The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management

Mansmann, Georg; Lau, Joseph; Balk, Ethan M; Rothberg, Michael B.; Miyachi, Yukitaka; Bornstein, Stefan R.

doi:10.1210/er.2002-0031

Cited by 687 publications

(482 citation statements)

References 383 publications

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“…The reported prevalence of subclinical Cushing's syndrome among patients with adrenal incidentaloma ranges from 5% to 20% (2,3,(11)(12)(13)(14)(15)(16)(17). The sources of this heterogeneity may be found in the different work-up protocols and variable criteria used to define subclinical cortisol excess as well as in different inclusion criteria and size of the reported series (table 1).…”

Section: Diagnosismentioning

confidence: 99%

Subclinical Cushing's Syndrome

et al. 2004

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Subclinical Cushing's syndrome (CS) is attracting increasing interest since the serendipitous discovery of an adrenal mass has become a rather frequent event owing to the routine use of sophisticated radiologic techniques. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50% of cases in surgical series and even greater shares in medical series. Incidentally discovered adrenal adenomas may secrete cortisol in an autonomous manner that is not fully restrained by pituitary feedback, in 5 to 20% of cases depending on study protocols and diagnostic criteria. The criteria for qualifying subclinical cortisol excess are controversial and presently there is no consensus on a gold standard for the diagnosis of this condition. An increased frequency of hypertension, central obesity, impaired glucose tolerance, diabetes and hyperlipemia has been described in patients with subclinical CS; however, there is still no clear demonstration of the long-term complications of this condition whose management remains largely empirical. Either adrenalectomy or careful observation associated with treatment of the metabolic syndrome have been suggested as treatment options. RESUMO Síndrome de Cushing Subclínica.A síndrome de Cushing subclínica (SCS) tem atraído interesse cada vez maior desde que a descoberta casual de uma massa adrenal se tornou um evento freqüente devido ao emprego rotineiro de técnicas sofisticadas de imagem. O adenoma cortical é o tipo mais freqüente de incidentaloma adrenal, correspondendo a cerca de 50% dos casos em séries cirúrgicas e até mais do que isso em séries médicas. Adenomas adrenais descobertos incidentalmente podem secretar cortisol de maneira autônoma ou não controlada totalmente pelo feedback hipofisário, em 5 a 20% dos casos, dependendo do protocolo de estudo e dos critérios diagnósticos. Os critérios para qualificar um excesso subclínico de cortisol são controversos e atualmente não existe consenso a respeito de "padrão ouro" para o diagnóstico dessa condição. Em pacientes com SCS, tem sido descrita uma freqüência elevada de hipertensão, obesidade central, intolerância à glicose, diabetes e hiperlipemia; entretanto, ainda não existe uma evidente demonstração de complicações a longo prazo dessa condição, cujo manejo permanece amplamente empírico. Tanto a adrenalectomia como a observação cuidadosa, associada com o tratamento da síndrome metabólica, têm sido sugeridos como opções terapêuticas.

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Section: Diagnosismentioning

confidence: 99%

Subclinical Cushing's Syndrome

et al. 2004

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“…It should be presumed a diagnosis of bilateral hyperplasia (BAH) is provided in approximately 50 % of patients, whereas in the remaining cases an aldosteroneproducing adenoma (APA) and asymmetrical aldosterone excess is present. Rarer entities include adrenal cortex carcinoma, which occurs in < 1 % of cases [12,13]. Patients with Conn's syndrome have a significantly increased risk of cardiac and vascular diseases, even when compared with patients with similarly poor blood pressure values, but without hyperaldosteronism [14,15].…”

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confidence: 99%

Indication and Technical Aspects of Adrenal Blood Sampling

Blondin

Quack

Kücükköylü

et al. 2014

Fortschr Röntgenstr

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Adrenal disorders are relative frequent with regard to the incidence of adrenal tumors and the high portion in causes of secondary hypertension. Morphological changes in the adrenal glands can lead to very different functional disorders that may be clinically overt or hard to diagnose. On the other hand, they can already be functionally relevant when structural changes are too small to be picked up by imaging. Adrenal venous sampling serves to determine the source of hormone excess through the analysis of adrenal blood. In this manuscript, we call attention to the clinical backgrounds, critical points in praxis, technical aspects and developments in the the field of adrenal venous sampling. The consideration of these important points in the clincal setting may make adrenal vein sampling studies sucessful and help to select patients that qualify for adrenalectomy. Key Points: ??Selective adrenal venous sampling (AVS) currently continues to be the gold standard for localization diagnostics in patients with primary hyperaldosteronism. ??Comprehensive standardization of all preceding examinations and AVS is necessary to ensure high success rates. ??The method is supported by contrast-enhanced imaging for ensuring proper positioning of the catheter in the adrenal veins and the rapid cortisol assay. ??Knowledge of the anatomy and normal variants of the adrenal veins facilitates adrenal venous sampling. Citation Format: ??Blondin D, Quack I, Haase M et?al. Indication and Technical Aspects of Adrenal Blood Sampling. Fortschr R?ntgenstr 2015; 187: 19???28

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“…The majority, but not all, recommend a conservative approach, except for masses suspected for malignancy and/or clearly hyperfunctioning which need surgical treatment (Jockenhovel et al, 1992;Ambrosi et al, 1997;Barzon et al, 1998;Barzon and Boscaro, 2000;Brunt and Moley, 2001; Thompson and Young, 2003;Mansmann et al, 2004). However, the follow-up of these apparently benign and nonfunctioning masses is arbitrary, reflecting the clinical experience of the individual Unit rather than deriving from clinical studies planned to evaluate this aspect.…”

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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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The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management

Cited by 687 publications

References 383 publications

Subclinical Cushing's Syndrome

Subclinical Cushing's Syndrome

Indication and Technical Aspects of Adrenal Blood Sampling

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

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