Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography

Virkkala, Anu; Välimäki, Matti; Pelkonen, Risto; Huikuri, Kauko; Kahri, Arvi; Kivisaari, Leena; Korhonen, Timo; Salmi, Jorma; Seppälä, P

doi:10.1530/acta.0.1210067

Cited by 63 publications

(29 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some patients with normal hormonal function also showed mass enlargement and, in this respect, the possible risk of malignant transformation must always be considered. Many studies have suggested that the likelihood of malignant transformation at long-term follow-up is very small (14,17,19,20). We observed a conspicuous mass increase in one woman 6 months after diagnosis: adrenalectomy was performed to remove the lesion, which was identified as a primary non-Hodgkin's lymphoma.…”

Section: Discussionmentioning

confidence: 72%

“…We found an enlargement $ 1 cm in 20% of the cases, similar to two previous investigations (14,15) that reported an increase in tumor size in 17% and 15% of patients respectively. No mass enlargement was observed in two other small studies (17,18) while, in larger series, tumor growth was detected in a very low percentage of cases (3.3 -4.3%) (19,20). However, in one of these studies (20), the investigators obtained only indirect data from office records, or by telephone or mail contacts for most patients.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Long-term follow-up study of patients with adrenal incidentalomas

Libé

Dall’Asta

Barbetta

et al. 2002

European Journal of Endocrinology

203

143

View full text Add to dashboard Cite

Background: The incidence of adrenal incidentalomas has sharply increased in recent decades and concurrent subtle endocrine abnormalities, or even subclinical conditions, have been identified. Nonetheless, data concerning possible changes in adrenal size and/or hormonal pattern during follow-up are still inadequate. Objective: To evaluate long-term morphological and functional evolution of adrenal incidentalomas after initial diagnosis and to identify possible risk factors for hormonal hyperactivity and mass enlargement. Patients: Sixty-four patients (34 -79 years) were followed-up for 12-120 months (median 25.5 months). Initial computerized tomography scan showed a unilateral mass in 51 patients and bilateral lesions in 13 patients. Average mass diameter at diagnosis was 2:5^0:1 cm (range 1.0 -4.0). Twelve patients had subclinical Cushing's syndrome, 41 had mild hormonal alterations, and 11 had normal adrenal function at baseline. All patients were investigated by morphological and functional evaluation 6 and 12 months after diagnosis, and then at 1-year intervals. Results: During follow-up, a mass size increase $1 cm was observed in 13 patients, and 18 developed further subtle endocrine alterations. Cumulative risk of developing endocrine abnormalities was 17% at 1 year, 29% at 2 years, and 47% at 5 years. The risk was higher in the first 2 years of follow-up if the initial tumor diameter was $ 3 cm. Overall, cumulative risk of mass enlargement was 6% at 1 year, 14% at 2 years, and 29% at 5 years, and it was greater in patients with normal adrenal function than in those with subtle hormonal abnormalities ðP , 0:05Þ: One female subject showed a mass enlargement after 6 months of follow-up and was eventually diagnosed with non-Hodgkin's lymphoma. Conclusions: Patients with an adrenal incidentaloma are at risk for tumor growth and development of hormonal alterations. The risk of adrenal malignancy, although not elevated, also indicates the need for long-term follow-up.

show abstract

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 96%

Long-term follow-up study of patients with adrenal incidentalomas

Libé

Dall’Asta

Barbetta

et al. 2002

European Journal of Endocrinology

203

143

View full text Add to dashboard Cite

show abstract

“…4 Most studies evaluating the natural history and long-term outcome of AIs were small and retrospective. [171][172][173][174][175][176][177][178][179] A multicenter Swedish prospective study involving 229 patients with AIs with a median follow-up period of 25 months (range 3-108 months) demonstrated an increase in size of ≥0.5 cm in 7.4% The percentage of AIs developing hyperfunction during follow-up is generally low (about 1.7%), ranging from 0 to 11%. 4 Indeed, the vast majority of studies demonstrated no hormonal alteration during follow-up.…”

Section: Natural History and Follow-up Strategymentioning

confidence: 99%

“…4 Indeed, the vast majority of studies demonstrated no hormonal alteration during follow-up. [173][174][175][176]178,179 The most common disorder observed is SCS, whereas catecholamine and ALD hypersecretion appear to be extremely rare. [1][2][3][4]172,177,180 The progression from SCS to overt disease is controversial.…”

