18F-fluorodeoxyglucose positron emission tomography as a diagnostic tool for malignancy of adrenocortical tumours? Preliminary results in 13 consecutive patients

Computed tomography (CT; unenhanced, followed by contrast-enhanced examinations) is the cornerstone of imaging of adrenal tumours. Attenuation values of !10 Hounsfield units on an unenhanced CT are practically diagnostic for adenomas. When lesions cannot be characterised adequately with CT, magnetic resonance imaging (MRI) evaluation (with T1-and T2-weighted sequences and chemical shift and fat-suppression refinements) is sought.

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“…www.endocrinology-journals.org uptake in adrenal adenomas (Tenenbaum et al 2004) but they have shown uptake in adrenal metastases Fig. 6).…”

Section: Ilias Et Al: Imaging Of Adrenal Tumoursmentioning

confidence: 99%

The optimal imaging of adrenal tumours: a comparison of different methods

Ilias

Sahdev²,

Reznek³

et al. 2007

Endocr Relat Cancer

234

162

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“…The quantitative analysis of FDG uptake is performed using standardized uptake values (SUV) or by qualitative visual evaluation with respect to liver uptake. The sensitivity of FDG-PET in identifying malignant lesions varied between 93 and 100% with a specificity between 80 and 100% (54)(55)(56)(57)(58). Necrotic or hemorrhagic malignant adrenal lesions may cause false-negative results showing poor FDG uptake.…”

Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

449

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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“…Thus, (18)-FDG PET scan appears to distinguish between benign and malignant adrenal tumors (Becherer et al 2001, Maurea et al 2001, Tenenbaum et al 2004. This simple, non-traumatic imaging procedure also participates in the extension work-up (Leboulleux et al 2006).…”

Section: Imaging Investigationsmentioning

confidence: 99%

Adrenocortical cancer: pathophysiology and clinical management

Libé¹,

Fratticci²,

Bertherat³

2007

Endocr Relat Cancer

236

159

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Adrenocortical cancer (ACC) is a rare tumor with a poor prognosis. By contrast, benign adrenocortical tumors are frequent, underlying the importance of a correct diagnosis of malignancy of such tumors. ACC can be diagnosed by the investigation of endocrine signs of steroid excess, symptoms due to tumor growth or an adrenal incidentaloma. Hormonal investigations demonstrate in most ACC steroid oversecretion, the dominant characteristics being a co-secretion of cortisol and androgens. Imaging by CT-scan or MRI shows a large heterogeneous tumor with a low fat content. Careful pathological investigation with the assessment of the Weiss score is important for the diagnosis of malignancy. Molecular markers can also be helpful and in the future might be important for prognosis. Tumors localized to the adrenal gland (McFarlane stages 1 and 2) have a better outcome than invasive and metastatic tumors (stages 3 and 4). Tumor removal by a specialized team is crucial for treatment and should always aim at complete removal. In patients with metastatic or progressive disease, medical treatment is started with mitotane that requires a close monitoring of its blood level. Surgery is indicated when possible for local recurrence but also in some cases of metastasis. Local treatment (radiofrequency, chemoembolization, and radiation therapy) can have some indications for metastatic disease. In patients with disease progression cytotoxic chemotherapy can be used. Despite the best care, the overall prognosis of ACC is poor with a 5-year survival rate below 30% in most series. Therefore, progress in the understanding of the pathophysiology of ACC is important. Despite the rarity of ACC, significant advances have been made in the understanding of its pathogenesis the last decade. These progresses came mainly from the study of the genetics of ACC, both at the germline level in rare familial diseases, and at the somatic level by the study of molecular alterations in sporadic tumors. These advances underline the importance of genetic alterations in ACC development and point-out to various chromosomal regions (2, 11p15, 11q, 17p13) and genes (IGF-II, p53, b-catenin, ACTH receptor). This review will summarize these advances as well as the current clinical management of ACC.

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18F-fluorodeoxyglucose positron emission tomography as a diagnostic tool for malignancy of adrenocortical tumours? Preliminary results in 13 consecutive patients

Cited by 58 publications

References 10 publications

The optimal imaging of adrenal tumours: a comparison of different methods

The optimal imaging of adrenal tumours: a comparison of different methods

AME Position Statement on adrenal incidentaloma

Adrenocortical cancer: pathophysiology and clinical management

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