Cohort study of patients with adrenal lesions discovered incidentally

Muth, Andreas; Hammarstedt, Lilian; Hellström, Mikael; Sigurjónsdóttir, Hrefna; Almqvist, Erik G.; Wängberg, Bo

doi:10.1002/bjs.7566

Cited by 50 publications

(28 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In agreement with the other contemporary reports [32,36] we found a low prevalence (1.6%) of primary adrenal carcinoma among patients with AI. The observed percentage may however underestimate the true frequency of the condition as some large tumours with invasion of adjacent tissues or distant metastases at the initial radiological examination may have been directly referred to surgical departments thus escaping prior endocrinological evaluation.…”

Section: Discussionsupporting

confidence: 93%

“…Earlier studies have reported higher proportion of hypersecreting tumours but some of them suffer from different forms of bias such as including patients from surgical and oncology series, excluding patients with small tumours or patients with non-functioning tumours, or analyzing small number of patients. A recent prospective study in Sweden including unselected patients from radiological departments estimated the prevalence of hormonally active tumours at 3.1% [32]. A meta-analysis deliberately excluding studies with potential selection bias also confirmed the previous overestimation of the prevalence of hypersecreting lesions by showing that they represent less than 10% of AIs [36].…”

Section: Discussionmentioning

confidence: 67%

“…Approaches to the management of these adrenal incidentalomas (AI) are mainly governed by the need to identify potential malignant diseases and endocrine hyperactivity. Large unbiased studies on which management recommendations can be based are however relatively few [31][32][33]. In the current study we present the clinical and functional characteristics, some metabolic aspects and follow-up data of a series of 515 patients with AI evaluated at a single endocrinological centre using a unified management protocol.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical characteristics and follow-up of incidentally found adrenal tumours — results from a single tertiary centre

et al. 2014

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical characteristics and follow-up of incidentally found adrenal tumours — results from a single tertiary centre

et al. 2014

View full text Add to dashboard Cite

show abstract

“…A systematic review of 14 studies assessing the natural course of 1410 patients with apparently benign, nonfunctioning adrenal incidentalomas (3) and 10 additional cohort studies were included (21,40,44,46,146,147,160,161,162,163,164,165,166,167 The quality of evidence from these studies was judged moderate or low. Selection criteria were often not reported, the duration of follow-up was heterogeneous across studies (medians ranging from 19 to 90 months) and the completeness of follow-up was difficult to assess.…”

Section: Natural Course Of Apparently Benign Adrenal Incidentaloma (Rmentioning

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

1,340

1,571

View full text Add to dashboard Cite

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...

show abstract

“…[2][3][4] The appropriate management-surgical vs medical-continues to be debated. 5 However, what has been established is that even in the setting of mild cortisol excess, though insufficient to instigate the typical findings of Cushing's syndrome, does predispose patients to metabolic and cardiovascular sequelae, including insulin resistance, type 2 diabetes, obesity and dyslipidemia.…”

mentioning

confidence: 99%

A Cautionary Case: Adrenal Insufficiency after Unilateral Adrenalectomy for Adrenocortical Carcinoma

Player¹,

Babkowski²

2015

World Journal of Endocrine Surgery

View full text Add to dashboard Cite

Subclinical Cushing's syndrome among patients with incidentally discovered adrenal masses has been well documented in the literature. This population does not exhibit the classic signs of Cushing's syndrome, but nonetheless present with postope rative adrenal insufficiency after unilateral adrenalectomy of nonfunctioning incidentalomas. Further, the results of extensive preoperative testing do not correlate with postoperative hypoadrenalism with adequate sensitivity. The patient is an 84-year-old male, who presented with vague complaints of abdominal pain and fatigue, with computed tomography (CT) scan demonstrating an enlarging left adrenal gland up to 5.5 cm. The patient had no evidence of hypothalamic-pituitary-adrenal axis dysfunction based on history, physical examination and preoperative testing. Thus, the lesion was presumed nonfunctional and was excised laparos copically. Pathology demonstrated an unfortunate diagnosis of adrenocortical carcinoma (ACC). On postoperative day 1, the patient exhibited hypotension and hypoglycemia, with a cortisol level of 0.3 mg/dl. The patient responded to hydrocortisone, supporting the presumed diagnosis of hypoadrenalism. ACC is a rare and aggressive tumor, with only 300 documented cases per year in the United States. Thus, there is a paucity of data related to pre-and postoperative management. Since a third of the patients present with nonfunctioning tumors, postsurgical care are based on literature from nonfunctional incidentalomas until further research establishes guidelines. Our experience with acute hypoadrenalism after unilateral adrenalectomy in the setting of ACC suggests the need for routine postoperative testing of cortisol levels.

show abstract

Cohort study of patients with adrenal lesions discovered incidentally

Abstract: In this prospective cohort study 6·6 per cent of patients with an AI had surgery and benign hormone-producing tumours were verified in 3·1 per cent. Repeat CT and hormone evaluation after 2 years did not increase the sensitivity for diagnosis of malignant or hormone-producing tumours.

Cited by 50 publications

References 24 publications

Clinical characteristics and follow-up of incidentally found adrenal tumours — results from a single tertiary centre

Clinical characteristics and follow-up of incidentally found adrenal tumours — results from a single tertiary centre

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

A Cautionary Case: Adrenal Insufficiency after Unilateral Adrenalectomy for Adrenocortical Carcinoma

Contact Info

Product

Resources

About