Needle biopsy of incidentally discovered adrenal masses is rarely informative and potentially hazardous

Quayle, Frank J.; Spitler, Jennifer A.; Pierce, Richard A.; Lairmore, Terry C.; Moley, Jeffrey F.; Brunt, L. Michael

doi:10.1016/j.surg.2007.07.013

Cited by 109 publications

(70 citation statements)

References 19 publications

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“…Inclusion criteria and definition of reference standard differed from the imaging meta-analysis mainly in population selection criteria (as adrenal biopsy is not indicated in incidentaloma population but rather in patients at high risk for malignancy) and in reference standard (where we accepted imaging and clinical follow-up in addition to histopathology, as most metastases would not undergo adrenalectomy). We identified 32 studies (90,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140) with a total of 2174 patients which reported at least one outcome of interest (complication rate, nondiagnostic rate, diagnostic accuracy parameters). Of these, only 8 studies (90,126,127,130,131,132,133,140) were included for the diagnostic accuracy analysis, reasons for exclusion being lack of any or optimal reference standard for at least 50% patients (n = 20) and more than 30% patients with nonadenomas in benign cohort (n = 4).…”

Section: Value Of An Adrenal Biopsy (Question 1b)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

1,339

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: Value Of An Adrenal Biopsy (Question 1b)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

1,339

1,571

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“…125,126 Complications include adrenal haematoma, haematuria, pneumothorax, haemothorax, pancreatitis, liver and duodenal haematoma. [124][125][126][128][129][130] A serious but rare adverse outcome reported is the metastatic spread of the tumor along the needle track. 128,129 Others report higher complication rates (8.4-9%) mainly with the transhepatic approach.…”

Section: Fine-needle Aspiration (Fna) Biopsymentioning

confidence: 99%

Adrenal incidentaloma: a diagnostic challenge

Anagnostis¹,

Karagiannis²,

Τζιόμαλος³

et al. 2009

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The widespread application of abdominal imaging procedures has resulted in an increased frequency of clinically silent adrenal masses. Adrenal incidentaloma (AI) is a term applied to an accidentally discovered adrenal mass on imaging performed for the investigation of an unrelated complaint. Adrenal incidentalomas (AIs) are a cluster of different pathologies, the majority of which are benign and non-functioning adrenal adenomas. However, mild hormonal alterations as well as metabolic abnormalities may be present in patients with AIs. Thus, a multidisciplinary approach with biochemical and radiologic evaluation is needed to characterize these lesions and identify patients who are at high risk for hormonal or malignant evolution. Significant new information has helped resolve controversies regarding the most reliable approach to this clinical problem. The present review considers the prevalence, pathology and natural history of AIs. We also discuss the reliability of available screening methods and localization techniques and consider optimal management and follow-up strategies.

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“…Fine needle aspiration cytology for adrenal mass is controversial unless in suspected metastasis. 11 Histopathological examination of adrenal schwannoma might show both the cellular and the conventional type. 1,5 A growth pattern is lack of Verocay bodies with increased mitotic activity.…”

Section: Discussionmentioning

confidence: 99%

Adrenal Schwannoma: A Rare Type of Adrenal Incidentaloma

Said

Muhammad

Othman

et al. 2017

World Journal of Endocrine Surgery

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Benign tumor of the myelin sheath or schwannoma is not uncommon, especially when it involves the peripheral or cranial nerves. But adrenal schwannoma is very rare and commonly presented as an incidentaloma. Adrenal incidentaloma by itself is not uncommon as more imaging is now being performed and its incidence is estimated to be around 4 to 6%. Clinical and imaging studies are not able to differentiate adrenal schwannoma from other causes of incidentaloma, making its diagnosis difficult preoperatively. We report a 64-year-old man who underwent computed tomography (CT) abdomen as part of his health-screening program. An 80 × 70 mm right adrenal tumor was discovered from the CT with features suggestive of malignancy. He has neither apparent abdominal symptoms nor symptoms related to adrenal hypersecretion. Apart from chronic hypertension, he also suffered from morbid obesity with body mass index (BMI) of 38. There was no clinical feature to suggest Cushing disease, pheochromocytoma, or primary hyperaldosteronism. His laboratories evaluation including endocrinology studies consistent with a non-functioning adrenal mass. He underwent an uneventful standard transabdominal right adrenalectomy. Immunohistochemistry report showed the tumor has characteristic of Antoni A type and positive for S-100 immunochemistry stain. The diagnosis of adrenal schwannoma was made. This case report highlights the difficulty in the management of adrenal incidentaloma.

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Needle biopsy of incidentally discovered adrenal masses is rarely informative and potentially hazardous

Cited by 109 publications

References 19 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

Adrenal incidentaloma: a diagnostic challenge

Adrenal Schwannoma: A Rare Type of Adrenal Incidentaloma

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