Adrenal Incidentaloma

Sherlock, Mark; Scarsbrook, Andrew; Abbas, Afroze; Fraser, Sheila; Limumpornpetch, Padiporn; Dineen, Rosemary; Stewart, Paul M.

doi:10.1210/endrev/bnaa008

Cited by 167 publications

(248 citation statements)

References 370 publications

(405 reference statements)

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“…Furthermore, only 11% of the reported cases of sarcomatoid ACC are functioning. On the other hand, ACC accounts for less than 2% of adrenal incidentalomas [ 5 , 193 ]. The rate of malignancy depends on size of the tumour [ 190 ].…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

Lam

2021

Biomedicines

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Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients’ prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.

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Section: Clinical Perspectivesmentioning

confidence: 99%

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

Lam

2021

Biomedicines

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“…While 11-deoxycorticosterone, progesterone and estradiol were significantly different in both males and females, aldosterone was lower in males, but 17 OH-progesterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS) and testosterone were higher in females [ 46 ]. Respecting serum steroid measurements variability because of the diurnal variation, a diagnostic preference was given to urinary steroid metabolomics examinations [ 56 ].…”

Section: Steroid Metabolome Profilingmentioning

confidence: 99%

“… Overview of normal steroidogenesis and urinary steroid metabolites i.e., “malignant steroid fingerprint” indicative of adrenocortical carcinoma [ 56 , 68 , 69 , 70 ]. …”

Section: Figurementioning

confidence: 99%

The Role of Biomarkers in Adrenocortical Carcinoma: A Review of Current Evidence and Future Perspectives

2021

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Adrenocortical carcinoma (ACC) is a rare endocrine malignancy arising from the adrenal cortex often with unexpected biological behavior. It can occur at any age, with two peaks of incidence: in the first and between fifth and seventh decades of life. Although ACC are mostly hormonally active, precursors and metabolites, rather than end products of steroidogenesis are produced by dedifferentiated and immature malignant cells. Distinguishing the etiology of adrenal mass, between benign adenomas, which are quite frequent in general population, and malignant carcinomas with dismal prognosis is often unfeasible. Even after pathohistological analysis, diagnosis of adrenocortical carcinomas is not always straightforward and represents a great challenge for experienced and multidisciplinary expert teams. No single imaging method, hormonal work-up or immunohistochemical labelling can definitively prove the diagnosis of ACC. Over several decades’ great efforts have been made in finding novel reliable and available diagnostic and prognostic factors including steroid metabolome profiling or target gene identification. Despite these achievements, the 5-year mortality rate still accounts for approximately 75% to 90%, ACC is frequently diagnosed in advanced stages and therapeutic options are unfortunately limited. Therefore, imperative is to identify new biological markers that can predict patient prognosis and provide new therapeutic options.

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“…The findings on CT scans were evaluated by radiologists at each institution. An apparent nodule on a CT scan was deemed to be a nodule if it was greater than or equal to 10 mm in diameter following a previous report (15). The appearance was determined to be bilateral normal if the size of the nodule or thickness of adrenal gland was less than 10 mm on both sides.…”

Section: Adrenal Lesions On Image Inspectionmentioning

confidence: 99%

Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?

et al. 2021

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IntroductionSome aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral.ObjectiveTo clarify the clinical need for AVS in PA patients without apparent ATs, taking into consideration the rates of adrenalectomy.MethodsThis is a retrospective cross-sectional study assessing 1586 PA patients without apparent ATs in the multicenter Japan PA study (JPAS). We analyzed which parameters could be used to distinguish unilateral PA patients without apparent ATs from bilateral patients. We also analyzed the prevalences of adrenalectomy in unilateral PA patients.ResultsThe unilateral subtype without an apparent AT was diagnosed in 200 (12.6%) of 1586 PA patients. Being young and female with a short hypertension duration, normokalemia, low creatinine level, low plasma aldosterone concentration, and low aldosterone-to-renin ratio (ARR) was significantly more common in bilateral than unilateral PA patients. If PA patients without apparent ATs were female and normokalemic with a low ARR (<560 pg/ml per ng/ml/h), the rate of unilateral PA was only 5 (1.1%) out of 444. Moreover, 77 (38.5%) of the 200 did not receive adrenalectomy, despite being diagnosed with the unilateral subtype based on AVS.ConclusionThe low prevalence of the unilateral subtype in PA patients without apparent ATs suggests AVS is not indicated for all of these patients. AVS could be skipped in female normokalemic PA patients without apparent ATs if their ARRs are not high. However, AVS should be considered for male hypokalemic PA patients with high ARRs because the rates of the unilateral subtype are high in these patients.

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Adrenal Incidentaloma

Cited by 167 publications

References 370 publications

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

The Role of Biomarkers in Adrenocortical Carcinoma: A Review of Current Evidence and Future Perspectives

Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?

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