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adrenal incidentalomas

James M Hawley, Laura J Owen, Miguel De Bono, John Newell-Price, Brian G Keevil
BACKGROUND: Measurement of serum dexamethasone during the overnight dexamethasone-suppression test (ONDST) has been recommended to reduce false positive results when investigating Cushing's syndrome or increasingly commonly found adrenal incidentalomas. Despite this, there remains a paucity of well-validated dexamethasone methods currently available. Here, we describe the development of a rapid and sensitive LC-MS/MS serum dexamethasone assay and validate its utility in a cohort of postmenopausal females...
January 1, 2018: Annals of Clinical Biochemistry
Emilia Sbardella, Marianna Minnetti, Denise D'Aluisio, Laura Rizza, Maria Rosaria Di Giorgio, Fabio Vinci, Riccardo Pofi, Elisa Giannetta, Mary Anna Venneri, Annarita Vestri, Sergio Morelli, Andrea Lenzi, Andrea M Isidori
BACKGROUND: Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas -recently defined as possible autonomous cortisol secretion (pACS)- has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. SUBJECTS AND METHODS: Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT02611258)...
March 6, 2018: European Journal of Endocrinology
Serkan Yener, Mustafa Secil, Omer Demir, Basak Ozgen, Kutsal Yorukoglu
CONTEXT: To investigate whether any association between chemical shift magnetic resonance (MRI) findings, cortisol secretion and pathological findings exist that could predict subclinical hypercortisolism (SCH) in patients with adrenal incidentalomas (AI). DESIGN: Retrospective, cross sectional study in a tertiary centre. PATIENTS: Sixty-eight subjects with AIs and 13 patients with Cushing's syndrome (CS). Patients with AIs were categorized according to cortisol levels post 1mg dexamethasone (post-DST)...
March 1, 2018: Clinical Endocrinology
Agathocles Tsatsoulis
Thyroid follicular cells, as well as adrenocortical cells, are endowed by an intrinsic heterogeneity regarding their growth potential, in response to various stimuli. This heterogeneity appears to constitute the underlying cause for the focal cell hyperplasia and eventually the formation of thyroid and adrenal nodules, under the influence of growth stimulatory factors. Among the main stimulatory factors are the pituitary tropic hormones, thyroid-stimulating hormone (TSH) or thyrotropin and adrenocorticotropic hormone (ACTH), which regulate the growth and function of their respective target cells, and the insulin/insulin-like growth factor system, that, through its mitogenic effects, can stimulate the proliferation of these cells...
February 26, 2018: Journal of Clinical Medicine
Marie Marty, Delphine Gaye, Paul Perez, Claire Auder, Marie-Laure Nunes, Amandine Ferriere, Magalie Haissaguerre, Antoine Tabarin
CONTEXT: the recent recommendations of the European endocrine society states that the performance of computed tomography (CT) to characterize true adrenal incidentalomas (AIs) remains debatable. OBJECTIVE: to determine relevant thresholds for usual CT parameters for the diagnosis of benign tumors using robust reference standard amongst a large series of "true" AIs recruited in an endocrinological setting. DESIGN: retrospective study of 253 AIs in 233 consecutive patients explored in a single university hospital: 183 adenomas, 33 pheochromocytomas, 23 adrenocortical carcinomas, 5 other malignant tumors and 9 other benign tumors...
February 21, 2018: European Journal of Endocrinology
Edward Buitenwerf, Tijmen Korteweg, Anneke Visser, Charlotte Msc Haag, Richard A Feelders, Henri J Timmers, Letizia Canu, H R Haak, Peter H Bisschop, E Marelise W Eekhoff, Eleonora Pm van der Kleij-Corssmit, Nanda C Krak, Elise Rasenberg, Janneke van den Bergh, Jaap Stoker, Marcel Jw Greuter, Robin P F Dullaart, Thera P Links, Michiel N Kerstens
BACKGROUND: A substantial proportion of all pheochromocytomas is currently detected during the evaluation of an adrenal incidentaloma. Recently it has been suggested that biochemical testing to rule out pheochromocytoma is unnecessary in case of an adrenal incidentaloma with an unenhanced attenuation value ≤10 Hounsfield Units (HU) at computed tomography (CT). OBJECTIVES: We aimed to determine the sensitivity of the 10 HU threshold value to exclude a pheochromocytoma...
