Differentiation of adrenal adenomas (lipid rich and lipid poor) from nonadenomas by use of washout characteristics on delayed enhanced CT

Kebapçı, Mahmut; Kaya, Tamer İrfan; Gürbüz, Esma; Adapınar, Baki; Kebapçı, Nur; Demirüstü, Canan

doi:10.1007/s00261-003-0015-0

Cited by 45 publications

(43 citation statements)

References 14 publications

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“…• Included: We identified 37 studies for inclusion in the systematic review (49,52,61,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112), with only 18 of them fulfilling the criteria for inclusion in the actual meta-analysis (61,79,80,81,82,83,84,85,86,87,88,89,90,91...…”

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

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

1,335

1,571

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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...

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Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

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

1,335

1,571

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“…Also 3-T MRI volumetric imaging is expected to improve the sensitivity and specificity for the diagnosis of lipid-poor adenomas [24]. Using these diagnostic methods, it is possible to discover huge lipid-poor heterogeneous lesions [25][26][27]. ACC usually occurs as a unilateral tumour of size 5-6 cm (median tumour size at diagnosis -about 10cm), often compressing the kidney.…”

Section: Imagingmentioning

confidence: 99%

“…Obrazowanie wolumetryczne 3T-MRI jest związane z nadzieją udoskonalenia czułości i specyficzności diagnozowania ASA o niskiej zawartości tkanki tłuszczowej [24]. Przy użyciu powyższych technik prawdopodobnie możliwe będzie diagnozowanie ubogich w tkankę tłuszczową, nieheterogennych gruczolaków o dużych rozmiarach [25][26][27]. Rak kory nadnercza zwykle występuje pod postacią jednostronnego guza wielkości powyżej 5-6 cm (średnia wielkość w momencie rozpoznania to ok. 10 cm), zwykle uciskającego nerkę.…”

Section: Patogeneza I Aspekty Molekularneunclassified

Rak kory nadnercza (ACC) — przegląd piśmiennictwa i doświadczenia własne

Dworakowska

Drabarek

Wenzel

et al. 2015

Endokrynologia Polska

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Adrenocortical carcinoma (ACC) is a malignant endocrine tumour. The rarity of the disease has stymied therapeutic development. Age distribution shows two peaks: the first and fifth decades of life, with children and women more frequently affected. Although 60-70% of ACCs are biochemically found to overproduce hormones, it is not clinically apparent in many cases. If present, endocrine symptoms include signs of hypercortisolaemia, virilisation or gynaecomastia. ACC carries a poor prognosis, and a cure can be achieved only by complete surgical resection. Mitotane is used both as an adjuvant treatment and also in non-operative patients. The role of radio-and chemotherapy is still controversial. The post-operative disease free survival is low and oscillates around 30% due to high tumour recurrence rate. The diagnosis is based on tumour histological assessment with the use of the Weiss score, however urinary steroid profiling (if available) can serve to differentiate between ACC and other adrenal tumours. Conventional prognostic markers in ACC include stage and grade of disease, and, as currently reported, the presence of hypercortisolaemia. Molecular analysis has had a significant impact on the understanding of the pathogenetic mechanism of ACC development and the evaluation of prognostic and predictive markers, among which alterations of the IGF system, the Wnt pathway, p53 and molecules involved in cancer cell invasion properties and angiogenesis seem to be very promising. We here summarise our own experience related to the management of ACC and present a literature overview. We have not aimed to include a detailed summary of the molecular alterations biology described in ACC, as this has already been addressed in other papers. StreszczenieRak kory nadnercza (ACC) jest złośliwym guzem endokrynnym. Rzadkość jego występowania przyczyniła się do spowolnienia rozwoju nowych opcji terapeutycznych. Zachorowalność występuje dwuszczytowo: w pierwszej oraz piątej dekadzie życia, przy czym zachorowalność dotyczy częściej kobiet i dzieci. Mimo że 60-70% ACC jest zwykle czynna hormonalnie, to klinicznie nie zawsze jest to oczywiste. W przypadku guzów aktywnych hormonalnie mamy do czynienia z objawami hiperkortyzolemii, wirylizacji czy ginekomastii. ACC jest nowotworem o złym rokowaniu, a jego wyleczenie może być osiągnięte poprzez całkowitą resekcję zmiany. Mitotan znajduje zastosowanie zarówno w leczeniu adjuwantowym jak i w przypadkach guzów nieresekcyjnych. Natomiast rola radio-oraz chemioterapii pozostaje nadal kontrowersyjna. Przeżywalność po zabiegu operacyjnym oscyluje w granicach 30% i wiąże się z wysokim odsetkiem nawrotów. Rozpoznanie stawiane jest na podstawie analizy histopatologicznej przy użyciu Weiss score, jednakże analiza wydalania steroidów w moczu (o ile jest dostępna) może pomóc w rozróżnieniu pomiędzy ACC a gruczolakiem nadnercza, a także innymi guzami nadnercza. Głównymi czynnikami prognostycznymi są: stopień zróżnicowania i zaawansowania nowotworu i, według ostatnich doniesień, obecność hiperko...

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“…All CT scans were blinded and independently reviewed by two experienced radiologists using standardized criteria, commonly used for adrenal gland investigations (Lee et al, 1991;McNicholas et al, 1995;Korobkin et al, 1996;Szolar and Kammerhuber, 1997;Cirillo et al, 1998;Pena et al, 2000;Caoili et al, 2002;Kebapci et al, 2003). If discordant opinions were recorded, an additional evaluation was carried out by a third operator.…”

Section: Radiological Parameters With Benign/malignant Criteriamentioning

confidence: 99%

Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

et al. 2005

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We investigated the natural course of adrenal incidentalomas in 115 patients by means of a long-term endocrine and morphological (CT) follow-up protocol (median 4 year, range 1 -7 year). At entry, we observed 61 subclinical hormonal alterations in 43 patients (mainly concerning the ACTH -cortisol axis), but confirmatory tests always excluded specific endocrine diseases. In all cases radiologic signs of benignity were present. Mean values of the hormones examined at last follow-up did not differ from those recorded at entry. However in individual patients several variations were observed. In particular, 57 endocrine alterations found in 43 patients (37.2%) were no longer confirmed at follow-up, while 35 new alterations in 31 patients (26.9%) appeared de novo. Only four alterations in three patients (2.6%) persisted. Confirmatory tests were always negative for specific endocrine diseases. No variation in mean mass size was found between values at entry (25.470.9 mm) and at follow-up (25.770.9 mm), although in 32 patients (27.8%) mass size actually increased, while in 24 patients (20.8%) it decreased. In no case were the variations in mass dimension associated with the appearance of radiological criteria of malignancy. Kaplan -Meier curves indicated that the cumulative risk for mass enlargement (65%) and for developing endocrine abnormalities (57%) over time was progressive up to 80 months and independent of haemodynamic and humoral basal characteristics. In conclusion, mass enlargement and the presence or occurrence over time of subclinical endocrine alterations are frequent and not correlated, can appear at any time, are not associated with any basal predictor and, finally, are not necessarily indicative of malignant transformation or of progression toward overt disease.

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Differentiation of adrenal adenomas (lipid rich and lipid poor) from nonadenomas by use of washout characteristics on delayed enhanced CT

Abstract: The absolute or relative percentage washout of contrast material on delayed contrast-enhanced CT is a highly specific test for the differentiation of lipid-poor and lipid-rich adrenal adenomas from adrenal nonadenomas.

Cited by 45 publications

References 14 publications

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

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

Rak kory nadnercza (ACC) — przegląd piśmiennictwa i doświadczenia własne

Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

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