CT of the adrenal glands

Moulton, Jonathan S.; Moulton, Jeffrey S.

doi:10.1016/s0037-198x(88)80039-7

Cited by 69 publications

(18 citation statements)

References 65 publications

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“…However, all presumptive diagnoses of pheochromocytoma or carcinoma were histologically proven, while in the remainder the diagnosis of a benign lesion was based on imaging characteristics of the mass as well as on clinical, endocrine and CT follow-up studies. The combination of these methods, in particular the re-evaluation after an interval of at least 12 months, means that a diagnosis of malignancy, either primary or secondary is very unlikely to be missed (17,18).…”

Section: Discussionmentioning

confidence: 99%

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

et al. 2000

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Objective: Owing to their increasing rate of discovery as incidental findings, the characterization of adrenal masses is an important diagnostic problem which frequently challenges the clinician's skill. Design: The results of dehydroepiandrosterone sulfate (DHEAS) measurement were evaluated in a consecutive series of 107 patients with an adrenal mass (39 men, 68 women aged 15-81 years, median 56 years). DHEAS levels observed in the patients were categorized as reduced, normal or elevated according to sex-and age-adjusted reference ranges obtained by measuring DHEAS in 214 healthy women and 142 healthy men aged 17-93 years. The working hypothesis was that a low DHEAS level is a marker of benignity. Methods: In 84 patients, the adrenal mass was discovered serendipitously, while in the remainder the mass was clinically symptomatic. Patients with known extra-adrenal malignancies were excluded. The adrenal masses were categorized as benign or malignant by computerized tomography (CT) criteria. All patients with suspected malignant tumors or with overtly hypersecreting tumors underwent adrenalectomy. The patients with a presumptive benign tumor were followed-up for at least 12 months. Results: In the overall series, the sensitivity and specificity of a low DHEAS level in the identification of a benign lesion were 41% and 100% respectively. Superimposable figures were obtained when considering only adrenal incidentalomas. DHEAS levels in adrenal cancers displayed some overlap with adrenal adenomas, but in only 2/11 adrenal cancers were DHEAS levels normal, while they were elevated in the remainder. Conclusions: The present data suggest that DHEAS measurement may help to differentiate benign from malignant adrenal masses as a complementary test of CT in a clinical research setting. The value of DHEAS measurement in general practice is limited because it may be difficult to differentiate between low and low-normal values, particularly in the elderly.

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Section: Discussionmentioning

confidence: 99%

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

et al. 2000

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“…Even in experienced hands almost 20% of the extra-adrenal PCCs remained undetected using contrast-enhanced CT (49). Extra-adrenal PCCs are multicentric in up to 25% of cases and non-functional ectopic localisations are not exceptional (48).…”

Section: Ectopic and Syndrome-related Pccs And Cat Levelsmentioning

confidence: 99%

The value of plasma markers for the clinical behaviour of phaeochromocytomas

Harst¹,

Herder²,

Krijger³

et al. 2002

European Journal of Endocrinology

106

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Objective: Phaeochromocytomas (PCCs) are widely known for their clinical unpredictability. This study intends to define predictive plasma markers for their variable postoperative behaviour. Furthermore, the diagnostic accuracy of these plasma tests was determined. Design and Methods: A retrospective correlative study was performed in a series of 83 operated and four autopsied patients in order to correlate preoperative catecholamine (CAT) levels of 103 PCCs with their clinical behaviour. In a subset of cases, chromogranin-A (Chr-A) and enzymes/precursors of the CAT biosynthesis were studied for their predictive value. Results: Basal CAT levels were elevated in 81/87 instances (sensitivity: 93%). Four of six cases with normal measurements showed only medullary hyperplasia. Larger PCCs, particularly those showing necrosis, capsular and vascular invasion, secreted higher CAT levels. Bilateral, hereditary tumours were less productive than their unilateral counterparts. Extra-adrenal PCCs secreted significantly lower levels of epinephrine (EPI) than intra-adrenal tumours. Fourteen patients developed metastases. According to Kaplan -Meier estimations, patients with higher levels of dopamine, norepinephrine (NE) and aromatic L-amino acid decarboxylase as well as lower ratios of EPI/EPI þ NE, had significantly shorter metastases-free intervals. Existence of preoperative hypertension, left ventricular hypertrophy and measured blood pressures showed significant positive relationships with CAT levels, but not with Chr-A. Conclusions: These data showed that plasma CAT measurement is a sensitive method in the diagnostic work-up of PCCs. Those tumours producing normal levels are commonly small and asymptomatic. Furthermore, certain secretion patterns are indicative of the presence of metastases as well as the size and site of sporadic and syndrome-related PCCs.

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“…The first and most important issue is to distinguish between malignant (either primary or metastatic) and benign lesions. CT or MR characteristics of the mass are helpful in the differential diagnosis [3][4][5] and the size of the mass is admittedly the most used discriminant for sur gical recommendations. However, the diameter below which silent incidentalomas can be safely presumed to be benign is presently ill-defined [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Adrenal Incidentaloma: An Overview of Clinical and Epidemiological Data from the National Italian Study Group

Angeli¹,

Osella²,

Amini³

et al. 1997

Horm Res

233

140

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Background: The incidental discovery of an adrenal mass raises the problem of distinguishing the frequent benign masses from the infrequent malignant ones that require surgery. At present, univocal guidelines to approach this problem are not available. The aim of the present study was to perform a multicentric retrospective analysis of adrenal masses incidentally discovered (adrenal incidentalomas). Patients and Methods: Hospital records of adrenal incidentalomas diagnosed over a 15-year period in 29 surgical and medical centers in Italy were scrutinized. Collected cases were 1,013, and 887 were analyzed. Results: The majority of patients were in the 5th and 6th decade and females were predominantly affected. The frequency of adrenocortical cancer was 12% among operated patients (316 cases). The tumor diameter was highly correlated with the risk of malignancy, as well as the CT characteristics such as density, shape and margins. The frequency of pheochromocytoma was 10% among operated patients. Conclusions: The occurrence of incidentally discovered adrenocortical carcinomas and pheochromocytomas is not rare. Evaluation of the mass size and CT characteristics are simple and effective methods to differentiate malignant lesions. Biochemical screening for pheochromocytoma is mandatory before surgery.

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CT of the adrenal glands

Cited by 69 publications

References 65 publications

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

The value of plasma markers for the clinical behaviour of phaeochromocytomas

Adrenal Incidentaloma: An Overview of Clinical and Epidemiological Data from the National Italian Study Group

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