Incidentally Discovered Mass of the Adrenal Gland

Belldegrun, Arie S.; Hussain, Sarwat; Seltzer, Steven E.; Loughlin, Kevin R.; Gittes, Ruben F.; Richie, Jerome P.

doi:10.1016/s0022-5347(17)44402-8

Cited by 68 publications

(92 citation statements)

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“…In such patients the risk of an adrenal mass being a metastasis is high, ranging from 45 to 73% (13,19,22). Moreover, the risk increases with adrenal mass size, as malignancy rates of 43 -100% have been reported for masses larger than 3 cm (19,22).…”

Section: Oncology Seriesmentioning

confidence: 99%

“…Tumor size determined at CT scan is usually less than the diameter reported on histological examination. Size underestimation at CT scan has been estimated to range from 20 to 47% (19,74). This is of interest since preoperative assessment of tumor size is one of the major decision criteria for surgery.…”

Section: Side and Size Distributionmentioning

confidence: 99%

“…1). However, mass diameter should not be used as the only criterion of malignancy, since malignant tumors less than 3 cm in diameter are not uncommon (19,69,74). As to mass size, subclinical adrenal hyperfunction is significantly more frequent in patients with larger masses than in those with small masses, as demonstrated in a review of about 1000 unselected cases from the literature (16,20,53,56,64,66) (Fig.…”

Section: Side and Size Distributionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

564

414

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Clinically silent adrenal masses discovered by imaging studies performed for unrelated reasons, i.e. adrenal incidentalomas, have become a rather common finding in clinical practice. However, only limited studies of incidence, prevalence, and natural history of adrenal incidentalomas are available. A comprehensive review of the literature shows the prevalence of adrenal incidentalomas to be 2.3% at autopsy and 0.5 -2% at abdominal computed tomography scan. Most lesions are adrenocortical adenomas at histology, whereas the prevalence of adrenocortical carcinomas is relatively low. The risk of malignancy over time for masses defined as benign at diagnosis is estimated at about 1/1000, even though 5-25% of masses increase in size during follow-up. Hyperfunction develops in about 1.7% of cases and the risk is higher in patients with lesions larger than 3 cm. Cortisol hypersecretion is the most likely disorder that may ensue, and it remains subclinical in about two-thirds of cases. The lack of controlled studies precludes making specific management recommendations. Large perspective controlled studies to define the epidemiology, natural history, and possible associated morbidity of adrenal incidentalomas and their impact on the quality of life of patients are needed.

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Section: Oncology Seriesmentioning

confidence: 99%

Section: Side and Size Distributionmentioning

confidence: 99%

Section: Side and Size Distributionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

564

414

View full text Add to dashboard Cite

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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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“…5 Imaging Improvements in imaging techniques have allowed the ready detection and characterization of adrenal gland metastases. [6][7][8][9][10][11][12] Computed tomography (CT) with and without oral and intravenous iodinated contrast is useful in assessing adrenal lesions. Oral contrast should be given to distinguish the adrenal glands from surrounding organs.…”

mentioning

confidence: 99%