Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions

Pasternak, Jesse D.; Seib, Carolyn D.; Seiser, Natalie; Tyrell, J. Blake; Liu, Chien-Ying; Cisco, Robin M.; Gosnell, Jessica E.; Shen, Wen T.; Suh, Insoo; Duh, Quan‐Yang

doi:10.1001/jamasurg.2015.1683

Cited by 39 publications

(29 citation statements)

References 22 publications

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“…Moreover, we found that patients with primary aldosteronism were more likely to present a lesion in the contralateral gland than participants without this disorder. Accumulating data suggest that adrenal incidentalomas are unilateral in more than 80% of cases, similar to our results. Regarding the lateralization of adrenal incidentalomas among individuals with primary aldosteronism, existing data are quite restricted.…”

Section: Discussionsupporting

confidence: 92%

Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

Stavropoulos

Imprialos

Katsiki

et al. 2018

J of Clinical Hypertension

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Primary aldosteronism (PA) is a common form of secondary hypertension. Several guidelines recommend that patients with adrenal incidentaloma have a high probability of suffering from PA. We conducted a prospective study of 269 consecutive adults with adrenal incidentaloma to investigate the prevalence and clinical characteristics of PA. In total, 9 participants were detected with PA, suggesting a prevalence of 3.35% among the study population. PA participants had a higher blood pressure level by 14/20.8 mm Hg and a lower serum potassium level by 0.8 mmol/L (P < .05). Importantly, all patients with PA presented with concurrent indications (hypertension with or without hypokalemia) for screening of the disease, but they have not undergone relative screening by the referring physician, thus casting doubts about the appropriate implementation of current guidelines in real-life practice. Intense efforts are needed to familiarize physicians with recommendations for PA to minimize undiagnosed cases and the detrimental sequelae of this endocrine form of hypertension.

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Section: Discussionsupporting

confidence: 92%

Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

Stavropoulos

Imprialos

Katsiki

et al. 2018

J of Clinical Hypertension

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“…However, hypertension, diabetes type 2 and dyslipidemia were comparable in both groups (65). More recently, in a surgical series including 112 unilateral AI and 23 bilateral AI, mild cortisol excess was present in 21.7% bilateral AI vs 6.2% of unilateral AI (66). Vassiliadi et al demonstrated an exaggerated response of cortisol and ACTH in patients with bilateral AI during the combined test of DST followed by CRH stimulation compared to unilateral AI and to a control group suggesting that the regulation of hypothalamicpituitary axis was disturbed in patients with bilateral AI; nevertheless, the diagnosis of BMAH was not excluded in this group (67).…”

Section: Modest Secretion Of Cortisol Is More Frequent In Bilateral Amentioning

confidence: 88%

MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

Bourdeau

Ghorayeb

Gagnon

et al. 2018

European Journal of Endocrinology

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The investigation and management of unilateral adrenal incidentalomas have been extensively considered in the last decades. While bilateral adrenal incidentalomas represent about 15% of adrenal incidentalomas (AIs), they have been less frequently discussed. The differential diagnosis of bilateral incidentalomas includes metastasis, primary bilateral macronodular adrenal hyperplasia and bilateral cortical adenomas. Less frequent etiologies are bilateral pheochromocytomas, congenital adrenal hyperplasia (CAH), Cushing's disease or ectopic ACTH secretion with secondary bilateral adrenal hyperplasia, primary malignancies, myelolipomas, infections or hemorrhage. The investigation of bilateral incidentalomas includes the same hormonal evaluation to exclude excess hormone secretion as recommended in unilateral AI, but diagnosis of CAH and adrenal insufficiency should also be excluded. This review is focused on the differential diagnosis, investigation and treatment of bilateral AIs.

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“…Bilateral masses have been observed from 9.4-20% (Kasperlik-Zaluska et al 2010;Tabuchi et al 2015). Bilateral incidentalomas are more likely associated with subclinical Cushing syndrome and less likely with the pheochromocytoma (Pasternak et al 2015). Th e average diameter of tumors was 21±11mm (Paterson et al 2014;Tabuchi et al 2015).…”

mentioning

confidence: 99%

Radiology of the adrenal incidentalomas. Review of the literature

Farrugia¹,

Martikos

Surgeon

et al. 2017

Endocrine Regulations

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The term “adrenal incidentaloma” is a radiological term. Adrenal incidentalomas are adrenal tumors discovered in an imaging study that has been obtained for indications exclusive to adrenal conditions (Udelsman 2001; Linos 2003; Bulow et al. 2006; Anagnostis et al. 2009). This definition excludes patients undergoing imaging testing as part of staging and work-up for cancer (Grumbach et al. 2003; Anagnostis et al. 2009). Papierska et al. (2013) have added the prerequisite that the size of a tumor must be “greater than 1cm in diameter”, in order to be called incidentaloma. Although in the most cases these masses are non-hypersecreting and benign, they still represent an important clinical concern because of the risk of malignancy or hormone hyperfunction (Barzon et al. 2003). Th e adrenal tumors belong to the commonest incidental findings having been discovered (Kanagarajah et al. 2012).

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Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions

Cited by 39 publications

References 22 publications

Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

Radiology of the adrenal incidentalomas. Review of the literature

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