An imaging algorithm for the differential diagnosis of adrenal adenomas and metastases.

Mcnicholas, M. M. J.; Lee, M J; Mayo-Smith, William W.; Hahn, Peter F.; Boland, Giles W.; Müeller, Peter R.

doi:10.2214/ajr.165.6.7484585

Cited by 125 publications

(65 citation statements)

References 21 publications

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“…The advantages of MRI over CT are its lack of radiation exposure, lack of iodine-based contrast media and its superior tissue contrast resolution. For the differentiation of benign and malignant adrenal masses, the MRI technique of chemical shift imaging is most commonly used (60,61,62,63,64,65). Chemical shift imaging relies on the fact that, within magnetic fields, protons in water vibrate at a slightly different frequency than protons in lipid.…”

Section: Short Overview On Adrenal Imagingmentioning

confidence: 99%

“…• Included: We identified 37 studies for inclusion in the systematic review (49,52,61,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112), with only 18 of them fulfilling the criteria for inclusion in the actual meta-analysis (61,79,80,81,82,83,84,85,86,87,88,89,90,91...…”

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

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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

1,339

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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Section: Short Overview On Adrenal Imagingmentioning

confidence: 99%

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

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

1,339

1,571

View full text Add to dashboard Cite

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“…78,79,84 Attenuation values seem to have better performance than size in diagnosing adrenal malignancy. 81,85 A threshold of 10 HU is the most widely advocated, 1-3,21,81,83,84,86-88 displaying a sensitivity-to-specificity ratio of 79%:96%, whereas a threshold of 0 HU changes this ratio to 47%:100%. 81 This is in accordance with a meta-analysis of ten studies designed to determine an optimal threshold for differentiating benign from malignant lesions, which showed that a threshold of 10 HU had 71% sensitivity and 98% specificity for characterizion of adrenal masses.…”

Section: Non-functional Imaging Modalitiesmentioning

confidence: 99%

Adrenal incidentaloma: a diagnostic challenge

Anagnostis¹,

Karagiannis²,

Τζιόμαλος³

et al. 2009

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The widespread application of abdominal imaging procedures has resulted in an increased frequency of clinically silent adrenal masses. Adrenal incidentaloma (AI) is a term applied to an accidentally discovered adrenal mass on imaging performed for the investigation of an unrelated complaint. Adrenal incidentalomas (AIs) are a cluster of different pathologies, the majority of which are benign and non-functioning adrenal adenomas. However, mild hormonal alterations as well as metabolic abnormalities may be present in patients with AIs. Thus, a multidisciplinary approach with biochemical and radiologic evaluation is needed to characterize these lesions and identify patients who are at high risk for hormonal or malignant evolution. Significant new information has helped resolve controversies regarding the most reliable approach to this clinical problem. The present review considers the prevalence, pathology and natural history of AIs. We also discuss the reliability of available screening methods and localization techniques and consider optimal management and follow-up strategies.

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“…All CT scans were blinded and independently reviewed by two experienced radiologists using standardized criteria, commonly used for adrenal gland investigations (Lee et al, 1991;McNicholas et al, 1995;Korobkin et al, 1996;Szolar and Kammerhuber, 1997;Cirillo et al, 1998;Pena et al, 2000;Caoili et al, 2002;Kebapci et al, 2003). If discordant opinions were recorded, an additional evaluation was carried out by a third operator.…”

Section: Radiological Parameters With Benign/malignant Criteriamentioning

confidence: 99%

Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

et al. 2005

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We investigated the natural course of adrenal incidentalomas in 115 patients by means of a long-term endocrine and morphological (CT) follow-up protocol (median 4 year, range 1 -7 year). At entry, we observed 61 subclinical hormonal alterations in 43 patients (mainly concerning the ACTH -cortisol axis), but confirmatory tests always excluded specific endocrine diseases. In all cases radiologic signs of benignity were present. Mean values of the hormones examined at last follow-up did not differ from those recorded at entry. However in individual patients several variations were observed. In particular, 57 endocrine alterations found in 43 patients (37.2%) were no longer confirmed at follow-up, while 35 new alterations in 31 patients (26.9%) appeared de novo. Only four alterations in three patients (2.6%) persisted. Confirmatory tests were always negative for specific endocrine diseases. No variation in mean mass size was found between values at entry (25.470.9 mm) and at follow-up (25.770.9 mm), although in 32 patients (27.8%) mass size actually increased, while in 24 patients (20.8%) it decreased. In no case were the variations in mass dimension associated with the appearance of radiological criteria of malignancy. Kaplan -Meier curves indicated that the cumulative risk for mass enlargement (65%) and for developing endocrine abnormalities (57%) over time was progressive up to 80 months and independent of haemodynamic and humoral basal characteristics. In conclusion, mass enlargement and the presence or occurrence over time of subclinical endocrine alterations are frequent and not correlated, can appear at any time, are not associated with any basal predictor and, finally, are not necessarily indicative of malignant transformation or of progression toward overt disease.

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An imaging algorithm for the differential diagnosis of adrenal adenomas and metastases.

Abstract: OBJECTIVE.The

Cited by 125 publications

References 21 publications

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

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

Adrenal incidentaloma: a diagnostic challenge

Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

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