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Wednesday, October 26, 2005
Management of the Clinically Inapparent Adrenal Mass
NIH consensus
Among unselected patients and those with nonendocrinologic complaints, clinically inapparent adrenal masses are most often nonfunctioning tumors (approximately 70 percent).
The available data suggest that nearly all lesions smaller than 4 cm are benign.
Masses greater than or equal to 3 cm are more likely to develop hyperfunction compared to smaller tumors. The interpretation of these followup studies is affected by variable length of followup and variable followup strategies.Most studies indicate that the transformation rate of small (less than 3 cm) nonfunctioning nodules to functional tumors is low.
Followup of patients with nonfunctioning adrenal masses suggests that 5 to 25 percent of masses increase in size by at least 1 cm.
Usually, large clinically inapparent adrenal masses (greater than 6 cm) are treated surgically. Approximately 25 percent of masses greater than 6 cm in diameter are adrenal cortical carcinomas.
A homogeneous mass with a smooth border and an attenuation value of less than 10 HU on an unenhanced CT study strongly suggests the diagnosis of a benign adrenal adenoma.
Although chemical shift MRI is commonly performed, it does not provide additional information beyond that which is already available on unenhanced CT.
CT-guided fine needle aspiration may be helpful in the diagnostic evaluation of patients with a history of cancer (particularly lung, breast, and kidney), with no other signs of metastases, and a heterogenous adrenal mass with a high attenuation value (greater than 20 HU). (Usually not recommended in Japan Since histopathological diagnosis upon smaller specimen may be challenging)
Exceptions of requirement for hormonal evaluation will include patients with imaging characteristics of myelolipoma or an adrenal cyst.
Patients with "silent" pheochromocytomas are at risk for a hypertensive crisis and should undergo adrenalectomy.
If a patient with a unilateral incidentaloma is found on history or physical examination to have the signs and symptoms suggestive of glucocorticoid, mineralocorticoid, adrenal sex hormone, or catecholamine excess that is confirmed biochemically, adrenalectomy is often considered
Matsunami Hospital Department of Endocrinology
体内のどこかに癌のある方にみつかった、副腎偶発腫瘍の場合、その4分の3はその癌が副腎に転移したものという統計結果があります
Among unselected patients and those with nonendocrinologic complaints, clinically inapparent adrenal masses are most often nonfunctioning tumors (approximately 70 percent).
The available data suggest that nearly all lesions smaller than 4 cm are benign.
Masses greater than or equal to 3 cm are more likely to develop hyperfunction compared to smaller tumors. The interpretation of these followup studies is affected by variable length of followup and variable followup strategies.Most studies indicate that the transformation rate of small (less than 3 cm) nonfunctioning nodules to functional tumors is low.
Followup of patients with nonfunctioning adrenal masses suggests that 5 to 25 percent of masses increase in size by at least 1 cm.
Usually, large clinically inapparent adrenal masses (greater than 6 cm) are treated surgically. Approximately 25 percent of masses greater than 6 cm in diameter are adrenal cortical carcinomas.
A homogeneous mass with a smooth border and an attenuation value of less than 10 HU on an unenhanced CT study strongly suggests the diagnosis of a benign adrenal adenoma.
Although chemical shift MRI is commonly performed, it does not provide additional information beyond that which is already available on unenhanced CT.
CT-guided fine needle aspiration may be helpful in the diagnostic evaluation of patients with a history of cancer (particularly lung, breast, and kidney), with no other signs of metastases, and a heterogenous adrenal mass with a high attenuation value (greater than 20 HU). (Usually not recommended in Japan Since histopathological diagnosis upon smaller specimen may be challenging)
Exceptions of requirement for hormonal evaluation will include patients with imaging characteristics of myelolipoma or an adrenal cyst.
Patients with "silent" pheochromocytomas are at risk for a hypertensive crisis and should undergo adrenalectomy.
If a patient with a unilateral incidentaloma is found on history or physical examination to have the signs and symptoms suggestive of glucocorticoid, mineralocorticoid, adrenal sex hormone, or catecholamine excess that is confirmed biochemically, adrenalectomy is often considered
Matsunami Hospital Department of Endocrinology
体内のどこかに癌のある方にみつかった、副腎偶発腫瘍の場合、その4分の3はその癌が副腎に転移したものという統計結果があります
Posted by: Ds20040999 / 6:50 PM 
