Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

Ceccato, Filippo; Tizianel, Irene; Voltan, Giacomo; Maggetto, Gianmarco; Boschin, Isabella Merante; Quaia, Emilio; Crimì, Filippo; Scaroni, Carla

doi:10.3389/fendo.2021.794197

Cited by 18 publications

(39 citation statements)

References 36 publications

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“…To date, the best approach in AI patients with PACS is a matter of debate, with some authors suggesting surgery in the presence of at least 2 complications of cortisol excess ( 26 ), while others, including the ESE guidelines, suggest a more prudent approach ( 27 , 28 ). Indeed, a conservative approach could be preferable in PACS patients without possible cortisol-related comorbidities ( 29 ), even considering that tumor growth is clinically modest in these patients ( 30 ). These discordances are due to the lack of homogeneity among the studies that have assessed the effect of the surgical approach in patients with PACS.…”

Section: Discussionmentioning

confidence: 99%

Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT

et al. 2022

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ObjectiveThe best approach to patients with adrenal incidentaloma (AI) and possible autonomous cortisol secretion (PACS) is debated. The aim of this study was to assess the metabolic effect of adrenalectomy in AI patients with PACS in relation to cortisol secretion parameters, peripheral activation, and glucocorticoid sensitivity.DesignThis is a multicenter randomized study (NCT number: NCT04860180).MethodsSixty-two AI outpatients (40–75 years) with AI >1 cm and cortisol after overnight dexamethasone suppression test (F-1mgDST) between 50 and 138 nmol/L were randomized to adrenalectomy (Arm A) or a conservative approach (Arm B). Fifty-five patients completed the 6-month follow-up, 25 patients in Arm A (17 female patients, aged 62.5 ± 10.4 years) and 30 patients in Arm B (24 female patients, 66.1 ± 9.1 years). Plasma adrenocorticotroph hormone (ACTH), 24-h urinary free cortisol, 24-h urinary free cortisone, F-1mgDST, glucose, lipids, glycated hemoglobin (HbA1c) levels, blood pressure (BP), body weight, and treatment variations were assessed. The 24-h urinary free cortisol/cortisone ratio (an 11-beta hydroxysteroid dehydrogenase type 2 activity marker), BclI, and the N363S variants of glucocorticoid receptor (GR) polymorphisms were also evaluated.ResultsBP control improved in 68% and 13% of the subjects in Arm A and Arm B, respectively (p = 0.001), and the glycometabolic control improved in 28% and 3.3% of the subjects in Arm A and Arm B patients, respectively (p = 0.02). Arm A subjects more rarely showed the BP and/or glycometabolic control worsening than Arm B patients (12% and 40%, respectively, p = 0.03). The surgical approach was independently associated with BP amelioration (OR 3.0, 95% CI 3.8–108.3, p < 0.001) but not with age, F-1mgDST levels, BMI, and hypertension and diabetes mellitus presence at baseline. The 24-h urinary free cortisol/cortisone ratio and the presence of sensitizing GR polymorphisms were not associated with the surgical outcome. The receiver operating characteristic (ROC) curve analysis showed that the BP control amelioration was associated with F-1mgDST [area under the curve (AUC), 0.82 ± 0.09 p = 0.012]. The F-1mgDST cutoff with the best compromise in predicting the BP amelioration was set at 75 nmol/L (sensitivity 77%, specificity 75%).ConclusionsAI patients with PACS benefit from surgery in terms of BP and glycometabolic control.

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Section: Discussionmentioning

confidence: 99%

Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT

et al. 2022

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“…This was mostly due to incomplete medical records in this retrospective study. A recent longitudinal study of CT attenuation changes indicated the necessity of obtaining autonomous cortisol secretion values to differentiate LPA (>10 HU) from other adrenal incidentalomas as LPA had a reduced cortisol suppression after dexamethasone test, and decreased attenuation values suggesting increased lipid content during follow-up ( 40 ). Therefore, we plan to include endocrine data for our future studies of adrenal incidentalomas.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Based Machine Learning Differentiates Adrenal Pheochromocytoma From Lipid-Poor Adenoma

Liu

Guan

et al. 2022

Front. Endocrinol.

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ObjectivesTo assess the accuracy of computed tomography (CT)-based machine learning models for differentiating subclinical pheochromocytoma (sPHEO) from lipid-poor adenoma (LPA) in patients with adrenal incidentalomas.Patients and MethodsThe study included 188 tumors in the 183 patients with LPA and 92 tumors in 86 patients with sPHEO. Pre-enhanced CT imaging features of the tumors were evaluated. Machine learning prediction models and scoring systems for differentiating sPHEO from LPA were built using logistic regression (LR), support vector machine (SVM) and random forest (RF) approaches.ResultsThe LR model performed better than other models. The LR model (M1) including three CT features: CTpre value, shape, and necrosis/cystic changes had an area under the receiver operating characteristic curve (AUC) of 0.917 and an accuracy of 0.864. The LR model (M2) including three CT features: CTpre value, shape and homogeneity had an AUC of 0.888 and an accuracy of 0.832. The S2 scoring system (sensitivity: 0.859, specificity: 0.824) had comparable diagnostic value to S1 (sensitivity: 0.815; specificity: 0.910).ConclusionsOur results indicated the potential of using a non-invasive imaging method such as CT-based machine learning models and scoring systems for predicting histology of adrenal incidentalomas. This approach may assist the diagnosis and personalized care of patients with adrenal tumors.

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“…The lower the negative pixel value and the larger the proportion in ROI, the greater the incidence of adenoma. The broadly accepted threshold is AV mean ≤ 10 HU, with a sensitivity of 47.6-82.2% and a specificity of 93.3-100% for the diagnosis of adenoma ( 6 – 10 ). AV mean is the minimum value of pixels in ROI, which is equivalent to the minimum value of pixels in CTH.…”

Section: Discussionmentioning

confidence: 99%

“…At present, the widely accepted threshold value for AV mean is ≤ 10 Hounsfield units (HU). Although its specificity of the diagnosis of adenoma can reach 93.3-100%, its sensitivity is somewhat insufficient and varies greatly, ranging from 47.6% to 82.2% ( 6 – 10 ). CTH is another method to diagnose adrenal adenoma.…”

Section: Introductionmentioning

confidence: 99%

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

Han

Wu²,

Wei³

et al. 2022

Front. Endocrinol.

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ObjectivesTo 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.MethodsThe 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.ResultsIn 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.ConclusionAVmean, 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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Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

Cited by 18 publications

References 36 publications

Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT

Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT

Computed Tomography-Based Machine Learning Differentiates Adrenal Pheochromocytoma From Lipid-Poor Adenoma

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

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