Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis

BACKGROUND: In most cases adrenal tumours are detected by accident while performing medical imaging tests for other diseases. These findings are treated as adrenal incidentaloma. Prevalence of incidentalomas detected on CT scans is up to 4%. According to different authors, 4–12% of all adrenal tumours are adrenocortical carcinomas. As for today, the most significant medical imaging technique is CT scan with bolus IV injection of contrast agent and assessment of tumour’s density. The analysis of the results of CT imaging in 67 patients with ACC was carried out according to a single protocol. The main signs characteristic of this disease are described. It is very important to evaluate typical signs of ACC on CT scans for risk assessment of ACC before surgical treatment. If malignant tumour is suspected during preoperative examination, it is extremely important to choose the right surgical treatment strategy.AIM: To evaluate the significance of CT as the main method of preoperative diagnosis in patients with malignant tumors of the adrenal cortex. Studying CT semiotics of adrenocortical cancer in a large group of patients using a single standard imaging protocol. Find the main radiological symptoms characteristic of adrenocortical cancerMATERIALS AND METHODS: Here are the results of retrospective study of CT scans performed on 67 patients with adrenocortical carcinoma who received treatment in the Department of Endocrine Surgery of Saint-Petersburg State University N.I. Pirogov Clinic of High Medical Technologies during 2012–2020. The diagnostic significance of CT in patients with ACC was assessed.RESULTS: The most common features of ACC: tumour heterogeneity (84.3%), tumour’s size 3–9 cm (75%), signs of invasion into surrounding structures (10%), pre-contrast density above +30 HU (75%), absolute contrast washout less than 60% (68.8%), relative contrast washout less than 40% (64.6%)CONCLUSION: CT scan with IV contrast was not able to show any definitive pathognomonic signs of ACC. Nevertheless, CT scan should be performed in all patients with suspected (or confirmed using other medical imaging technique) adrenal tumour according to standard protocol. Bolus injection of contrast agent should be performed in all patients with tumour’s pre-contrast density above +5 HU.

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Diagnostic value of ct in examination of patients with adrenal cancer

Rusakov

Shcherbakov

Чинчук

et al. 2022

Probl Endokrinol (Mosk)

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Difficulties and missteps of diagnosis and surgical treatment of patient with multifocal metachronic carcinoma associated with primary hyperparathyroidism

Sergiiko,

Korotovskii,

Lukyanov

et al. 2023

Endo Serg

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We present a clinical case of a patient with metachronous primary multiple carcinoma of left kidney (2004) with left adrenal metastasis (2021), occult low-grade follicular thyroid carcinoma with lateral neck lymph node metastasis (2019), central lung cancer (2020), primary hyperparathyroidism with coherent parathyroid adenomas with intrathyroid and typical location.Patient had undergone left-side nephrectomy with bilateral adrenalectomy, double-staged thyroidectomy with parathyroidectomy and selective lateral neck dissection and right-side pulmonectomy with 4 sessions of chemotherapy. Almost 20 years after first operation patient has no signs of tumors recurrence. In addition, patient is undergoing hormone replacement therapy (HRT) of adrenal insufficiency and thyroid hormone suppression therapy.This case represents combination of non-hereditary endocrine neoplasms with multiple carcinomas. It also examples mistakes and difficulties of differential diagnosis of primary adrenal tumors and adrenal metastasis.

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Diagnostic algorithm of the subclinical forms of adrenal neoplasms

Blyumina

Григорьевна²,

Romashchenko

et al. 2021

Bulletin of the Russian Military Medical Academy

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The possibility of modifying the existing diagnostic algorithm of latent forms of hormone-active and potentially malignant formations in the adrenal glands using modern methods of laboratory diagnostics and radiation imaging is substantiated. In the clinic of a faculty of surgery and on its clinical base, experience in the examination and treatment of 1457 patients with various formations of the adrenal glands has been accumulated. Among them, 270 (14.9%) patients were selected, in whom precursor hormones of steroidogenesis and metabolites of catecholamines in the blood plasma were specially studied by high-performance liquid chromatography, tumor marker measurement, and three-phase computed tomography with intravenous contrast enhancement. Determination of steroidogenesis precursor hormones and catecholamine metabolites in the blood plasma by high-performance liquid chromatography in combination with traditional methods of laboratory diagnostics, use of computed tomography with intravenous contrast enhancement, construction of multiplanar reconstructions, and postprocessor image processing are the basis of a modified algorithm for verification of latent forms of hormone-active and potentially malignant tumors of the adrenal glands. The implementation of the diagnostic algorithm developed in the clinic made early diagnosis of the subclinical forms of NP neoplasms possible, as well as ensure the implementation of minimally invasive surgical interventions before the development of endocrine and metabolic disorders and consequently prevent the development of intraoperative and postoperative complications, which thereby reduce the duration of rehabilitation and disability of patients with good long-term treatment results and high quality of life.

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Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis

Cited by 4 publications

References 38 publications

Diagnostic value of ct in examination of patients with adrenal cancer

Diagnostic value of ct in examination of patients with adrenal cancer

Difficulties and missteps of diagnosis and surgical treatment of patient with multifocal metachronic carcinoma associated with primary hyperparathyroidism

Diagnostic algorithm of the subclinical forms of adrenal neoplasms

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