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adrenal incidentalomas

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https://www.readbyqxmd.com/read/29144180/intraoperative-hemodynamic-instability-and-diagnosis-of-pheochromocytoma-during-excision-of-adrenal-incidentaloma-with-incomplete-workup-a-case-report
#1
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
https://www.readbyqxmd.com/read/29141379/-clinical-value-of-tumor-size-in-the-evaluation-of-adrenal-incidentalomas
#2
L L Li, L Zhao, J T Dou, G Q Yang, W J Gu, Z H Lü, J M Ba, Y M Mu, J M Lu, C Y Pan
Objective: To investigate the clinical value of tumor size in the evaluation of endocrinological and histological natures regarding adrenal incidentaloma (AI) patients. Methods: A total of 1 941 AI patients who were hospitalized in Department of Endocrinology, Chinese PLA General Hospital between January 1997 and December 2016 were retrospectively reviewed. The demographics of patients, imaging features, functional status and histological results were analyzed. Results: Of 1 941 patients, 984 (50.70%) were males, and 957 (49...
November 14, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29129360/less-is-more-cost-effectiveness-analysis-of-surveillance-strategies-for-small-nonfunctional-radiographically-benign-adrenal-incidentalomas
#3
Kathryn Chomsky-Higgins, Carolyn Seib, Holly Rochefort, Jessica Gosnell, Wen T Shen, Jamess G Kahn, Quan-Yang Duh, Insoo Suh
BACKGROUND: Guidelines for management of small adrenal incidentalomas are mutually inconsistent. No cost-effectiveness analysis has been performed to evaluate rigorously the relative merits of these strategies. METHODS: We constructed a decision-analytic model to evaluate surveillance strategies for <4cm, nonfunctional, benign-appearing adrenal incidentalomas. We evaluated 4 surveillance strategies: none, one-time, annual for 2 years, and annual for 5 years. Threshold and sensitivity analyses assessed robustness of the model...
November 9, 2017: Surgery
https://www.readbyqxmd.com/read/29126119/lower-trabecular-bone-score-in-patients-with-primary-aldosteronism-human-skeletal-deterioration-by-aldosterone-excess
#4
Beom-Jun Kim, Mi Kyung Kwak, Seong Hee Ahn, Hyeonmok Kim, Seung Hun Lee, Jung-Min Koh
Context: Despite the potential detrimental effects of aldosterone excess on bone metabolism, there are discrepancies between fracture risk and bone mass in patients with and without primary aldosteronism (PA). Objective: To clarify the possibility that aldosterone excess may mainly affect bone properties which are not explained by bone mineral density (BMD). Design, Setting, and Patients: Among 625 consecutive patients with newly diagnosed adrenal incidentaloma, 72 patients with biochemically confirmed PA and 335 patients with nonfunctional adrenal incidentaloma were defined as cases and controls, respectively...
November 6, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29125476/adrenalectomy-was-recommended-for-patients-with-subclinical-cushing-s-syndrome-due-to-adrenal-incidentaloma
#5
Dong Wang, Zhi-Gang Ji, Han-Zhong Li, Yu-Shi Zhang
OBJECTIVE: To assess whether adrenalectomy may improve biochemical and metabolic impairment for patients with subclinical Cushing syndrome (SCS) due to adrenal incidentaloma (AI) compared with conservative management. METHODS: A total of 87 patients with SCS due to AI in Peking Union Medical College Hospital between September 2011 and January 2016 have been treated. Forty-eight patients underwent laparoscopic adrenalectomy (operative group), whereas 39 were managed conservatively (control group)...
