Fine-needle aspiration of catecholamine-producing adrenal masses: a possibly fatal mistake

McCorkell, SJ; Niles, NL

doi:10.2214/ajr.145.1.113

Cited by 114 publications

(44 citation statements)

References 8 publications

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“…Urinary total catechol amines were increased in almost all cases in which they were measured and this finding has an important impact on the diagnostic approach to the adrenal mass. An early diagnosis of phcochromocytoma is important to avoid the likelihood of future hypertensive crisis, and also because a preoperative specific diagnosis is essential in decreasing the risk of complications at operation as well as in diving needle biopsy [24][25][26], The diagnostic role of M1BG or Octeotride scintiscan was not addressed in the present study.…”

Section: Italian Study On Adrenal Incidentalomamentioning

confidence: 95%

Adrenal Incidentaloma: An Overview of Hormonal Data from the National Italian Study Group

et al. 1997

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Adrenal masses are more and more frequently detected by adrenal ultrasound, computed tomography or nuclear magnetic resonance carried out for a reason other than the suspicion of adrenal disease (incidentalomas). The finding of an incidentaloma still leaves many diagnostic and therapeutic questions open. We report the results of a multicentric retrospective evaluation of patients with adrenal incidentalomas, performed by a Study Group of the Italian Society of Endocrinology. According to the definition of incidentaloma, exclusion criteria a priori were: severe or paroxysmal hypertension, frank hypokalemia and clinical signs of hypercortisolism or hyperandrogenism. 29 centers participated in the study and the data obtained by questionnaire were collected in 2 centers for final elaboration. Center 1 carried out the epidemiological and clinical evaluation. Basal and dynamic hormonal evaluation of 786 among the 1013 cases recruited were performed in our center (center 2). Functional studies included: diurnal rhythm of cortisol, urinary free cortisol (UFC), ACTH, DHEAS, 17-OH progesterone, testosterone, androstenedione, supine and upright plasma renin activity (PRA) and aldosterone, urinary aldosterone, urinary catecholamines and VMA. The hormonal dynamic evaluation included the overnight dexamethasone suppression test (1 mg), CRH test and ACTH test. In our study, 89% (702 patients) of adrenal incidentalomas were non-hyper-secretory masses; 6.2% (49 patients) showed a preclinical Cushing’s syndrome (PCS) (at least two altered parameters of pituitary-adrenal axis); 3.4% (27 patients) were pheochromocytomas; 0.89% (7 patients) were aldosteronomas. One tumor was a masculinizing adrenocortical carcinoma. Two hundred sixty patients underwent surgical exploration and the histological diagnosis showed: 138 adenomas (53%), 32 carcinomas (12%), 26 pheochromocytomas (10%), 16 myelolipomas (8%), 13 cystic lesions (5.5%), 7 tumors of neuronal lineage (3%), 12 metastases (4%), 13 others (5%). The 138 patients with adenomas had the following hormonal diagnosis: 103 nonfunctional adenomas (74%), 31 PCS (23%) and 4 cases of hyperaldosteronism (3%). In the patients with PCS an abnormal dexamethasone suppression test was found in 86% of cases (37/ 41 patients). Values for ACTH were low in 78% (32/41 patients). UFC was elevated in 64% of patients, the diurnal rhythm of cortisol evaluated in 14 patients was absent in 7. Only in 50% of cases DHEAS values (12/24 patients) were decreased, whereas they were normal in the other 50%. Interestingly, 8 patients with normal DHEAS and normal UFC showed nonsuppressible cortisol by dexamethasone test (1 mg). Blunted ACTH response to CRH was detected in 9 of 14 patients (64%). Thus our data suggest that the best parameter for evaluating subclinical hypercortisolism seems to be the overnight dexamethasone suppression test. In 27 patients with pheochromocytoma 24-hour urinary catecholamine and VMA levels were elevated in 86 and 46% of cases respectively. In 7 patients with hyperaldosteronism upright PR...