February 21, 2018: European Journal of Endocrinology
Geraldine Vitellius, Séverine Trabado, Christine Hoeffel-Fornes, Jerome Bouligand, Antoine Bennet, Frédéric Castinetti, Bénédicte Decoudier, Anne Guiochon-Mantel, Marc Lombes, Brigitte Delemer
Recently discovered mutations of NR3C1 gene, encoding for the Glucocorticoid Receptor (GR), in patients with glucocorticoid resistance and bilateral adrenal incidentalomas prompted us to investigate whether GR mutations might be associated with adrenal hyperplasia. OBJECTIVE: The multicenter French Clinical Research Program (Muta-GR) was set up to determine the prevalence of GR mutations and polymorphisms in patients harboring bilateral adrenal incidentalomas associated with hypertension and/or biological hypercortisolism without clinical Cushing's signs...
February 14, 2018: European Journal of Endocrinology
Vincenzo Nuzzo, Tiziana Attardo, Giuseppe Augello, Davide Brancato, Salvatore Camerlingo, Clelia Canale, Federica Coretti, Alessandro Franco, Francesco Giacometti, Maurizio Gambacorta, Massimo Loreno, Ada Maffettone, Vincenzo Provenzano, Alfonso Zuccoli
Audit is a clinical instrument of government characterized by a whole process of evaluation inter pares to improve medical behaviors in the clinical practice. Different endocrinopathies are underestimated in the clinical and diagnostics practice but they can be a real problem in patients admitted in the departments of Internal Medicine. The Adrenal Incidentaloma (AI) is an accidental discovery with an incidence equal to 4% in radiologic studies but it's rarely considereted in the internal disorders. In the departments of Internal Medicine are hospitalized each year approximately 1...
February 13, 2018: Minerva Endocrinologica
Youichi Ohno, Masakatsu Sone, Daisuke Taura, Toshinari Yamasaki, Katsutoshi Kojima, Kyoko Honda-Kohmo, Yorihide Fukuda, Koji Matsuo, Toshihito Fujii, Akihiro Yasoda, Osamu Ogawa, Nobuya Inagaki
Adrenal tumors are increasingly found incidentally during imaging examinations. It is important to distinguish pheochromocytomas from other adrenal tumors because of the risk of hypertensive crisis. Although catecholamines and their metabolites are generally used to diagnose pheochromocytoma, false-positive test results are common. An effective screening method to distinguish pheochromocytoma from adrenal incidentalomas is needed. We analyzed 297 consecutive patients with adrenal incidentalomas. Our findings included 162 non-functioning tumors, 47 aldosterone-producing adenomas, 26 metastases, 22 cases of subclinical Cushing's syndrome, 21 pheochromocytomas, 12 cases of Cushing's syndrome, and 7 adrenocortical cancers...
January 18, 2018: Hypertension Research: Official Journal of the Japanese Society of Hypertension
Ljiljana V Marina, Miomira Ivović, Milina Tančić-Gajić, Zorana Arizanović, Dragana Raković, Jelena Milin-Lazović, Aleksandra Kendereški, Dragan Micić, Svetlana Vujović
OBJECTIVE: A high prevalence of insulin resistance (IR) has proven to manifest in patients with adrenal incidentalomas (AI). It has been demonstrated that an increase in IR is related to the size of tumourous masses; additionally, luteinizing hormone (LH) dependent adrenal pathologies are well documented in patients with LH responsive adrenal tumours occurring under conditions of physiologically elevated LH. We hypothesized that an association between LH and insulin might play a role in adrenal tumourigenesis and steroidogenesis...
December 30, 2017: Clinical Endocrinology
Doğuş Vurallı, Nurgün Kandemir, Graeme Clark, Diclehan Orhan, Ayfer Alikaşifoğlu, Nazlı Gönç, Saniye Ekinci, Alev Özön
Vurallı D, Kandemir N, Clark G, Orhan D, Alikaşifoğlu A, Gönç N, Ekinci S, Özön A. A pheochromocytoma case diagnosed as adrenal incidentaloma. Turk J Pediatr 2017; 59: 200-206. There are two problems that needs to be addressed in cases of an adrenal incidentaloma. The first is to decide whether the adrenal mass is benign or malignant, and the second is to determine whether the mass is hormonally active or not. A 17-year-old male was admitted with the complaint of progressive weight gain. Abdominal ultrasonography was performed for elevation in transaminases which revealed a hypoechoic mass located in the left adrenal gland...
2017: Turkish Journal of Pediatrics
L L Li, L Zhao, J T Dou, G Q Yang, W J Gu, Z H Lü, J M Ba, Y M Mu
Objective: To evaluate the efficacy of 24 h urinary free cortisol (24 h UFC) in the diagnosis of subclinical Cushing's syndrome (SCS), and explore the best diagnostic cut-off value. Methods: The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital between January 2008 and December 2016 was retrospectively reviewed and analyzed. All SCS patients were diagnosed based on the current Cushing's syndrome (CS) guidelines and confirmed by histopathology and then treated as study group, and additional patients with non-functional adrenal adenoma (NFA) were enrolled as control group...
