Adrenal findings in FDG-PET: analysis of a cohort of 1021 patients from a cancer center

Abstract

Purpose: The use of FDG-PET/TC for cancer staging has been leading to the increasing diagnosis of adrenal lesions, which usually represent a clinical challenge. Our aim was to characterize the adrenal lesions found in FDG-PET of patients followed in a cancer center.Methods: Retrospective analysis of all FDG-PET studies performed in our center in the last 10 years. Exams reporting adrenal lesions in the CT component and/or anomalous adrenal FDG uptake were selected. Cases were characterized regarding clinical, laboratorial, imaging and pathological ndings.Results: We identi ed 27,427 FDG-PET studies. Of those, 7.6% evidenced adrenal ndings. We included 1364 exams corresponding to 1021 patients. Only 15.6% were referred to the endocrinology department and 38% of the lesions were not studied.Malignant lesions were present in 38.9% of the studied patients: metastases in 37.5%, carcinoma in 1.2% and other malignant tumors in 0.4%. Median SUVmax of malignant lesions was signi cantly higher than the SUVmax of the benign ndings (p<0.05). We also observed a higher median SUVmax in adrenal metastases than in adenomas (p<0.05). There was a tendency for higher SUVmax of adrenal carcinomas when comparing with other malignant lesions (p=0.066). The median SUVmax was not different between pheochromocytomas and other tumors (p>0.05).Conclusion: Occult adrenal lesions discovered during FDG-PET/CT are common in cancer context and are frequently benign. SUVmax may be a useful tool in the workup of adrenal lesions but with several important caveats.

Endocrinology application of molecular imaging: current role of PET/CT

“…Adrenal incidentaloma is a term used to describe focal adrenal lesions discovered unexpectedly during abdominal imaging conducted for reasons unrelated to adrenal evaluation (prevalence of about 4-10%) [55]. In patients without a known malignancy, the likelihood of these incidentalomas being cancerous is generally low and are often asymptomatic [55].…”

“…Pheochromocytomas typically present with symptoms related to the excessive secretion of catecholamines. Diagnosis can be confirmed through serum or urine metanephrines measurement [55]. Imaging plays a crucial role in identifying and assessing these tumors.…”

COVID-19, diabetes mellitus type 2, endocrine genetics, and pituitary and adrenal diseases

“…Publishing on pituitary and adrenal diseases forms, of course, a major part of any journal dedicated to endocrinology. The present issue of Hormones contains highly interesting and important articles on growth hormone excess and acromegaly [16][17][18] and on adrenal diseases and their diagnoses [19][20][21][22].…”