The Relationship between Adrenal Incidentalomas and Mortality Risk

Taya, Michio; Paroder, Viktoriya; Bellin, Eran; Haramati, Linda B.

doi:10.2139/ssrn.3235649

Cited by 5 publications

(6 citation statements)

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“…for APW is 0.69 (95% CI 0.61-0.78) for the entire cohort and 0.64 (95% CI 0.55-0.73) for the subgroup, whereas the AUC for RPW is 0.79 (95% CI 0.73-0.84) for all adrenal masses and 0.69 (95% CI 0.60-0.78) for the subgroup. 2 50 confirmed by histology 3 29 confirmed by histology 4 11 confirmed by histology. including histological-confirmed atypical myelolipomas (n=6), atypical adrenal cysts (n=2), ganglioneuromas (n=2), tuberculosis-related adrenal masses (n=1).…”

Section: Discussionmentioning

confidence: 89%

“…The other authors declare no competing interest. 1 for definition, see Supplementary Table 1 2 24 confirmed by histology 3 14 confirmed by histology 4 5 confirmed by histology: including histological-confirmed atypical myelolipomas (n=2), atypical adrenal cysts (n=1), ganglioneuromas (n=1), tuberculosis-related adrenal masses (n=1). 5 3 confirmed by histology: including histological-confirmed atypical adrenal cysts (n=1), ganglioneuromas (n=1), tuberculosis-related adrenal masses (n=1).…”

Section: Disclosurementioning

confidence: 97%

“…Adrenal lesions are routinely encountered in about 3-5% of patients undergoing abdominal computed tomography (CT) (1,2,3,4). In most cases, imaging is performed for reasons other than for suspected adrenal disorders and these masses are commonly referred to as adrenal incidentalomas (5).…”

Section: Introductionmentioning

confidence: 99%

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Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses

Schloetelburg

Ebert

Petritsch

et al. 2022

European Journal of Endocrinology

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Objective: Reliable results of wash-out CT in the diagnostic workup of adrenal incidentalomas are scarce. Thus, we evaluated the diagnostic accuracy of delayed wash-out CT and determined thresholds to accurately differentiate adrenal masses. Design: Retrospective, single-center cohort study including 216 patients with 252 adrenal lesions who underwent delayed wash-out CT. Definitive diagnoses based on histopathology (n=92) or comprehensive follow-up. Methods: Size, average attenuation values of the adrenal lesions in all CT scan phases, absolute and relative percentage washout (APW/RPW) were determined by an expert radiologist blinded for clinical data. Adrenal lesions with unenhanced attenuation values >10HU built a subgroup (n=142). Diagnostic accuracy were calculated. Results: The study group consisted of 171 adenomas, 32 other benign tumors, 11 pheochromocytomas, 9 adrenocortical carcinomas and 29 other malignant tumors. All (potentially) malignant and 46% of benign lesions showed unenhanced attenuation values >10HU. In this most relevant subgroup, the established thresholds of 60% for APW and 40% for RPW misclassified 35.9% and 35.2% of masses, respectively. When we applied optimized cutoffs (APW>83%; RPW>58%) and excluded pheochromocytomas, we missed only 1 malignant tumor by APW and none by RPW. However, only 11% and 15% of benign tumors were correctly identified. Conclusions: Washout CT with the established thresholds for APW und RPW is insufficient to reliably diagnose adrenal masses. Using the proposed cutoff of 58% for RPW, malignant tumors will be correctly identified, but the added value is limited, namely 15% of patients with benign tumors can be prevented from additional imaging or even unnecessary surgery.

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Section: Discussionmentioning

confidence: 89%

Section: Disclosurementioning

confidence: 97%

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Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses

Schloetelburg

Ebert

Petritsch

et al. 2022

European Journal of Endocrinology

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“…7 Recently, a cohort study reported a slightly elevated mortality in 969 patients with adrenal incidentalomas compared to 2907 patients without. 8 Furthermore, several studies have focused on the association between ACTH-independent cortisol autonomy (defined as non-suppressible serum cortisol after DST) and mortality in these patients, but results are conflicting. Three single centre studies that included 198 to 365 patients [9][10][11] and one population-based study from Sweden (with 1048 patients) 12 reported an increased mortality in persons with elevated cortisol after the 1 mg DST.…”

Section: Introductionmentioning

confidence: 99%

Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study

Deutschbein¹,

Reimondo²,

Dalmazi³

et al. 2022

The Lancet Diabetes & Endocrinology

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“…With the wide use of imaging techniques, there was an increasing number of AIs. Some studies thought AIs may be a clinically valuable biomarker because AIs were associated with a distinctly increased incidence of malignancies and higher mortality [14] . Most AIs were benign, but a few were functional and malignant [15] .…”

Section: Discussionmentioning

confidence: 99%

Summary of clinical characteristics of common primary adrenal malignancies in adults

zhang¹,

wang²,

Li³

et al. 2020

Preprint

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Background To summary the clinical characteristics of common primary adrenal malignancies in adults, the survival time of the patients, and the prognostic factors associated with these rare malignancies. Methods The Surveillance, Epidemiology, and End Results database (1975–2016) was queried for all patients who were diagnosed with primary adrenal malignancies, including adrenocortical carcinoma(ACC), pheochromocytoma and paraganglioma (PPGL), lymphoma, and sarcoma (SA). The clinical characteristics, overall survival (OS) and cancer-specific survival (CSS) were analyzed, in which propensity score methodology, logistic regression modeling and Kaplan-Meier survival curves were used. The Multivariate Cox proportional hazard model was used to identify factors affecting the prognosis of patients with ACC. Results 3204 patients with primary adrenal malignancies were identified, including 2180 with ACC, 593 with PPGL, 307 with lymphoma, and 124 with SA. Generally, PPGL had a better prognosis than others. For ACC and PPGL, the non-metastatic group had better OS and CSS than the metastatic group; for SA, the non-metastatic group had better OS, however, there was no significant difference in CSS between the two groups. Furthermore, For ACC, the single metastasis group had a better OS than the multiple metastasis group. After tumors metastasis, the surgery group, surgery of primary adrenal lesions, had better OS and CSS than the non-surgery group for ACC and PPGL. For lymphoma, the chemotherapy group had better OS and CSS; for ACC and PPGL, the chemotherapy group had better CSS and worse OS; for SA, the survival showed no significant difference between the two groups. Radiotherapy had the same effect on patients' survival as chemotherapy, except for the lymphoma and the ACC. As for lymphoma, the radiotherapy group had better CSS, whereas the survival showed no significant difference in OS between the two groups. For ACC, the non- radiotherapy group had better CSS and OS. More importantly, for lymphoma, under the condition that both cohorts were the same basically, the surgical group had a better prognosis. The prognosis of ACC was related to sex, age, seer historic stage, surgery, chemotherapy. Conclusion Understanding the clinical characteristics of these tumors and factors affecting prognosis can facilitate the selection of more appropriate clinical treatment options.

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The Relationship between Adrenal Incidentalomas and Mortality Risk

Cited by 5 publications

References 0 publications

Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses

Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses

Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study

Summary of clinical characteristics of common primary adrenal malignancies in adults

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