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

Nasir, Joohi; Walton, Christopher

doi:10.1136/bmj.313.7061.872

Cited by 9 publications

(44 citation statements)

References 10 publications

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“…Among six, two each were adolescent and neonate, and one each was young infant and prenatal. Clinical presentation was variable; hypertensive retinopathy,[ 1 ] virilization[ 1 ] and bleeding diathesis,[ 1 ] antenatal suprarenal mass,[ 1 ] prenatal adrenal angiolipoma,[ 1 ] and spontaneous resolution of Stage III suprarenal mass. [ 1 ] Ultrasound and contrast-enhanced computed tomography revealed well-defined, heterogeneous adrenal mass.…”

Section: Resultsmentioning

confidence: 99%

“…Functioning type includes virilization, cushing's syndrome, feminization features, and malignant hypertensive retinopathy. [ 1 ] Close clinical follow-up, endocrine work-up, and contrast-enhanced computed tomography (CECT) are helpful in assessing the adrenal mass and optimizing the success of adrenalectomy. [ 1 2 3 ] Spontaneous resolution of variable adrenal mass will determine the management approach.…”

Section: Introductionmentioning

confidence: 99%

“…Histopathology of tumor revealed pheochromocytoma and borderline oncocytoma. Spontaneous resolution of adrenal mass had varied etiology; adrenal hemorrhagic lesion,[ 1 ] simple cyst,[ 1 ] neuroblastoma. [ 1 ] Follow-up varied from 3 months to 2 years.…”

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confidence: 99%

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Adrenal mass: Unusual presentation and outcome

Ramareddy

Alladi

2017

Indian J Med Paediatr Oncol

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Aim:Adrenal mass may be functioning or nonfunctioning with varied clinical presentations. This study aimed to report the nature and management of uncommon adrenal mass and to review literature.Materials and Methods:This was an retrospective observational analysis of children with uncommon adrenal mass admitted during 2009–2015. Clinical features, investigations, and management of patients were analyzed.Results:Among six, two each were adolescent and neonate, and one each was young infant and prenatal. Clinical presentation was variable; hypertensive retinopathy,[1] virilization[1] and bleeding diathesis,[1] antenatal suprarenal mass,[1] prenatal adrenal angiolipoma,[1] and spontaneous resolution of Stage III suprarenal mass.[1] Ultrasound and contrast-enhanced computed tomography revealed well-defined, heterogeneous adrenal mass. Size varied from 2 to 15 cm. Urinary metanephrine and serum testosterone were raised in adolescent hypertensive boys and virilized girls, respectively. Laparoscopy-assisted adrenalectomy was done in two and other four were managed conservatively. Histopathology of tumor revealed pheochromocytoma and borderline oncocytoma. Spontaneous resolution of adrenal mass had varied etiology; adrenal hemorrhagic lesion,[1] simple cyst,[1] neuroblastoma.[1] Follow-up varied from 3 months to 2 years. All patients were asymptomatic on last follow-up.Conclusion:Close clinical follow-up, contrast-enhanced tomography, and limited/specific endocrine work-up have definite role in the management of uncommon adrenal mass.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adrenal mass: Unusual presentation and outcome

Ramareddy

Alladi

2017

Indian J Med Paediatr Oncol

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“…2 Experience with these uncommon tumours is limited and most published observations are based on individual cases 3-8. They may secrete various steroid hormones including androgens, oestrogens, cortisol, and aldosterone 9.…”

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confidence: 99%

Androgen secreting adrenocortical tumours

Wolthers

Cameron

Scheimberg

et al. 1999

Archives of Disease in Childhood

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Background-Androgen secreting adrenocortical tumours are rare in children and the determination of their malignant potential can be diYcult. Objectives-To assess the presentation, histology, and clinical behaviour of these tumours. Setting-Two tertiary referral centres. Study design-Retrospective analysis of children diagnosed with an androgen secreting adrenocortical tumour between 1976 and 1996. Patients-Twenty three girls and seven boys aged 0-14 years. Results-Pubic hair was observed in all children, clitoromegaly or growth of the phallus in 23 children, acceleration of linear growth in 22 children, and advanced bone age (> 1.5 years) in 18 children. Hypersecretion of androgens was detected by assessment of serum androgen concentrations alone in four patients and by 24 hour urine steroid excretion profiles in 22 patients. All 16 tumours measuring < 5 cm in diameter were benign. Of the tumours measuring 5-9 cm, three were malignant and seven were benign, whereas all four tumours > 10 cm were malignant. Histological slides were available for reassessment in 25 children. Although mitoses and necrosis were more characteristic of tumours with malignant behaviour, no exclusive histological features of malignancy were seen. Conclusion-Histological criteria for malignancy are not reliable, whereas tumour size is important in assessing malignant potential. (Arch Dis Child 1999;80:46-50)

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“…Editor–We agree with Joohi Nasir and Christopher Walton that all patients with adrenal masses should undergo complete endocrine evaluation before adrenalectomy is considered 1. Although after full biochemical evaluation has been carried out computed tomography provides additional valuable anatomical information, it should be remembered that other radiological investigations supply both anatomical and functional data.…”

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confidence: 99%