Frequently asked questions and answers (if any) in patients with adrenal incidentaloma

Ceccato, Filippo; Barbot, Mattia; Scaroni, Carla; Boscaro, Marco

doi:10.1007/s40618-021-01615-3

Cited by 23 publications

(18 citation statements)

References 156 publications

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“…Their management is not a minor concern for patients and healthcare-related costs. After comprehensive radiological (to exclude adrenal or metastatic malignancies) and endocrine evaluation (to assess excessive cortical or medullary secretion), a conservative management is proposed in patients with NFAI ( 1 , 2 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…If attenuation value was not sufficient to indicate a lipid-rich adenoma in unenhanced CT (HU <10), a contrast-enhanced CT or a MR was performed. Adrenal adenoma was confirmed in case of absolute washout of >60% or a relative washout of >40% in the delayed images (15 min for the venous phase) during contrast-enhanced CT or a signal drop in the out-of-phase images of >20% during MR scan ( 23 ). Same criteria were used in the follow-up study.…”

Section: Methodsmentioning

confidence: 99%

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Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

et al. 2021

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ContextA tendency to grow has been reported in adrenal incidentalomas. However, long-term data regarding attenuation value, a measure of lipid content, are not available.AimThis study aims to collect radiological data (diameter in mm and attenuation value in Hounsfield units, HU) with computed tomography (CT) in adrenal incidentalomas, in order to compare baseline characteristics with the last follow-up imaging.DesignThis is a longitudinal study which included patients with a new diagnosis of adrenal incidentaloma, evaluated from January 2002 to June 2020.SettingReferral University-Hospital center.PatientsTwo hundred seventy-seven patients with 355 different cortical adenomas (baseline group) were evaluated at the first outpatient visit; the follow-up cohort consists of 181 patients with 234 adenomas (12–175 months after baseline). Inclusion criteria were conservative management and radiological features able to minimize malignancy or risk of progression.Main Outcome MeasureCT modification according to endocrine function: autonomous cortisol secretion (ACS) if cortisol >50 nmol/L after 1-mg dexamethasone test (DST).ResultsAt baseline CT, mean diameter was 18.7 mm and attenuation value was 0.8 HU (higher in ACS, 66 cases >10 HU), without modification in early imaging (12–36 months). The size increased over time (r = 0.289), achieving the largest differences after at least 60 months of follow-up (mean diameter, +2 mm; attenuation value, −4 HU), combined with a reduction in the attenuation value (r = −0.195, especially in patients with ACS). Lipid-poor adenomas (>10 HU) presented a reduced cortisol suppression after 1-mg DST, an increase in size and the largest decrease in attenuation value during follow-up. Univariate analysis confirmed that larger adenomas presented reduced suppression after DST and increase in size during follow-up.ConclusionsGrowth is clinically modest in adrenal incidentaloma: the first follow-up CT 5 years after baseline is a reasonable choice, especially in ACS. Mean density is increased in patients with ACS and overt hypercortisolism. Mean density reduces during follow-up in all adrenal adenomas, suggesting an increase in lipid content, especially in those with ACS.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

et al. 2021

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“…The first radiological approach should discriminate benign adenomas from malignant lesions: An attenuation value <10 Hounsfield unit (HU) in unenhanced computed tomography is able to diagnose lipid-rich benign cortical adenomas [ 2 , 9 ]. From a functional point of view, steroid-secreting cells in the adrenal cortex contain a large number of lipids (steroidogenesis comes from cholesterol); therefore, non-functioning benign adrenal adenomas usually contain a high number of lipids [ 10 ], recognised by unenhanced CT and quantified with the attenuation value. On the other hand, 30% of benign adrenal adenomas present an attenuation value of >10 HU (lipid-poor adenomas).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of CT Texture Analysis in Adrenal Masses: A Systematic Review

