Clinical Utility of Noncontrast Computed Tomography Attenuation Value (Hounsfield Units) to Differentiate Adrenal Adenomas/Hyperplasias from Nonadenomas: Cleveland Clinic Experience

Hamrahian, Amir H.; Ioachimescu, Adriana G.; Remer, Erick M.; Motta-Ramírez, Gaspar Alberto; Bogabathina, Hari; Levin, Howard S.; Reddy, S. Sethu K.; Gill, Inderbir S.; Siperstein, Allan; Bravo, Emmanuel L.

doi:10.1210/jc.2004-1627

Cited by 241 publications

(178 citation statements)

References 67 publications

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“…To test the effectiveness of the different proposed cortisol cut-off after the 1-mg DST by using Bayesan analysis we had to define a priori the probability of autonomous cortisol secretion based on observed alterations in the tests used to assess the function of the HPA axis. We acknowledge that such a definition is arbitrary, but the presence of at least two alterations of the HPA axis has been widely used in previous work (14,22,23,24). Our data confirm that only a cut-point at 138 nmol/l achieves an incremental diagnostic effectiveness to detect functional adrenal autonomy.…”

Section: Discussionsupporting

confidence: 61%

“…an adrenal mass detected serendipitously by an imaging work-up performed for the evaluation of unrelated diseases in patients without clear signs or symptoms suggestive of adrenal disease), exclusion criteria a priori were severe or paroxysmal arterial hypertension, hypokalemia (<3.5 mEq/L), clinical signs of hypercortisolism or hyperandrogenism, and patients with previous or current history of malignancies known to metastasize commonly in the adrenal glands (4,12). When not histologically proven, the diagnosis of cortical adenoma rested on the following computed tomography (CT) criteria: size less than 6.0 cm, regular shape with well-defined margins, homogenous and hypodense content (13,14). The diagnosis of adenoma was confirmed by a repeat CT scan after 6 months showing no significant increase in mass size, or change in mass density, in any patient (4,12).…”

Section: Subjectsmentioning

confidence: 99%

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Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Reimondo

Allasino

Bovio

et al. 2011

J Endocrinol Invest

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The results of dexamethasone suppression tests (DST) in the screening of subclinical hypercortisolism are not readily comparable. Aim of the present study was to review the effectiveness of the overnight 1-mg DST and 8-mg DST to look for functional autonomy of clinically inapparent adrenal adenomas.Sixty-eight consecutive patients with clinically inapparent adrenal adenomas were enrolled. All patients underwent 1-mg DST. The 8-mg DST was performed in the 11 patients who had post 1-mg DST cortisol >138 nmol/L and in 11 patients who had post 1-mg DST cortisol between 50 -138 nmol/L. The a priori probability to have autonomous cortisol secretion was defined by the presence of at least two alterations of the HPA axis among reduced ACTH concentrations, elevated UFC or elevated midnight serum cortisol. Cortisol levels > 138 nmol/L after the 1-mg DST increases the post-test probability of adrenal functional autonomy to 55%, whereas cortisol levels <50 nmol/L reduce the post-test probability to 8%. Cortisol levels recorded after the 8-mg DST were non-significantly lower than after the 1-mg DST and all the patients with cortisol >138 nmol/L after the 1 mg DST maintained cortisol above this cut-point.The 1-mg DST should be considered as the more effective test to detect autonomous cortisol secretion by a clinically inapparent adrenal adenoma when cortisol levels are >138 nmol/l, while cortisol levels < 50 nmol/L reduces remarkably the post-test probability of this event. The 8-mg DST seems to replicate by large the results of the 1-mg DST.4

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Section: Discussionsupporting

confidence: 61%

Section: Subjectsmentioning

confidence: 99%

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Reimondo

Allasino

Bovio

et al. 2011

J Endocrinol Invest

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“…A number of studies have shown that the unenhanced CT attenuation value is the most reliable tool in the differentiation of benign and malignant lesions (7,16). Adrenocortical adenomas are usually rich in lipids and show low attenuation values, whereas high-density masses are suspected for malignancy.…”

Section: Discussionmentioning

confidence: 99%

The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations?

