Unsuspected pheochromocytoma: risk of blood-pressure alterations during percutaneous adrenal biopsy.

Casola, Giovanna; Nicolet, Viviane; vanSonnenberg, Eric; Withers, C; Bretagnolle, M; Saba, Raya; Bret, Patrice M.

doi:10.1148/radiology.159.3.3517958

Cited by 147 publications

(56 citation statements)

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“…It is mandatory to biochemically exclude a pheochromocytoma before FNAB is performed (74). Recommendations on the radiological assessment of adrenal incidentalomas are given in Table 4.…”

Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

456

412

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Objective: To assess currently available evidence on adrenal incidentaloma and provide recommendations for clinical practice. Design: A panel of experts (appointed by the Italian Association of Clinical Endocrinologists (AME)) appraised the methodological quality of the relevant studies, summarized their results, and discussed the evidence reports to find consensus. Radiological assessment: Unenhanced computed tomography (CT) is recommended as the initial test with the use of an attenuation value of %10 Hounsfield units (HU) to differentiate between adenomas and non-adenomas. For tumors with a higher baseline attenuation value, we suggest considering delayed contrast-enhanced CT studies. Positron emission tomography (PET) or PET/CT should be considered when CT is inconclusive, whereas fine needle aspiration biopsy may be used only in selected cases suspicious of metastases (after biochemical exclusion of pheochromocytoma). Hormonal assessment: Pheochromocytoma and excessive overt cortisol should be ruled out in all patients, whereas primary aldosteronism has to be considered in hypertensive and/or hypokalemic patients. The 1 mg overnight dexamethasone suppression test is the test recommended for screening of subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l for considering this condition. A value of 50 nmol/l virtually excludes SCS with an area of uncertainty between 50 and 138 nmol/l. Management: Surgery is recommended for masses with suspicious radiological aspects and masses causing overt catecholamine or steroid excess. Data are insufficient to make firm recommendations for or against surgery in patients with SCS. However, adrenalectomy may be considered when an adequate medical therapy does not reach the treatment goals of associated diseases potentially linked to hypercortisolism.

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“…It is mandatory to biochemically exclude a pheochromocytoma before FNAB is performed (74). Recommendations on the radiological assessment of adrenal incidentalomas are given in Table 4.…”

Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

456

412

View full text Add to dashboard Cite

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“…Adrenal biopsy is contraindicated for pheochromocytoma, because of the risk of a lethal crisis, as reported by Casola et al (1986). Careful biochemical and endocrinologic evaluation are indispensable in all patients with adrenal incidentaloma before puncture.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Biopsy for Adrenal Tumors Using Ultrasonically Guided Puncture.

Kojima

Saitoh

Itoh

et al. 1994

Tohoku J. Exp. Med.

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“…Ako postoji podatak o malignoj bolesti, treba pacijenta uputiti na pozitronsku emisijsku tomografiju (PET) ili razmotriti moguć-nost biopsije. U oba slučaja treba provesti biokemijsko testiranje da se isključi feokromocitom budući da su hemoragija i hipertenzivna kriza moguće komplikacije biopsije feokromocitoma 67,68 .Postupak s lezijama veličine 1 -4 cm ovisi o tome postoji li prethodna slikovna obrada te boluje li pacijent od maligne bolesti. Ako prethodna slikovna obrada ukazuje na stabilnu veliči-nu u razdoblju duljem od jedne godine, smatra se da je lezija benigna i ne zahtijeva daljnju obradu.…”

Section: Postupak S Novootkrivenom Lezijom Nadbubrežne žLijezdeunclassified

Computed tomography and magnetic resonance imaging of adrenal lesions

et al. 2017

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Sažetak.Od ranije je poznato kako učestalost ekspanzivnih lezija nadbubrežnih žlijezda na obdukcijama značajno nadilazi broj klinički potvrđenih adrenalnih lezija. Zbog sve učestalijeg korištenja slojevnih tehnika snimanja posljednjih godina otkriva se značajno veći broj suprarenalnih tvorbi koje zahtijevaju karakterizaciju i endokrinološku obradu. Većina tih lezija su nefunkcionalni (silentni) adenomi, tzv. incidentalomi, no potrebna je slikovna karakterizacija lezija kako bi se isključio maligni tumor i odredili daljnji terapijski postupci. U radu prikazujemo pregled literature o slikovnoj dijagnostici najčešćih benignih i malignih lezija nadbubrežnih žlijezda, s fokusom na kompjutoriziranu tomografiju i magnetsku rezonanciju s prikazom primjera iz vlastite kliničke prakse. U nastavku prikazujemo algoritam temeljen na preporukama ACR-a (American College of Radiology) i algoritmu koji je sastavio Incidental Findings Committee o optimalnom odabiru slikovne metode i daljnjim postupcima s novootkrivenim lezijama nadbubrežnih žlijezda.Ključne riječi: adenom; incidentalom; nadbubrežne žlijezde; slikovne metode Abstract. The incidence of adrenal lesions on autopsy significantly overcomes the number of clinically diagnosed adrenal lesions. Due to increasing use of cross-sectional imaging in the past few years, a significantly higher number of adrenal lesions is detected, which require characterisation and endocrinological workup. Although a majority of these lesions are nonfunctional (silent) adenomas, imaging characterisation is required to exclude malignant process and determine further management. In this article we present the review of current litterature on imaging of benign and malignant adrenal lessions, with emphassis on computed tomography (CT) and magnetic resonance imaging (MRI) characteristics, presenting images from our clinical practice. Furthermore, we present the algorithm based on the recommendations of American College of Radiology Incidental Findings Committee on how to select optimal imaging method and further management of adrenal lesions.

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Unsuspected pheochromocytoma: risk of blood-pressure alterations during percutaneous adrenal biopsy.

Cited by 147 publications

References 0 publications

AME Position Statement on adrenal incidentaloma

AME Position Statement on adrenal incidentaloma

Percutaneous Biopsy for Adrenal Tumors Using Ultrasonically Guided Puncture.

Computed tomography and magnetic resonance imaging of adrenal lesions

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