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Adrenal incidental adenomas
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Cell typesAdrenal incidentalomas can arise from the adrenal cortex, adrenal medulla, or as metastatic disease from an extra-adrenal cancer.Tumors arising from the adrenal cortex include nonfunctional adrenocortical adenomas, cortisol-producing adenomas, aldosterone-producing adenomas, and adrenocortical carcinoma.A tumor arising from the adrenal medulla is a pheochromocytoma.5The most common etiology of an adrenal incidentaloma is a benign, non-hypersecreting adrenocortical adenoma.8
Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
What is the differential diagnosis of an adrenal incidentaloma?Functional: Adrenal cortex – adenoma, nodular hyperplasia, carcinomaAdrenal medulla – phaeochromocytoma, ganglioneuroma/blastomaNon-functional: Adrenal masses – lipoma, cyst, haematoma, hamartoma, teratoma, amyloidosis, neurofibromaMetastases – breast, lung, lymphoma, renalLeukaemiaPseudo adrenal masses – lymph nodes, renal/pancreatic/splenic mass
Techniques of adrenalectomy
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Minerva Angelica Romero Arenas, Ashley Stewart, Nancy D. Perrier
However, not all tumors are functional. Nonfunctional tumors may also arise from the native tissue of the adrenal gland and other more rare tumors that are not composed of medullary or cortical tissues. These tumors can be found incidentally when a patient undergoes radiographic evaluation for an unrelated issue (commonly termed adrenal incidentaloma). Adrenal neoplasms, particularly those which are nonfunctional, can also grow to a size where the mass effect creates pain or adjacent organ dysfunction, such as ureteral or bowel obstruction. Identification of any adrenal lesion requires a thorough biochemical, radiographic, and, if indicated, genetic evaluation prior to any operative intervention.
Secondary hypertension as a cause of treatment resistance
Published in Blood Pressure, 2023
Isabella Sudano, Paolo Suter, Felix Beuschlein
While glucocorticoid excess does play a role in blood pressure regulation, arterial hypertension is only rarely the leading clinical feature in patients with Cushing’s syndrome. Considering the rarity of the condition, it is, therefore, prudent to restrict screening procedures in hypertensive patients to those suggested by current guidelines [24,25]:Patients with unusual features for age (e.g. osteoporosis, hypertension).Patients with multiple and progressive features [25], particularly those that are morepredictive of Cushing’s syndrome such as between others facial plethora, Striae or proximal myopathy [24].Children with decreasing height percentile and increasing weight.Patients with adrenal incidentaloma compatible with adenoma.
Niche point-of-care endocrine testing – Reviews of intraoperative parathyroid hormone and cortisol monitoring
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Li-Sheng Chen, Ravinder J. Singh
Adrenal incidentaloma is a common finding in clinical practice. Patients with functional adrenal incidentaloma may have clinical or subclinical ACTH-independent Cushing syndrome [62]. Imaging studies cannot distinguish functioning and non-functioning adrenal cortical masses; thus, diagnosis relies on laboratory hormonal evaluations. AVS is useful for distinguishing three types of bilateral adrenal masses: cortisol-secreting adenoma with a contralateral non-functioning cortical adenoma, bilateral cortisol-secreting adenoma, and bilateral ACTH-independent macronodular adrenal hyperplasia. SI greater than 6.5 with dexamethasone stimulation is consistent with a cortisol-secreting adenoma (unilateral or bilateral). SI equal to or less than 3.3 indicates a non-functioning adenoma, whereas SI is moderately increased in patients with ACTH-independent macronodular adrenal hyperplasia. LI is 2.0 or less in patients with clinically important bilateral cortisol masses, while LI of 2.3 or greater is consistent with autonomous cortisol secretion predominantly from a single adrenal gland [63].