The Incidentally Discovered Adrenal Mass

Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
New England Journal of Medicine (Impact Factor: 55.87). 03/2007; 356(6):601-10. DOI: 10.1056/NEJMcp065470
Source: PubMed
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    • "The adrenal gland is a relatively frequent site for metastatic disease [3]. The most common malignant lesions that metastasize to the adrenal gland include malignant melanoma, breast, lung, kidney, esophagus, pancreas , liver, stomach, and colon cancers [4] [5] [6]. In patients with a primary neoplasm, in whom an adrenal metastasis is an important consideration, most adrenal masses are benign, commonly non-hyper functioning adenomas [7]. "
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    ABSTRACT: Purpose: Our aim was to evaluate the diagnostic value of MRI using different param-eters in differentiation of adenomas versus non-adenomas adrenal lesions. Materials and methods: Forty-five patients with 48 adrenal masses (28 lipid rich adenomas, 3 lipid poor adenomas, 15 metastases and 2 lymphoma) were retrospectively evaluated with MRI. The mean diameter of adrenal mass, T2WI signal, signal drop on chemical shift imaging (CSI) and enhancement pattern were assessed separately and in various combinations. Accuracies, sensitivi-ties, specificities, PPV, NPV and P values by Chi-square test were calculated for individual and combined parameters. Results: Signal drop on CSI and enhancement pattern were the most statistically significant diag-nostic discriminators of adenomatous and non-adenomatous lesions with accuracies, specificities and sensitivities of 93.8%, 90.3%, 100% and 91.7%, 93.5%, 88.2%, respectively (P-value <0.0001). The best performance of a combination of parameters was obtained after exclusion of the size, with an accuracy of 89.6% (P-value <0.0001). Conclusion: The most specific predictors for adrenal mass characterization were CSI signal drop and Gd-DTPA enhancement characteristics. Combining the MR parameters did not prove superior (S. Emad-Eldin). Peer review under responsibility of Egyptian Society of Radiology and Nuclear Medicine.
    Egyptian Journal of Radiology and Nuclear Medicine 07/2014; 45(3). DOI:10.1016/j.ejrnm.2014.06.004
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    • "2) Neuroblastoma , Gangiloneuroma and pheochromocytoma which arise from medulla of the adrenal glands. Most adrenal pheochromocytomas and all adrenocortical adenomas are benign tumors, which do not metastasize, but which may still cause significant health problems by giving rise to hormonal imbalances (Young 2007). Hyperadrenocorticism (HAC) is caused by either excessive pituitary ACTH secretion, as in pituitary-dependent hyperadrenocorticism (PDH), or an autonomously functioning tumor of the adrenal cortex (AT)(Feldman et al. 1996). "
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    • "On the other hand, in the absence of hormonal hypersecretion, imaging studies for risk assessment of malignancy are required, typically beginning with unenhanced CT densitometry of the abdomen [5]. When the unenhanced CT densitometry cannot differentiate between benign and malignant adrenal masses, chemical shift MRI or delayed contrast-enhanced CT can be used [1,2]. In oncology patients with adrenal incidentalomas, the characterization of adrenal masses is important in cancer staging, treatment planning and prognosis assessment because nearly 50% of adrenal incidentalomas in oncology patients have been reported as metastases [6,7,8]. "
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    ABSTRACT: Adrenal incidentalomas are adrenal masses serendipitously detected during an imaging study performed for reasons unrelated to suspicion of adrenal disease. The incidence of adrenal incidentalomas has increased because of the widespread use of various imaging modalities. In oncology patients with adrenal incidentalomas, the characterization of the adrenal masses is challenging because nearly 50% of incidental adrenal masses are metastatic lesions that need special medical attention. Although unenhanced computed tomography (CT) densitometry, chemical shift magnetic resonance imaging (MRI), delayed contrast-enhanced CT and CT histogram analysis have been used as sensitive and specific modalities for differentiating benign from malignant adrenal masses, F-18 fluoro-2-deoxy-D-glucose positron emission tomography (F-18 FDG PET)/CT is a highly accurate imaging modality compared to CT or MRI, especially when these two imaging modalities are combined. In addition, a semiquantitative analysis using standardized uptake value ratio further improves the diagnostic accuracy of F-18 FDG PET/CT in differentiating benign from malignant adrenal masses. Thus, F-18 FDG PET/CT is very helpful for determining the best therapeutic management, especially for assessing the need for surgery.
    03/2014; 29(1):5-11. DOI:10.3803/EnM.2014.29.1.5
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