Adrenal Tumors - Diagnostics and the Factual Situation

Krajewska, Ewa; Toutounchi, Sadegh; Fiszer, Patryk; Cieśla, Witold; Pogorzelski, Ryszard; Bednarczuk, Tomasz; Cieszanowski, Andrzej; Łoń, Izabela; Skórski, Maciej

doi:10.2478/v10035-012-0034-z

Cited by 2 publications

(3 citation statements)

References 9 publications

(1 reference statement)

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“…However, in a systematic screening approach, ultrasound could be considered as a less invasive examination, with correct performances. According to Krawjeska et al (26), its specificity considering adrenal gland evaluation is estimated at 92%, whereas its sensitivity is estimated at 76%, lower in case of left-sided tumors, those <2 cm in diameter, and in obese patients. In this study, two out of the 27 ultrasounds were positive -one case of secreting PHEO (patient 2) and one case of non-secreting PHEO (patient 7).…”

Section: :4mentioning

confidence: 99%

Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1

Képénékian

Mognetti

Lifante

et al. 2016

European Journal of Endocrinology

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Objective: Pheochromocytoma (PHEO) may occur in 0.1-5.7% of patients presenting with a neurofibromatosis type 1 (NF1). Current recommendations are to explore only symptomatic patients. The objective of the study is to evaluate the prevalence and the interest of a systematic PHEO screening in this population. Design: A prospective study in a French tertiary center including consecutive NF1 patients older than 18 years. Methods: A systematic screening combining abdominal imaging and urinary fractionated metanephrines was proposed. In case of positivity of one or both exams, 123 I-metaiodobenzylguanidine scintigraphy or [ 18 F]-fluoro-dihydroxyphenylalanine PET imaging was performed. The diagnosis of secreting PHEO was retained in case of elevated urinary metanephrines associated with positive scintigraphy and non-secreting PHEO when urinary metanephrines were normal with a positive scintigraphy. Results: Between January 2014 and August 2015, 234 patients were included and 156 patients (66.7%) completed both exams. In these 156 patients, 12 PHEOs were diagnosed, representing a prevalence of 7.7%. Of these, six PHEOs were secreting, with only two symptomatic patients. The tumor size of these PHEOs were bigger than that of non-secreting PHEO (25.2 ± 6.6 vs 14 ± 6.9 mm, P = 0.0165). One lesion was bilateral. Mean metanephrine and normetanephrine levels were 3.2 ± 2.6 N and 2.8 ± 1 N respectively. Three patients underwent surgery. The six patients with non-secreting PHEO were asymptomatic. One of them had bilateral lesion and one underwent surgery. Conclusions: PHEO in NF1, whether or not secreting, are mostly asymptomatic. The current strategy to explore only symptomatic patients leads to an underestimation of prevalence with the risks inherent to the existence of an unrecognized PHEO.

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Section: :4mentioning

confidence: 99%

Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1

Képénékian

Mognetti

Lifante

et al. 2016

European Journal of Endocrinology

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“…It is vital to bear in mind that in spite of the huge progress in imaging examinations, in a number of cases the diagnosis of "non-adenomatous" lesions is possible only after surgery, in the course of histopathological tests [14,15].…”

Section: Adrenal Biopsymentioning

confidence: 99%

“…Podstawową interpretację wyników badań obrazowych przedstawiono w tabeli III. Należy pamiętać, że pomimo wielkiego postępu w badaniach obrazowych, w wielu przypadkach dokładne rozpoznanie zmian typu "nie-gruczolaki" jest możliwe dopiero po operacji podczas badania histopatologicznego [14,15].…”

Section: Biopsja Nadnerczyunclassified

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

Bednarczuk

Bolanowski

Sworczak

et al. 2016

Endokrynologia Polska

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Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations. Methods: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations. Imaging and hormonal assessment: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia. Treatment: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases. (Endokrynol Pol 2016; 67 (2): 234-258)

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Adrenal Tumors - Diagnostics and the Factual Situation

Cited by 2 publications

References 9 publications

Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1

Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

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