October 31, 2017: Cancer Biomarkers: Section A of Disease Markers
https://www.readbyqxmd.com/read/29118987/massive-adrenal-incidentalomas-and-late-diagnosis-of-congenital-adrenal-hyperplasia-in-prostate-cancer
#6
Xin Feng, Gregory Kline
In a 61-year-old Caucasian male with prostate cancer, leuprolide and bicalutamide failed to suppress the androgens. He presented to endocrinology with persistently normal testosterone and incidental massive (up to 18 cm) bilateral adrenal myelolipomas on CT scan. Blood test did not reveal metanephrine excess. The patient was noted to have short stature (151 cm) and primary infertility. Elementary school photographs demonstrated precocious puberty. Physical examination revealed palpable abdominal (adrenal) masses...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29081161/-surgery-versus-conservative-management-for-subclinical-cushing-s-syndrome-in-adrenal-incidentalomas
#7
L L Li, L Zhao, J T Dou, G Q Yang, W J Gu, Z H Lü, J M Ba, Y M Mu, J M Lu, C Y Pan
Objective: To determine the effect of the surgical and conservative approaches on the metabolic profiles in patients with subclinical Cushing's syndrome (SCS) in adrenal incidentalomas (AI). Methods: A hundred and thirty AI patients with SCS in Department of Endocrinology, PLA General Hospital between January 2008 and December 2016 were studied, surgery was performed in 88 patients (surgical group), and the rest received conservative approach (conservative group). The improvement/worsening of blood pressure, blood glucose, lipid profiles and body weight after a duration of >18 months follow-up were analyzed, respectively...
October 31, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29068510/characteristics-of-adrenal-incidentalomas-in-a-new-zealand-centre
#8
Z Goh, I Phillips, P J Hunt, S Soule, T J Cawood
BACKGROUND: Management of adrenal incidentalomas (AI) is becoming more conservative, based on international data showing a low incidence of functional or malignant lesions. The clinical characteristics of AI in New Zealand are unknown. Therefore, whether the AI guidelines apply to the New Zealand population is also unknown. AIMS: To investigate the clinical characteristics of patients with AI presenting to a tertiary-care centre in New Zealand. METHOD: This study prospectively evaluated consecutive patients aged 18 or older with AI, 1 cm or larger, diagnosed in Canterbury, New Zealand...
October 25, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29043559/nonfunctioning-adrenal-incidentaloma-affecting-central-blood-pressure-and-arterial-stiffness-parameters
#9
Tolga Akkan, Mustafa Altay, Yasemin Ünsal, Murat Dağdeviren, Esin Beyan
PURPOSE: Recently, cardiovascular risk is thought to be increased in patients with nonfunctioning adrenal incidentaloma (NFAI). There are no sufficient studies in the literature to evaluate this situation in NFAI patients without cardiovascular risk. The objective of this study is to compare peripheral and central blood pressure and arterial stiffness between patients with NFAI and healthy volunteers (of a similar age, gender and body mass index as the NFAI group) who have no traditional cardiovascular risk factors and autonomous cortisol secretion, with pulse wave analysis (PWA)...
October 17, 2017: Endocrine
https://www.readbyqxmd.com/read/28981236/-adrenal-disease-diagnosis-management-of-adrenal-incidentaloma
#10
A S Azzi, N Driessens
Adrenal glands are specialized in biosynthesis of several hormones correlated to different clinical phenotypes in case of excess or lack of production. In addition to secretion disorders, tumors, secreting or not, can take place in adrenal glands. Incidentalomas are the most common adrenal diseases in clinical practice. The challenge of the management is to determine whether the lesion is benign or malignant and secreting or not in order to direct therapeutic management towards surgical option, pharmacotherapy or clinical follow-up...
2017: Revue Médicale de Bruxelles
https://www.readbyqxmd.com/read/28972640/nationellt-v%C3%A3-rdprogram-f%C3%A3-r-adrenala-incidentalom-programmet-har-harmoniserats-med-europeiska-riktlinjer-%C3%A2-ger-f%C3%A3-renklad-handl%C3%A3-ggning-av-patienter
#11
Andreas Muth, Lilian Hammarstedt, Mikael Hellström, Ulf Nyman, Anders Sundin, Hans Wahrenberg, Bo Wängberg
Swedish guidelines for the management of adrenal incidentalomas  Adrenal incidentalomas are seen in about five percent of abdominal CT examinations, and in most cases represent non-hormone-producing adrenocortical adenomas, but hormone-producing or malignant lesions occur. Revised Swedish guidelines for the evaluation and management of adrenal incidentalomas based on recently published European guidelines are presented. The importance of a thorough radiological, clinical and biochemical initial evaluation is emphasized...
