Diagnostic and therapeutic approach to incidental adrenal mass

Guerrero, Luis Alejandro Vargas

doi:10.1016/0090-4295(85)90149-9

Cited by 41 publications

(13 citation statements)

References 19 publications

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“…If our patient had been medically treated follow up computed tomography of her adrenal mass, which measured 3 cm by 2 cm, would have been considered to monitor changes in size. Some people think that masses measuring 3.0 cm or more in diameter should be considered for early removal in view of the risk of malignancy,6 7 but others have suggested that a cut off point of 6.0 cm is more appropriate 1 8. Possible decrease in size or at least no further increase could be anticipated after partial suppression of adrenocorticotrophin secretion 3 9…”

Section: Discussionmentioning

confidence: 99%

Lesson of the Week: Adrenal mass with virilisation: importance of endocrine investigation

Nasir

Walton

1996

BMJ

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Section: Discussionmentioning

confidence: 99%

Lesson of the Week: Adrenal mass with virilisation: importance of endocrine investigation

Nasir

Walton

1996

BMJ

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“…discovery of an adrenal mass without clinical manifestation has been increasing due to the development of imaging techniques such as ultrasonography (US), computed tomography (CT), and more recently, magnetic resonance imaging (MRI) [1][2][3][4][5][6][7][8][9][10][11]. These so-called "adrenal incidentalomas" are usually asymptomatic and often classified as non-functional tumors, but in recent years there have been several case reports of asymptomatic cortisol producing adrenal adenoma (ASCA) which secretes cortisol without clinical evidence of Cushing's syndrome, the so-called "Pre-Cushing's syndrome" or "Preclinical Cushing's syndrome" [12][13][14][15][16][17][18][19][20][21].…”

Section: Incidentalmentioning

confidence: 99%

Serum Levels of Dehydroepiandrosterone Sulfate in Patients with Asymptomatic Cortisol Producing Adrenal Adenoma: Comparison with Adrenal Cushing's Syndrome and Non-Functional Adrenal Tumor.

et al. 1996

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Abstract.The reported number of adrenal incidentalomas has been increasing because of wider application of imaging techniques. Patients with asymptomatic cortisol producing adrenal adenoma (ASCA) which secretes cortisol without clinical evidence of Cushing's syndrome has been more frequently observed than previously assumed, and they have a risk of adrenal insufficiency after adrenalectomy. Therefore patients with incidentalomas should be screened for cortisol overproduction. The aim of this study is to discover an easy screening test to uncover ASCA. We investigated the hormone profiles of 4 patients with ASCA in comparison with 11 patients with non-functional adrenal tumor and 10 patients with adrenal Cushing's syndrome.We also investigated the expression of dehydroepiandrosterone sulfotransferase (DHEA-ST) in surgically removed attached non-neoplastic adrenal tissues by immunostaining, which was considered to represent the degree of suppression of the hypothalamo-pituitary-adrenal axis. Serum dehydroepiandrosterone sulfate (DHEA-S) levels of all the patients with ASCA and adrenal Cushing's syndrome were lower than those of healthy subjects of corresponding age, but they were within the normal range in the patients with non-functional adrenal tumors. The serum DHEA-S level reflects the degree of suppression of the normal adrenal gland by cortisol hypersecretion from adrenal tumors. But the serum level of DHEA-S decreases with age, and because the normal range of serum DHEA-S is low in elderly subjects, we should be careful to evaluate the level of DHEA-S in elderly patients with adrenal Cushing's syndrome or ASCA. The immunohistochemical study showed DHEA-ST expression was noticeably suppressed in the adjacent adrenal cortex in ASCA and adrenal Cushing's syndrome. The decreased expression of DHEA-ST may reflect autonomous neoplastic cortisol secretion and subsequent ACTH suppression in ASCA and adrenal Cushing's syndrome.A single measurement of plasma ACTH or measurement of ACTH response to corticotropin-releasing hormone was not enough to screen for ASCA because of the wide variation among the cases. Dexamethasone suppression test is essential in identifying ASCA and also a single determination of serum DHEA-S is easy and may be useful for the screening of ASCA in adrenal incidentalomas in young and middle aged subjects, and is especially useful for outpatients.

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“…1,2,7,21,[23][24][25] Determination of hormonal biochemical activity is a fundamental consideration.…”

Section: Discussionmentioning

confidence: 99%

The role of adrenocortical scintigraphy in the evaluation of unilateral incidentally discovered adrenal and juxtaadrenal masses

et al. 1993

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We reviewed the findings of adrenocortical scintigraphy with 131I-6-beta-iodomethyl-19-norcholesterol (NCL-6-131I) of 39 patients to clarify its role in the evaluation of unilateral adrenal or juxtaadrenal masses incidentally discovered by CT, ultrasonography or plain radiography. Twenty-seven benign adrenal masses showed various scintigraphic findings (hot nodule: 12 silent adenomas, warm nodule: one solid mass, normal appearance: one cyst and 2 solid masses, diffuse decrease: each one; solid mass, myelolipoma, ganglioneuroma and calcified adrenal and partial or complete defect: each one; solid mass, myelolipoma and ganglioneuroma and 2 cysts and 2 pheochromocytomas); while a partial or complete defect was shown in a nonfunctioning carcinoma and 3 metastases and a complete defect or inhomogeneous uptake without opposite adrenal visualization was shown in 2 patients with cortisol-producing carcinoma. Therefore a hot nodule and an inhomogeneous uptake or complete defect with nonvisualization of the opposite adrenal are specific to a benign tumor and a cortisol-producing carcinoma, respectively. The impaired tumor uptake of NCL-6-131I is a nonspecific finding. The scintigraphic findings of juxtaadrenal masses were normal in 4 and deviated adrenals in 2. Thus adrenocortical scintigraphy can identify silent adenomas and cortisol-producing carcinomas among the adrenal masses and may help to differentiate juxtaadrenal from adrenal masses.

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Diagnostic and therapeutic approach to incidental adrenal mass

Cited by 41 publications

References 19 publications

Lesson of the Week: Adrenal mass with virilisation: importance of endocrine investigation

Lesson of the Week: Adrenal mass with virilisation: importance of endocrine investigation

Serum Levels of Dehydroepiandrosterone Sulfate in Patients with Asymptomatic Cortisol Producing Adrenal Adenoma: Comparison with Adrenal Cushing's Syndrome and Non-Functional Adrenal Tumor.

The role of adrenocortical scintigraphy in the evaluation of unilateral incidentally discovered adrenal and juxtaadrenal masses

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