December 12, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Stéphanie Espiard, Kanza Benomar, Camille Loyer, Claire Vahé, Marie-Christine Vantyghem
No abstract text is available yet for this article.
December 11, 2017: Annales D'endocrinologie
Kamani Liyanarachchi, Richard Ross, Miguel Debono
The daily rhythm of the hypothalamo-pituitary-adrenal (HPA) axis is regulated by the central clock in the suprachiasmatic nucleus. Cortisol, a glucocorticoid, acts as a secondary messenger between the central clock and the peripheral tissues. Changes in clock time, as seen in shift workers, alters the HPA axis and results in metabolic disturbances associated with ill health. Depression, anorexia nervosa and obstructive sleep apnoea, are associated with cortisol rhythm phase shifts and increased cortisol exposure...
October 2017: Best Practice & Research. Clinical Endocrinology & Metabolism
Henrik Falhammar, Magnus Kjellman, Jan Calissendorff
BACKGROUND: With the increasing access to imaging more pheochromocytomas are diagnosed in the workup of adrenal incidentalomas. This may have changed the occurrence of the classic presentation with hypertension and the classic triad (headaches, sweating and palpitation). METHODS: We reviewed 94 consecutive cases of pheochromocytomas. Two cases of ectopic ACTH-syndrome were subsequently excluded. RESULTS: Of the 92 cases included 64% had presented as an incidentaloma, 32% as a suspected pheochromocytoma and 4% had been screened because of previously diagnosed MEN2A...
January 2018: Endocrine Connections
Naru Babaya, Yukako Makutani, Shinsuke Noso, Yoshihisa Hiromine, Hiroyuki Ito, Yasunori Taketomo, Kazuki Ueda, Hokuto Ushijima, Yoshifumi Komoike, Yuto Yamazaki, Hironobu Sasano, Yumiko Kawabata, Hiroshi Ikegami
BACKGROUND: We report a rare case of a juxta-adrenal schwannoma that could not be discriminated from an adrenal tumor before surgical resection and was complicated by bilateral hyperaldosteronism. To the best of our knowledge, this is first case in which both a juxta-adrenal schwannoma and hyperaldosteronism co-existed. CASE PRESENTATION: A 69-year-old male treated for hypertension was found to have a left supra-renal mass (5.8 × 5.2 cm) by abdominal computed tomography...
December 6, 2017: BMC Endocrine Disorders
Mariana Arruda, Emanuela Mello Ribeiro Cavalari, Marcela Pessoa de Paula, Felipe Fernandes Cordeiro de Morais, Guilherme Furtado Bilro, Maria Caroline Alves Coelho, Nathalie Anne de Oliveira E Silva de Morais, Diana Choeri, Aline Moraes, Leonardo Vieira Neto
There are limited data regarding the frequency of hypertension in nonfunctioning adrenal incidentaloma (NFAI). Our objectives were to investigate rates of hypertension and resistant hypertension in NFAI patients, and compare them to a control group without adrenal adenoma. We also aimed to evaluate the relationship between cortisol levels after 1 mg-dexamethasone suppression test (DST) and hypertension in NFAI patients. We selected 40 patients with NFAI and 40 control patients over the age of 18 without adrenal lesions on abdominal imaging...
December 2017: Journal of Human Hypertension
Ábel Decmann, Pál Perge, Miklós Tóth, Peter Igaz
INTRODUCTION: Adrenal myelolipoma is an invariably benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma following adrenocortical adenomas. It is composed of elements of adipose tissue and extramedullary hematopoiesis. Hypotheses on stem cells and hormonal factors have been formulated regarding its pathogenesis that is still obscure. Despite its benign behavior, adrenal myelolipoma is clinically relevant as it might cause significant difficulties in the differential diagnosis of adrenal tumors...
January 2018: Endocrine
V Morelli, L Minelli, C Eller-Vainicher, S Palmieri, E Cairoli, A Spada, M Arosio, I Chiodini
OBJECTIVE: To evaluate if the parameters of hypothalamic-pituitary-adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing's syndrome (CS) and with adrenal incidentaloma (AI). METHODS: We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels...
November 18, 2017: Journal of Endocrinological Investigation
Anthony Chang, George Silvay, Andrew Goldberg
Preoperative evaluation of incidentalomas for pheochromocytoma is imperative. This case report describes a scheduled adrenalectomy in an asymptomatic patient with what was eventually determined to be an incomplete biochemical workup. The intraoperative course was complicated by labile and rapid increases in blood pressure and heart rate, suggesting the missed diagnosis of pheochromocytoma. It is important for anesthesiologists to ensure adequate preoperative biochemical workup before excluding the possibility of coexisting pheochromocytoma...
November 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
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