Section: Natural History and Follow-up Strategymentioning

confidence: 99%

Adrenal incidentaloma: a diagnostic challenge

Anagnostis¹,

Karagiannis²,

Τζιόμαλος³

et al. 2009

View full text Add to dashboard Cite

The widespread application of abdominal imaging procedures has resulted in an increased frequency of clinically silent adrenal masses. Adrenal incidentaloma (AI) is a term applied to an accidentally discovered adrenal mass on imaging performed for the investigation of an unrelated complaint. Adrenal incidentalomas (AIs) are a cluster of different pathologies, the majority of which are benign and non-functioning adrenal adenomas. However, mild hormonal alterations as well as metabolic abnormalities may be present in patients with AIs. Thus, a multidisciplinary approach with biochemical and radiologic evaluation is needed to characterize these lesions and identify patients who are at high risk for hormonal or malignant evolution. Significant new information has helped resolve controversies regarding the most reliable approach to this clinical problem. The present review considers the prevalence, pathology and natural history of AIs. We also discuss the reliability of available screening methods and localization techniques and consider optimal management and follow-up strategies.

show abstract

“…These so-called "adrenal incidentalomas" are usually asymptomatic and often classified as non-functional tumors, but in recent years there have been several case reports of asymptomatic cortisol producing adrenal adenoma (ASCA) which secretes cortisol without clinical evidence of Cushing's syndrome, the so-called "Pre-Cushing's syndrome" or "Preclinical Cushing's syndrome" [12][13][14][15][16][17][18][19][20][21]. Some cases with incidentaloma were reported to have had adrenocortical insufficiency after removal of the adrenal tumor [17,20].…”

Section: Incidentalmentioning

confidence: 99%

Serum Levels of Dehydroepiandrosterone Sulfate in Patients with Asymptomatic Cortisol Producing Adrenal Adenoma: Comparison with Adrenal Cushing's Syndrome and Non-Functional Adrenal Tumor.

et al. 1996

View full text Add to dashboard Cite

Abstract.The reported number of adrenal incidentalomas has been increasing because of wider application of imaging techniques. Patients with asymptomatic cortisol producing adrenal adenoma (ASCA) which secretes cortisol without clinical evidence of Cushing's syndrome has been more frequently observed than previously assumed, and they have a risk of adrenal insufficiency after adrenalectomy. Therefore patients with incidentalomas should be screened for cortisol overproduction. The aim of this study is to discover an easy screening test to uncover ASCA. We investigated the hormone profiles of 4 patients with ASCA in comparison with 11 patients with non-functional adrenal tumor and 10 patients with adrenal Cushing's syndrome.We also investigated the expression of dehydroepiandrosterone sulfotransferase (DHEA-ST) in surgically removed attached non-neoplastic adrenal tissues by immunostaining, which was considered to represent the degree of suppression of the hypothalamo-pituitary-adrenal axis. Serum dehydroepiandrosterone sulfate (DHEA-S) levels of all the patients with ASCA and adrenal Cushing's syndrome were lower than those of healthy subjects of corresponding age, but they were within the normal range in the patients with non-functional adrenal tumors. The serum DHEA-S level reflects the degree of suppression of the normal adrenal gland by cortisol hypersecretion from adrenal tumors. But the serum level of DHEA-S decreases with age, and because the normal range of serum DHEA-S is low in elderly subjects, we should be careful to evaluate the level of DHEA-S in elderly patients with adrenal Cushing's syndrome or ASCA. The immunohistochemical study showed DHEA-ST expression was noticeably suppressed in the adjacent adrenal cortex in ASCA and adrenal Cushing's syndrome. The decreased expression of DHEA-ST may reflect autonomous neoplastic cortisol secretion and subsequent ACTH suppression in ASCA and adrenal Cushing's syndrome.A single measurement of plasma ACTH or measurement of ACTH response to corticotropin-releasing hormone was not enough to screen for ASCA because of the wide variation among the cases. Dexamethasone suppression test is essential in identifying ASCA and also a single determination of serum DHEA-S is easy and may be useful for the screening of ASCA in adrenal incidentalomas in young and middle aged subjects, and is especially useful for outpatients.

show abstract

Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography

Cited by 63 publications

References 0 publications

Long-term follow-up study of patients with adrenal incidentalomas

Long-term follow-up study of patients with adrenal incidentalomas

Adrenal incidentaloma: a diagnostic challenge

Serum Levels of Dehydroepiandrosterone Sulfate in Patients with Asymptomatic Cortisol Producing Adrenal Adenoma: Comparison with Adrenal Cushing's Syndrome and Non-Functional Adrenal Tumor.

Contact Info

Product

Resources

About