Kaštelan

Kraljević

Dušek

et al. 2015

European Journal of Endocrinology

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Objective: The current guidelines for the management of adrenal incidentaloma advise hormonal and radiological follow-up of patients for 2-5 years after the initial diagnosis. However, the vast majority of adrenal incidentaloma are non-functional benign cortical adenomas that require no treatment, so the routine application of the current strategies often results in a number of unnecessary biochemical and radiological investigations. The aim of this study was to analyse the clinical course of patients with adrenal incidentaloma and to provide a critical review of the current management strategy of the disease. Design and methods: This was a retrospective study performed in the Croatian Referral Center for adrenal gland disorders. The study included 319 consecutive patients with adrenal incidentaloma, 174 of which were followed for at least 24 months. Results: The vast majority of patients were diagnosed with benign adrenal masses, whereas in about 5% of them adrenal tumor corresponded to adrenal carcinoma or metastasis. Tumor density was found to be superior to tumor size in distinguishing benign adrenal masses from malignant tumors and pheochromocytomas. During the follow-up, no patient demonstrated a clinically significant increase in tumor size. In addition, no changes, either in metanephrines and normetanephrines or in the activity of renin-aldosterone axis, were observed during the follow-up. Six patients developed subclinical Cushing's syndrome (SCS) whereas eight patients with SCS showed biochemical remission during follow-up. Conclusion: The study suggests that the risk of an adrenal mass initially diagnosed as benign and non-functional becoming malignant or hormonally active is extremely low. Therefore, the clinical management of those patients should be tailored on an individual basis in order to avoid unnecessary procedures.

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“…Her urinary metanephrines were repeatedly negative on two collections (0.86 µg/mg creatinine and 0.8 µg/mg creatinine; normal value: < 1.0 µg/mg creatinine). However, computerized tomography of the abdomen showed a rightsided adrenal mass; non-contrast images revealed a density of 36 Hounsfield units, findings that are highly suggestive for a pheochromocytoma (11). Moreover, this mass was also positive on MIBG scintigraphy.…”

Section: Sequence Analysismentioning

confidence: 93%

Molecular analysis of the Von Hippel-Lindau (VHL) gene in a family with non-syndromic pheochromocytoma: the importance of genetic testing

Cruz

Fernandes

Clara

et al. 2007

Arq Bras Endocrinol Metab

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The two index patients of the family analyzed in this study had undergone bilateral adrenalectomy for pheochromocytomas. This prompted genetic analyses of the probands and seven first-degree relatives. The two pheochromocytoma patients and two additional asymptomatic family members were found to harbor a mutation c496G>T in exon 3 of the VHL gene. The family was then lost to systematic follow-up. Three years after performing the initial genetic evaluation, the sister of the probands, who was known to carry the same VHL germline mutation, was referred to our service after a pregnancy that was complicated by preeclampsia. She reported paroxysms suggestive for pheochromocytoma, but her urinary metanephrines were negative. However, computerized tomography of the abdomen showed an adrenal mass that was also positive on metaiodobenzylguanidine (MIBG) scintigraphy. This study illustrates that molecular analysis of the index patient(s) can lead to the identification of presymptomatic relatives carrying the mutation. Moreover, despite negative urinary metanephrines, the identification of a specific mutation has led to an increased suspicion and detection of a pheochromocytoma in the sister of the probands. Dois pacientes índices da família analisada neste estudo foram submetidos a adrenalectomia bilateral devido a feocromocitoma. Foi, então, realizado o estudo genético dos pacientes e de sete parentes de primeiro grau. Os dois pacientes com feocromocitoma e dois outros membros assintomáticos da família apresentaram a mutação c496G>T no exon 3 do gene VHL. A família perdeu seguimento médico. Três anos após a realização da avaliação genética, a irmã dos pacientes, portadora da mutação, foi encaminhada para o nosso serviço após uma gestação complicada por pré-eclampsia. Ela referia paroxismos sugestivos de feocromocitoma, mas as metanefrinas urinárias eram negativas. Entretanto, a tomografia computadorizada de abdômen evidenciou uma massa adrenal que também se contrastou na cintilografia com metaiodobenzilguanidina (MIBG). Esse estudo mostra que a análise molecular do paciente índice pode levar à identificação de parentes assintomáticos portadores da mutação. Além disso, mesmo com as metanefrinas urinárias negativas, a identificação de uma mutação específica levou a um aumento da suspeita e detecção de feocromocitoma na irmã dos afetados pela doença.

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Clinical Utility of Noncontrast Computed Tomography Attenuation Value (Hounsfield Units) to Differentiate Adrenal Adenomas/Hyperplasias from Nonadenomas: Cleveland Clinic Experience

Cited by 241 publications

References 67 publications

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations?

Molecular analysis of the Von Hippel-Lindau (VHL) gene in a family with non-syndromic pheochromocytoma: the importance of genetic testing

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