Adrenal Incidentaloma That Mimics Adrenocortical Carcinoma

Contact Info

Product

Resources

About