September 29, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28956783/congenital-adrenal-hyperplasia-as-a-cause-of-adrenal-incidentaloma
#12
E Buitenwerf, T P Links, I P Kema, M L Haadsma, M N Kerstens
Congenital adrenal hyperplasia (CAH) can present as a benign adrenal tumour, which should be treated medically. The diagnosis of CAH must be considered in a patient presenting with adrenal incidentaloma in order to avoid unnecessary adrenalectomy. Urinary steroid profiling is a useful diagnostic tool to identify the presence of CAH.
September 2017: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/28956262/daily-salivary-cortisol-and-cortisone-rhythm-in-patients-with-adrenal-incidentaloma
#13
Filippo Ceccato, Mattia Barbot, Nora Albiger, Giorgia Antonelli, Marialuisa Zilio, Marco Todeschini, Daniela Regazzo, Mario Plebani, Carmelo Lacognata, Maurizio Iacobone, Franco Mantero, Marco Boscaro, Carla Scaroni
BACKGROUND AND AIM: Impaired cortisol rhythm is a characteristic feature of Cushing's Syndrome, nevertheless late night salivary cortisol (LNSC) is not suitable to detect subclinical hypercortisolism in patients with adrenal incidentaloma (AI). We studied daily salivary cortisol (F) and cortisone (E) rhythm in patients with AI. MATERIALS AND METHODS: Six saliva samples were collected from awakening to night in 106 patients with AI and 40 controls. F and E were measured with LC-MS/MS and daily F exposure was calculated with the area under the curve (AUC)...
September 27, 2017: Endocrine
https://www.readbyqxmd.com/read/28932767/patient-specific-workup-of-adrenal-incidentalomas
#14
REVIEW
Romy R de Haan, Johannes B R Visser, Ewoud Pons, Richard A Feelders, Uzay Kaymak, M G Myriam Hunink, Jacob J Visser
PURPOSE: : To develop a clinical prediction model to predict a clinically relevant adrenal disorder for patients with adrenal incidentaloma. MATERIALS AND METHODS: : This retrospective study is approved by the institutional review board, with waiver of informed consent. Natural language processing is used for filtering of adrenal incidentaloma cases in all thoracic and abdominal CT reports from 2010 till 2012. A total of 635 patients are identified. Stepwise logistic regression is used to construct the prediction model...
2017: European Journal of Radiology Open
https://www.readbyqxmd.com/read/28931176/the-role-of-cortisol-acth-ratio-for-screening-of-subclinical-hypercortisolism-in-patients-with-adrenal-incidentalomas
#15
Lele Li, Guoqing Yang, Jingtao Dou, Weijun Gu, Zhaohui Lv, Juming Lu, Yiming Mu
Introduction The cortisol/ACTH ratio was supposed to be helpful in the screening of subclinical hypercortisolism (SHC) in the published literatures. This study assessed the cortisol/ACTH ratio in patients with adrenal incidentaloma (AI) confirmed to have SHC and investigated its role for screening SCS in patients with AI. Methods This descriptive retrospective study included 183 patients with AIs [45 with SHC and 138 with non-functional adenoma (NFA)]. Cortisol and ACTH levels were measured at 8:00, 16:00, and 0:00, and the cortisol/ACTH ratio was calculated...
