Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

Abstract

Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations. Methods: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations. Imaging and hormonal assessment: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia. Treatment: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases. (Endokrynol Pol 2016; 67 (2): 234-258)

Metabolomic Biomarkers in Urine of Cushing’s Syndrome Patients

“…The presence of Cushing’s syndrome was confirmed on the basis of clinical evaluation in terms of clinical symptoms (altered fat distribution, wide purple striae, etc. ), assessment of 24-h urinary cortisol (normal range 12–330 nmol/24 h), serum cortisol levels after suppression test applying 1 mg dexamethasone (DXM) (immunofluorescent assay, concentrations > 140 nmol/L indicated hypercortisolism), and analysis of plasma ACTH levels (normal range 15–46 pg/mL) [41,42]. Fourteen patients had adrenal Cushing’s syndrome due to adrenal adenomas and two patients suffered from pituitary CS.…”

“…The activity of AIs was assessed by determining UFC in 24-h urine and serum cortisol levels after suppression test with DXM using immunofluorescent assay (concentrations < 50 nmol/L excluded hypercortisolism, intermediate cut-off point of 94 nmol/L indicated subclinical hypercortisolism), dehydroepiandrosterone sulphate (DHEA-S) in serum (normal range equal to 34–430 μg/dL), aldosterone levels in serum and urine, potassium in blood, and methoxycatecholamines in 24-h urine [22,41,42]. The immunochemical assays revealed that AIs were non-hypersecretory.…”

“…Negative control and adrenal incidentaloma patients had the UFC values which belonged to the normal range. For control subjects the UFC range was from 71 to 137 nmol/24 h with median 106 nmol/24 h (5th percentile 76 nmol/24 h, 95th percentile 135 nmol/24 h) and for AI patients the range was 86–164 nmol/24 h and median was equal to 112 nmol/24 h (5th percentile 86 nmol/24 h, 95th percentile 144 nmol/24 h) [41]. BMI values for control were in the range 25.3–30.1 kg/m 2 with median 28.5 kg/m 2 (5th percentile 25.9, 95th percentile 30), for AI patients they were between 27.7–30.6 kg/m 2 with median 28.9 kg/m 2 (5th percentile 27.9, 95th percentile 30.3).…”

A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

“…Patients with bilateral hyperplasia are treated with a mineralocorticoid receptor antagonist, whereas the subjects with a unilateral adenoma undergo adrenalectomy [8,9]. Because aldosterone-producing microadenomas and multiple bilateral lesions are often undetectable on computed tomography (CT), there is a substantial risk of misdiagnosis when using only CT scanning [10][11][12][13][14][15][16]. The current guidelines on the management of PA recommend adrenal vein sampling (AVS) as a "gold standard" procedure to differentiate between both subtypes in the majority of patients with PA [15].…”

Adrenopause – does it really exist?

“…However, the hormonal function of the tumor should also be assessed (evaluation of cortisol and androgen concentrations in serum, evaluation of daily excretion of free cortisol, 17-OH steroids and 17-ketosteroids, metanephrines in urine or blood, aldosterone and renin plasma activity or renin concentration in blood). The best test to exclude subclinical hypercortisolemia is a dexamethasone suppression test [29]. Subclinical form of hypercortisolemia occurs in the case of autonomous cortisol secretion from the tumor, usually at normal cortisol concentrations.…”