The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas

Humbert, Anne-Laure; Lecoanet, Guillaume; Moog, Sophie; Bouderraoui, Fehd; Bresler, L.; Vignaud, Jean-Michel; Chevalier, E.; Brunaud, Laurent; Klein, Marc; Cuny, Thomas

doi:10.1007/s12020-018-1522-7

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…In contrast, only 9.1 % of cortisol secreting adenoma were lipid-rich in our study. Similar observations were made in two studies from France, one reporting 12 % (3/25) and another reporting 20.6 % (7/34) of cortisol-secreting ACA having a basal HU of < 10 [23,24]. In a clinicopathological correlation study, unlike aldosterone-secreting ACA that were characterized by lipid-rich clear cells, most of cortisol-secreting ACA were characterized by the presence of granule cells [25].…”

Section: Discussionsupporting

confidence: 80%

“…Similarly, a patient of ACA with poor washout characteristics had a lesion SUVmax of 6.7, which was indicative of its benign nature. Also, higher FDG uptake has been observed in cortisol-secreting ACA in comparison to non-secreting ones [23].…”

Section: Discussionmentioning

confidence: 91%

“…Hence, basal attenuation of < 10 HU has less diagnostic sensitivity for cortisol secreting ACA. However, a baseline attenuation of < 10 HU excludes ACC, irrespective of secretory status, and can be useful to differentiate ACA, including a small proportion of cortisol-secreting ones, with this radiological characteristic (10-20 %) from ACC [23,24,26].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Spectrum of Adrenal Cushing’s Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience

Gosavi¹,

Lila²,

Memon³

et al. 2022

Horm Metab Res

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To describe the differences in presentation, biochemistry, and radiological evaluation of various etiologies of adrenal Cushing’s syndrome (CS) from a single center. To emphasize caution for interpretation of plasma adrenocorticotropic hormone (ACTH), as a spuriously unsuppressed ACTH level by immunometric assay may lead to therapeutic misadventures in adrenal CS. Design: Retrospective, single-center, observational study. Methods: Fifty-eight adrenal CS patients [Adrenocortical carcinoma (ACC), n=30; Adenoma (ACA), n=15; Primary pigmented nodular adrenocortical disease (PPNAD), n=10; ACTH independent macronodular adrenal hyperplasia (AIMAH), n=3) evaluated at a tertiary care center in western India between January 2006 to March 2020 were included. Data on demography, clinical evaluation, biochemistry, imaging, management, histopathology, and outcome were recorded in a standard format and analyzed. Results: Cortisol secreting ACC presented at 38(1–50) years with abdominal mass in 26/30 (86.7%) and 16/30 (53.3%) had metastases at presentation. ACA with autonomous cortisol excess presented at 25(4.9–40) years with discriminating features of CS in 14/15 (93.3%), sex steroid production in 2/15, unenhanced HU <10 in only one, and relative washout >40% in 8/11 (72.7%). One ACA and eight ACC patients had plasma ACTH (by Siemens Immulite assay) > 20 pg/ml, despite hypercortisolemic state. Conclusions: Cortisol-secreting ACC and ACA most often present with mass effects and florid CS, respectively. Baseline HU has low sensitivity to differentiate cortisol-secreting ACA from ACC. Plasma ACTH measured by Seimens Immulite is often unsuppressed, especially in ACC patients, which can be addressed by measuring ACTH by more accurate assays.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Clinical Spectrum of Adrenal Cushing’s Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience

Gosavi¹,

Lila²,

Memon³

et al. 2022

Horm Metab Res

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“…Over the past years, PET/CT examinations have marked a step forward regarding localization, relapse, and assessment of the aggressiveness of the disease. Recent studies also suggest that PET/CT may, in certain circumstances, yield information about the functional status of an adrenal lesion, especially in case of cortisolsecreting lesions [17].…”

Section: Discussionmentioning

confidence: 99%

“…The synthesis of catecholamines and their subsequent secretion in PHEO, albeit heterogeneous, are likely to occur in all parts of the tumor, so that whether the SUV max is a reliable tool for predicting the capacity of the tumor to secrete catecholamines is questionable. Until now, the SUV max has mostly been used to predict the malignancy or proliferative activity [17,22,23] rather than the secretion status of different types of tumors -including adrenal cortical tumors, in which it strongly correlates with the definitive histopathological Weiss score system [24].…”

Section: Discussionmentioning

confidence: 99%

18F-FDOPA PET/CT Uptake Parameters Correlate with Catecholamine Secretion in Human Pheochromocytomas

Moog¹,

Houy²,

Chevalier³

et al. 2018

Neuroendocrinology

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Background: ¹⁸F-FDOPA positron emission tomography/computed tomography (PET/CT) is a sensitive nuclear imaging technology for the diagnosis of pheochromocytomas (PHEO). However, its utility in determining predictive factors for the secretion of catecholamines remains poorly studied. Methods: Thirty-nine histologically confirmed PHEO were included in this retrospective single-center study. Patients underwent ¹⁸F-FDOPA PET/CT before surgery, with an evaluation of several uptake parameters (standardized uptake values [SUV_max and SUV_mean] and the metabolic burden [MB] calculated as follows: MB = SUV_mean × tumor volume) and measurement of plasma and/or urinary metanephrine (MN), normetanephrine (NM), and chromogranin A. Thirty-five patients were screened for germline mutations in the RET, SDHx, and VHL genes. Once resected, primary cultures of 5 PHEO were used for real-time measurement of catecholamine release by carbon fiber amperometry. Results: The MB of the PHEO positively correlated with 24-h urinary excretion of NM (r = 0.64, p < 0.0001), MN (r = 0.49, p = 0.002), combined MN and NM (r = 0.75, p < 0.0001), and eventually plasma free levels of NM (r = 0.55, p = 0.006). In the mutated patients (3 SDHD, 2 SDHB, 3 NF1, 1 VHL, and 3 RET), a similar correlation was observed between MB and 24-h urinary combined MN and NM (r = 0.86, p = 0.0012). For the first time, we demonstrate a positive correlation between the PHEO-to-liver SUV_max ratio and the mean number of secretory granule fusion events of the corresponding PHEO cells revealed by amperometric spikes (p = 0.01). Conclusion: While the ¹⁸F-FDOPA PET/CT MB of PHEO strongly correlates with the concentration of MN, amperometric recordings suggest that ¹⁸F-FDOPA uptake could be enhanced by overactivity of catecholamine exocytosis.

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Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) on diagnosis of Cushing's syndrome

Tabarin

Assié

Barat

et al. 2022

Annales d'Endocrinologie

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The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas

Abstract: The relative adrenal WO analysis consolidates the benign nature of an ACA, especially in case of cortisol oversecretion, a condition known to compromise the diagnostic accuracy of the 10 HU unenhanced CT attenuation threshold.

Cited by 9 publications

References 26 publications

Clinical Spectrum of Adrenal Cushing’s Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience

Clinical Spectrum of Adrenal Cushing’s Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience

18F-FDOPA PET/CT Uptake Parameters Correlate with Catecholamine Secretion in Human Pheochromocytomas

Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) on diagnosis of Cushing's syndrome

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