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Section: Italian Study On Adrenal Incidentalomamentioning

confidence: 95%

Adrenal Incidentaloma: An Overview of Hormonal Data from the National Italian Study Group

et al. 1997

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“…Ako postoji podatak o malignoj bolesti, treba pacijenta uputiti na pozitronsku emisijsku tomografiju (PET) ili razmotriti moguć-nost biopsije. U oba slučaja treba provesti biokemijsko testiranje da se isključi feokromocitom budući da su hemoragija i hipertenzivna kriza moguće komplikacije biopsije feokromocitoma 67,68 .Postupak s lezijama veličine 1 -4 cm ovisi o tome postoji li prethodna slikovna obrada te boluje li pacijent od maligne bolesti. Ako prethodna slikovna obrada ukazuje na stabilnu veliči-nu u razdoblju duljem od jedne godine, smatra se da je lezija benigna i ne zahtijeva daljnju obradu.…”

Section: Postupak S Novootkrivenom Lezijom Nadbubrežne žLijezdeunclassified

Computed tomography and magnetic resonance imaging of adrenal lesions

et al. 2017

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Sažetak.Od ranije je poznato kako učestalost ekspanzivnih lezija nadbubrežnih žlijezda na obdukcijama značajno nadilazi broj klinički potvrđenih adrenalnih lezija. Zbog sve učestalijeg korištenja slojevnih tehnika snimanja posljednjih godina otkriva se značajno veći broj suprarenalnih tvorbi koje zahtijevaju karakterizaciju i endokrinološku obradu. Većina tih lezija su nefunkcionalni (silentni) adenomi, tzv. incidentalomi, no potrebna je slikovna karakterizacija lezija kako bi se isključio maligni tumor i odredili daljnji terapijski postupci. U radu prikazujemo pregled literature o slikovnoj dijagnostici najčešćih benignih i malignih lezija nadbubrežnih žlijezda, s fokusom na kompjutoriziranu tomografiju i magnetsku rezonanciju s prikazom primjera iz vlastite kliničke prakse. U nastavku prikazujemo algoritam temeljen na preporukama ACR-a (American College of Radiology) i algoritmu koji je sastavio Incidental Findings Committee o optimalnom odabiru slikovne metode i daljnjim postupcima s novootkrivenim lezijama nadbubrežnih žlijezda.Ključne riječi: adenom; incidentalom; nadbubrežne žlijezde; slikovne metode Abstract. The incidence of adrenal lesions on autopsy significantly overcomes the number of clinically diagnosed adrenal lesions. Due to increasing use of cross-sectional imaging in the past few years, a significantly higher number of adrenal lesions is detected, which require characterisation and endocrinological workup. Although a majority of these lesions are nonfunctional (silent) adenomas, imaging characterisation is required to exclude malignant process and determine further management. In this article we present the review of current litterature on imaging of benign and malignant adrenal lessions, with emphassis on computed tomography (CT) and magnetic resonance imaging (MRI) characteristics, presenting images from our clinical practice. Furthermore, we present the algorithm based on the recommendations of American College of Radiology Incidental Findings Committee on how to select optimal imaging method and further management of adrenal lesions.

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“…Попытки верификации диагноза феохромоци-томы с помощью цитологического исследования да-тируются периодом, когда отсутствовала возмож-ность качественной диагностики опухолевой гипер-катехоламинемии [40,41]. В настоящий момент пункционная биопсия для диагностики феохромо-цитомы не рекомендована [42].…”

Section: диагностикаunclassified

Federal clinical practice guidelines on the diagnostics and treatment of adrenocortical cancer

Мельниченко¹,

Стилиди²,

Алексеев³

et al. 2014

Probl Endokrinol (Mosk)

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Statement of hormonal activity and potential malignancy are the most important issues of diagnosis and selection of appropriate treatment way for patients with adrenal tumors. Adrenal cortical carcinoma (ACC) is rare disease with poor prognosis. Incidience of ACC is about 0.5-2 per million, and no more then 2-4% among adrenal tumors. This draft of guidelines of diagnosis and treatment of ACC is offered to common discussion among wide round of specialists.

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Fine-needle aspiration of catecholamine-producing adrenal masses: a possibly fatal mistake

Cited by 114 publications

References 8 publications

Adrenal Incidentaloma: An Overview of Hormonal Data from the National Italian Study Group

Adrenal Incidentaloma: An Overview of Hormonal Data from the National Italian Study Group

Computed tomography and magnetic resonance imaging of adrenal lesions

Federal clinical practice guidelines on the diagnostics and treatment of adrenocortical cancer

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