September 20, 2017: Experimental and Clinical Endocrinology & Diabetes
https://www.readbyqxmd.com/read/28911138/resetting-the-abnormal-circadian-cortisol-rhythm-in-adrenal-incidentaloma-patients-with-mild-autonomous-cortisol-secretion
#16
COMPARATIVE STUDY
Miguel Debono, Robert F Harrison, Rita Chadarevian, Carole Gueroult, Jean-Louis Abitbol, John Newell-Price
Context: Adrenal incidentalomas (AIs) are found commonly on axial imaging. Around 30% exhibit autonomous cortisol secretion (ACS) associated with increased cardiovascular events and death. Objective: We hypothesized that AI/ACS patients have an abnormal cortisol rhythm that could be reversed by use of carefully timed short-acting cortisol synthesis blockade, with improvement in cardiovascular disease markers. Design, Setting, and Participants: In a phase 1/2a, prospective study (Eudract no...
September 1, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28893861/adrenal-venous-sampling-for-primary-aldosteronism-laboratory-medicine-best-practice
#17
REVIEW
Gregory Kline, Daniel T Holmes
Primary aldosteronism (PA) is the most common form of secondary hypertension and is critical to identify because when caused by an aldosterone-producing adenoma (APA) or another unilateral form, it is potentially curable, and even when caused by bilateral disease, antihypertensives more specific to PA treatment can be employed (ie, aldosterone antagonists). Identification of unilateral forms is not generally accomplished with imaging because APAs may be small and elude detection, and coincidental identification of a non-functioning incidentaloma contralateral to an APA may lead to removal of an incorrect gland...
November 2017: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28887710/increased-mortality-in-patients-with-adrenal-incidentalomas-and-autonomous-cortisol-secretion-a-13-year-retrospective-study-from-one-center
#18
Jekaterina Patrova, Magnus Kjellman, Hans Wahrenberg, Henrik Falhammar
PURPOSE: To compare long-term outcomes in patients with adrenal incidentalomas (AIs) with the response to a 1 mg overnight dexamethasone suppression test (DST). METHODS: Consecutive patients with "non-functional" AIs (n = 365) were examined. Patients with overt hormone excess, adrenocortical cancer and known malignancy had been excluded. Patients were classified to normal cortisol secretion group (n = 204, DST ≤ 50 nmol/l), possible autonomous cortisol secretion group (n = 128, DST 51-138 nmol/l) and autonomous cortisol secretion group (n = 33, DST ≥ 138 nmol/l)...
November 2017: Endocrine
https://www.readbyqxmd.com/read/28870984/optimal-follow-up-strategies-for-adrenal-incidentalomas-reappraisal-of-the-2016-ese-ensat-guidelines-in-real-clinical-practice
#19
A Ram Hong, Jung Hee Kim, Kyeong Seon Park, Kyong Young Kim, Ji Hyun Lee, Sung Hye Kong, Seo Young Lee, Chan Soo Shin, Sang Wan Kim, Seong Yeon Kim
OBJECTIVE: Recently, the European Society of Endocrinology (ESE), in collaboration with the European Network for the Study of Adrenal Tumors (ENSAT), asserted that adrenal incidentalomas (AIs) <4 cm and ≤10 Hounsfield units (HU) do not require further follow-up imaging. To validate the clinical application of the follow-up strategies suggested by the 2016 ESE-ENSAT guidelines, we explored the clinical characteristics and natural course of AIs in a single center over 13 years. DESIGN AND METHODS: This retrospective cohort study included a total of 1149 patients diagnosed with AIs between 2000 and 2013 in a single tertiary center...
December 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28852452/adrenal-incidentaloma-in-a-patient-with-hiv-aids
#20
Jason Ramsingh, Carol Watson
Human immunodeficiency virus (HIV) is well known to be associated with various neoplasms and opportunistic infections. Kaposi sarcoma (KS), associated with human herpes virus 8 (HHV8) infection, is the most common tumour in HIV positive patients and is also an acquired immune deficiency syndrome (AIDS) defining illness. Cutaneous manifestations are the most common presenting symptom; however, visceral involvement is also recognized. We present the case of a 55-year-old male who was diagnosed with AIDS-related KS, who was referred to our surgical unit with an indeterminate left adrenal lesion...
July 2017: Journal of Surgical Case Reports
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