Prevalence of Adrenal Carcinoma Among Incidentally Discovered Adrenal Masses

Terzolo, Massimo; Alı̀, Anna; Osella, Giangiacomo; Mazza, Enrico

doi:10.1001/archsurg.1997.01430320116020

Cited by 135 publications

(55 citation statements)

References 25 publications

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“…The difference is not trivial because a biochemical marker of benignity is more appealing than a marker of malignancy for the clinician dealing with adrenal incidentalomas, as the majority of these masses are actually benign (5,23). The present findings demonstrate that a reduction in DHEAS levels could be useful to assess the benign nature of an adrenal mass in a clinical research setting.…”

Section: Discussionmentioning

confidence: 77%

“…If there is local expertise with DHEAS measurement and interpretation of DHEAS results, with special emphasis on the need for a large database of normal subjects to be confident with normal ranges, DHEAS measurement may be of help in the diagnostic approach to an adrenal mass. Since a CT scan is unable to categorize correctly all adrenal masses (5,23,24), the result of DHEAS measurement could complement radiological information in the decision regarding the method of management (surgery vs follow-up), particularly in high surgical risk patients.…”

Section: Discussionmentioning

confidence: 99%

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The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

et al. 2000

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Objective: Owing to their increasing rate of discovery as incidental findings, the characterization of adrenal masses is an important diagnostic problem which frequently challenges the clinician's skill. Design: The results of dehydroepiandrosterone sulfate (DHEAS) measurement were evaluated in a consecutive series of 107 patients with an adrenal mass (39 men, 68 women aged 15-81 years, median 56 years). DHEAS levels observed in the patients were categorized as reduced, normal or elevated according to sex-and age-adjusted reference ranges obtained by measuring DHEAS in 214 healthy women and 142 healthy men aged 17-93 years. The working hypothesis was that a low DHEAS level is a marker of benignity. Methods: In 84 patients, the adrenal mass was discovered serendipitously, while in the remainder the mass was clinically symptomatic. Patients with known extra-adrenal malignancies were excluded. The adrenal masses were categorized as benign or malignant by computerized tomography (CT) criteria. All patients with suspected malignant tumors or with overtly hypersecreting tumors underwent adrenalectomy. The patients with a presumptive benign tumor were followed-up for at least 12 months. Results: In the overall series, the sensitivity and specificity of a low DHEAS level in the identification of a benign lesion were 41% and 100% respectively. Superimposable figures were obtained when considering only adrenal incidentalomas. DHEAS levels in adrenal cancers displayed some overlap with adrenal adenomas, but in only 2/11 adrenal cancers were DHEAS levels normal, while they were elevated in the remainder. Conclusions: The present data suggest that DHEAS measurement may help to differentiate benign from malignant adrenal masses as a complementary test of CT in a clinical research setting. The value of DHEAS measurement in general practice is limited because it may be difficult to differentiate between low and low-normal values, particularly in the elderly.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

et al. 2000

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“…4 Current literature suggests lowering this absolute cut-off to 4 cm because most adrenocortical carcinomas (ACC) are >4 cm in size. [29][30][31] This value was shown to provide the best sensitivity (93%) in predicting malignant processes, however the specificity is low (42%) owing to the low prevalence of ACC. 32 Any recommendation for surgery must also take into account patient age, comorbidities and clinical judgement.…”

Section: Sizementioning

confidence: 99%

Guidelines for the management of the incidentally discovered adrenal mass

Kapoor¹,

Morris²,

Rebello³

2011

cuaj

112

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“…Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine tumor showing an annual incidence of 0.5-2 cases/million population (1,2). Surgery is the mainstay of therapy and complete surgical removal of ACC is the most important prognostic factor for longterm survival together with stage.…”

Section: Introductionmentioning

confidence: 99%

Mitotane levels predict the outcome of patients with adrenocortical carcinoma treated adjuvantly following radical resection

Terzolo

Baudin

Ardito

et al. 2013

European Journal of Endocrinology

122

109

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Context: Mitotane plasma concentrations R14 mg/l have been shown to predict tumor response and better survival in patients with advanced adrenocortical carcinoma (ACC). A correlation between mitotane concentrations and patient outcome has not been demonstrated in an adjuvant setting. Objective: To compare recurrence-free survival (RFS) in patients who reached and maintained mitotane concentrations R14 mg/l vs patients who did not. Design and setting: Retrospective analysis at six referral European centers. Patients: Patients with ACC who were radically resected between 1995 and 2009 and were treated adjuvantly with mitotane targeting concentrations of 14-20 mg/l. Main outcome measures: RFS (primary) and overall survival (secondary). Results: Of the 122 patients included, 63 patients (52%) reached and maintained during a median follow-up of 36 months the target mitotane concentrations (group 1) and 59 patients (48%) did not (group 2). ACC recurrence was observed in 22 patients of group 1 (35%) and 36 patients in group 2 (61%). In multivariable analysis, the maintenance of target mitotane concentrations was associated with a significantly prolonged RFS (hazard ratio (HR) of recurrence: 0.418, 0.22-0.79; PZ0.007), while the risk of death was not significantly altered (HR: 0.59, PZ0.20). Grades 3-4 toxicity was observed in 11 patients (9%) and was managed with temporary mitotane discontinuation. None of the patients discontinued mitotane definitively for toxicity. Conclusions: Mitotane concentrations R14 mg/l predict response to adjuvant treatment being associated with a prolonged RFS. A monitored adjuvant mitotane treatment may benefit patients after radical removal of ACC.

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Prevalence of Adrenal Carcinoma Among Incidentally Discovered Adrenal Masses

Cited by 135 publications

References 25 publications

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

Guidelines for the management of the incidentally discovered adrenal mass

Mitotane levels predict the outcome of patients with adrenocortical carcinoma treated adjuvantly following radical resection

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