Adrenal lesion frequency: A prospective, cross-sectional CT study in a defined region, including systematic re-evaluation

Hammarstedt, Lilian; Muth, Andreas; Wängberg, Bo; Björneld, L.; Sigurjónsdóttir, Hrefna; Götherström, Galina; Almqvist, Erik G.; Widell, Håkan; Carlsson, Stefan; Ander, Stefan; Hellström, Mikael

doi:10.3109/02841851.2010.516016

Cited by 58 publications

(49 citation statements)

References 16 publications

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“…The frequency of the problem Adrenal adenoma is found on average in 1-8% (mean, 2.3%) of autopsies [5]; incidentaloma is identified on abdominal CT, depending upon the age of the patient, in 0.2% (20-29-year olds) to 7% (over 70 years) of examinations [6] but may well be under reported [7]. When patients with a history of malignancy and clinical suspicion of a functioning lesion are excluded, ACA (a radiological diagnosis) is the cause of incidentaloma in 75% [8].…”

Section: Resultsmentioning

confidence: 97%

The indeterminate adrenal mass

Harrison

2011

Langenbecks Arch Surg

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Section: Resultsmentioning

confidence: 97%

The indeterminate adrenal mass

Harrison

2011

Langenbecks Arch Surg

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“…(74,75). The recommendations are worded as recommend (strong recommendation) and suggest (weak recommendation).…”

Section: Summary Of Methods Used For Guideline Developmentmentioning

confidence: 99%

“…Overall incidence of adrenal incidentaloma in a population undergoing routine imaging not related to suspected adrenal disease is reported as 1-4% (15,74,76,216). While 10% or more of individuals older than 70 years harbor an adrenal mass detectable upon imaging or autopsy, adrenal nodules in individuals <40 years are much less prevalent and are a rarity in children and young adults.…”

Section: Reasoningmentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,335

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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“…These masses are more frequently unilateral incidentalomas (UAI), but in about 15% of cases they present as bilateral (2,3). Bilateral adrenal incidentalomas (BAI) may be: metastatic diseases of the adrenal glands, the contemporary presence of two unilateral adenomas or the expression of ACTH-independent macronodular adrenal hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Bilateral and unilateral adrenal incidentalomas: biochemical and clinical characteristics

Morelli

Palmieri

Salcuni

et al. 2013

European Journal of Endocrinology

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Objective: The possible different prevalence of arterial hypertension (AH), type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and vertebral fractures (FX) between patients with bilateral and unilateral adrenal incidentalomas (BAI and UAI, respectively) with and without subclinical hypercortisolism (SH) is unknown. In this study we compared the prevalence of AH, T2DM, DL and FX in BAI and UAI patients in relation to SH. Design: Prospective study. Methods: In 175 UAI and 38 BAI patients, we evaluated BMI, spinal and femoral bone mineral density (LS and FN BMD, respectively) and the presence of AH, T2DM, DL and FX. SH was diagnosed in the presence of R2 of the following: urinary free cortisol levels O193 nmol/24 h, serum cortisol levels after 1 mg dexamethasone suppression test O83 nmol/l or ACTH levels !2.2 pmol/l. Results: Age, BMI and cortisol secretion were comparable, while FN BMD was lower in BAI than in UAI patients (K0.45G0.86 vs 0.09G1.07, PZ0.004). The prevalence of SH, AH, T2DM, and DL was comparable, while the prevalence of FX was higher in BAI than in UAI (52.6 vs 28%, PZ0.007). The presence of FX was associated with BAI (odds ratio (OR) 2.6, 95% confidence interval (95% CI) 1.2-5.6, PZ0.016), after adjusting for SH (OR 1.77, 95% CI 0.85-3.7, PZ0.12), BMI (OR 1.06, 95% CI 0.98-1.13, PZ0.1), age (OR 1.07, 95% CI 1.04-1.11, PZ0.0001) and LS BMD (OR 1.31, 95% CI 1.03-1.67, PZ0.03). Conclusion: BAI patients have an increased FX risk than UAI ones. Further studies should investigate the causes of bone involvement in BAI patients.

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Adrenal lesion frequency: A prospective, cross-sectional CT study in a defined region, including systematic re-evaluation

Abstract: adrenal lesions are under-reported in clinical practice. Prevalence figures for adrenal incidentalomas should therefore be interpreted with caution, especially in multi-center settings.

Cited by 58 publications

References 16 publications

The indeterminate adrenal mass

The indeterminate adrenal mass

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Bilateral and unilateral adrenal incidentalomas: biochemical and clinical characteristics

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