Crimì

Quaia

Cabrelle

et al. 2022

IJMS

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Adrenal incidentalomas (AIs) are incidentally discovered adrenal neoplasms. Overt endocrine secretion (glucocorticoids, mineralocorticoids, and catecholamines) and malignancy (primary or metastatic disease) are assessed at baseline evaluation. Size, lipid content, and washout characterise benign AIs (respectively, <4 cm, <10 Hounsfield unit, and rapid release); nonetheless, 30% of adrenal lesions are not correctly indicated. Recently, image-based texture analysis from computed tomography (CT) may be useful to assess the behaviour of indeterminate adrenal lesions. We performed a systematic review to provide the state-of-the-art of texture analysis in patients with AI. We considered 9 papers (from 70 selected), with a median of 125 patients (range 20–356). Histological confirmation was the most used criteria to differentiate benign from the malignant adrenal mass. Unenhanced or contrast-enhanced data were available in all papers; TexRAD and PyRadiomics were the most used software. Four papers analysed the whole volume, and five considered a region of interest. Different texture features were reported, considering first- and second-order statistics. The pooled median area under the ROC curve in all studies was 0.85, depicting a high diagnostic accuracy, up to 93% in differentiating adrenal adenoma from adrenocortical carcinomas. Despite heterogeneous methodology, texture analysis is a promising diagnostic tool in the first assessment of patients with adrenal lesions.

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“…After many attempts, the current definition of this entity comes from the 2016 guidelines of the European Society of Endocrinology and the European Network for the Study on Adrenal Tumors (ESE / ENSAT). An adrenal incidentaloma (AI), by definition, is a clinically silent lesion, most often located in the cortical layer of the left adrenal gland, visible on radiographs performed for reasons other than this organ disease [3,5]. In the current guidelines, only a tumor with a size of at least 1 cm can be defined as an AI [6].…”

Section: Description Of the State Of Knowledge 21 Definition And Etio...mentioning

confidence: 99%

“…In the current guidelines, only a tumor with a size of at least 1 cm can be defined as an AI [6]. This limit is arbitrary; however, reviews of clinical data do not indicate the need for a more detailed diagnosis of lesions below 1 cm in diameter, due to the low risk of malignant tumor and adrenal gland dysfunction [5,6]. Lesions of such small size occur in even 65% of adrenal glands examined post-mortem [17].…”

Section: Description Of the State Of Knowledge 21 Definition And Etio...mentioning

confidence: 99%

Adrenal incidentaloma (AI) - a puzzle not only for endocrinologists

Dubaj

Dembowska

Bigosiński

2022

J Educ Health Sport

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An adrenal incidentaloma (AI) is any lesion ≥ 1 cm in diameter detected during radiological diagnostics unrelated to suspected adrenal pathology. Each case of an AI requires extended hormonal and imaging assessments to accurately determine the nature of the tumor and its hormonal activity. The frequency of this tumor’s diagnostics has increased exponentially due to the continuous progress in the development of imaging methods, especially computed tomography and magnetic resonance imaging. The most common etiology of AIs are hormonally inactive adenomas of the adrenal cortex, but there are also adrenal cortex carAIcinomas, phaeochromocytoma, metastatic or infectious lesions. In the case of confirmation of the type of lesion, the management involves adrenalectomy or a sufficiently long clinical observation. In recent years, new markers of the malignancy of AI tumors have been discovered, both in imaging and biochemical diagnostics, which is associated with improvements in the accuracy of diagnosis and patient management. The aim of this study was to describe the definition, etiology and epidemiology of AIs and to draw attention to the complexity of diagnostics and therapy of accidentally diagnosed adrenal tumors. Current publications and guidelines from scientific societies around the world were reviewed, using keywords that were compatible with MeSH.

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Frequently asked questions and answers (if any) in patients with adrenal incidentaloma

Cited by 23 publications

References 156 publications

Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

Diagnostic Accuracy of CT Texture Analysis in Adrenal Masses: A Systematic Review

Adrenal incidentaloma (AI) - a puzzle not only for endocrinologists

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