Adrenal incidentalomas: ‘the rule of four'

As more and more adrenal neoplasms are found incidentally or symptomatically, the need for interventional procedures has being increasing. In recent years these procedures registered continued steady expansion. Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. They may be applied both in benign and in malignant pathologies. The present review reports the current status of indications, techniques results and complications of the image-guided procedures.

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“…The risk of malignancy increases with increasing size of the mass and decreases with greater lipid content (12)(13)(14)(15).…”

Section: Indicationsmentioning

confidence: 99%

“…A cut-off size of 4 cm has been accepted to distinguish between benign and malignant lesions: 6% of masses over 4 cm are malignant and the risk of malignancy in masses over 6 cm is 25% (sensitivity 93%, specificity 25% and positive predictive value 25%) (12).…”

Section: Indicationsmentioning

confidence: 99%

Interventional radiology of the adrenal glands: current status

et al. 2018

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“…Moreover, adrenal oncocytoma does not follow the rule of four: (a) 4% diagnosed on CT, (b) 4% of these tumors are pheochromocytoma or adrenocortical carcinoma, (c) ≥4 cm in size is an indication for surgery, and (d) 4 years of followup is required [23]. …”

Section: Discussionmentioning

confidence: 99%

Glutamine/Glutamate Metabolism Studied with Magnetic Resonance Spectroscopic Imaging for the Characterization of Adrenal Nodules and Masses

Goldman

Nunes

Melo

et al. 2013

BioMed Research International

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Purpose. To assess glutamine/glutamate (Glx) and lactate (Lac) metabolism using proton magnetic resonance spectroscopic imaging (1H-MRS) in order to differentiate between adrenal gland nodules and masses (adenomas, pheochromocytomas, carcinomas, and metastases). Materials and Methods. Institutional review board approval and informed consent were obtained. A total of 130 patients (47 men) with 132 adrenal nodules/masses were prospectively assessed (54 ± 14.8 years). A multivoxel system was used with a two-dimensional point-resolved spectroscopy/chemical-shift imaging sequence. Spectroscopic data were interpreted by visual inspection and peak amplitudes of lipids (Lip), choline (Cho), creatine (Cr), Lac, and Glx. Lac/Cr and Glx/Cr were calculated. Glx/Cr was assessed in relation to lesion size. Results. Statistically significant differences were observed in Glx/Cr results between adenomas and pheochromocytomas (P < 0.05), however, with a low positive predictive value (PPV). Glx levels were directly proportional to lesion size in carcinomas. A cutoff point of 1.44 was established for the differentiation between carcinomas larger versus smaller than 4 cm, with 75% sensitivity, 100% specificity, 100% PPV, and 80% accuracy. Lac/Cr results showed no differences across lesions. A cutoff point of −6.5 for Lac/Cr was established for carcinoma diagnosis. Conclusion. Glx levels are directly proportional to lesion size in carcinomas. A cutoff point of −6.5 Lac/Cr differentiates carcinomas from noncarcinomas.

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“…The widespread use of imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), during diagnostic testing or treatment for many clinical conditions, has resulted in the identification of previously unsuspected adrenal lesions defined as adrenal incidentalomas (AIs). 1,2 The assessment of AIs is aimed at deciding whether or not the tumor should be surgically removed, 3 adrenalectomy being indicated in hormonal hypersecretory states (such as pheocromocytoma) and in potentially malignant lesions. 4 Adrenal cortical carcinoma (ACC) is a rare and heterogeneous malignancy with incompletely understood pathogenesis and poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Adrenal incidentaloma: a case of carcinoma

Ruotolo

Ambrosio²,

Caroleo³

et al. 2010

CIA

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Adrenal incidentaloma (AI) is a term applied to an accidentally discovered adrenal mass on imaging performed for reasons unrelated to adrenal pathology. The widespread application of abdominal imaging procedure has resulted in an increased frequency of clinically silent adrenal masses. Although most AIs are nonfunctioning benign adenomas, a multidisciplinary approach with biochemical and radiological evaluation is needed to characterize these lesions and identify patients who are at high risk for hormonal or malignant evolution. Herein, we describe a case of a 69-year-old man with a pain at the base of right chest. On the basis of clinical evaluation, biochemical analysis, as well as imaging procedures, a diagnosis of right adrenocortical carcinoma was made. The patient underwent medical treatment.

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Adrenal incidentalomas: ‘the rule of four'

Cited by 20 publications

References 24 publications

Interventional radiology of the adrenal glands: current status

Interventional radiology of the adrenal glands: current status

Glutamine/Glutamate Metabolism Studied with Magnetic Resonance Spectroscopic Imaging for the Characterization of Adrenal Nodules and Masses

Adrenal incidentaloma: a case of carcinoma

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