Clinical and Laboratory Evaluation of Adrenal Dysfunction
Fuad S. Ashkar, Lelio G. Colombetti in Radiobioassays, 2019
In patients in whom the diagnosis of adrenal tumor has been established, an attempt at identifying the site of the lesion is indicated. While adrenal adenomas are not regularly demonstrable by i.v. pyelography, malignant adrenal tumors will have attained sufficient size to be clinically palpable or radiographically visualized in fully 50% of patients at the time of presentation. In selected patients, arteriography may be helpful. Catheterization with sampling of the adrenal venous effluents for steroid determinations provides localization based on increased hormone secretion on the affected side with suppressed output contralaterally. It should be emphasized that none of these procedures is appropriately used to establish the diagnosis of hypercortisolism resulting from an adrenal tumor, but rather to localize such a lesion once proven by the hormonal measurements and manipulations described (Figure 4).
Coincidental adrenal masses and adrenal cancer
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
The size of the lesion used to be considered as a major predictor of malignancy, and surgery is usually recommended for lesions >4–6 cm. The prevalence of adrenocortical carcinoma (ACC) is thought to be 2% among tumors that are ≤4 cm, 6% among tumors that are 4.1–6.0 cm, and 25% among larger tumors.11 Size has both a low specificity and low sensitivity for the detection of cancer because 75% of tumors >6 cm are not malignant, and also small ACCs have been reported. In lesions of <4 cm, a repeat imaging evaluation at 3–6 months, depending on the size and imaging characteristics of the mass, is usually advocated. A rapid and significant (usually >5 mm) change in size may occasionally indicate malignancy, but again it is not an accurate predictor of adrenal cancer.7,12 The role of further repeat imaging has been challenged recently by Cawood et al.7 who raised concerns that the risk of inducing cancer from the ionizing radiation delivered from multiple computed tomography (CT) scans outweighs the possible benefits, given the substantially small probability of malignant transformation of these tumors.
Chronic hypertension and acute hypertensive crisis
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Many women with chronic hypertension are under the care of a primary care physician and already have been evaluated for causes of secondary hypertension, such as primary aldosteronism, pheochromocytoma, or Cushing’s disease (3). Women with paroxysmal hypertension, frequent “hypertensive crisis,” seizure disorders, or anxiety attacks should be evaluated for pheochromocytoma with measurements of 24-hour urine vanillylmandelic acid, metanephrines, or unconjugated catecholamines (10). Primary aldosteronism is rare in pregnancy, but may present with hypokalemia. Imaging studies (magnetic resonance imaging or computed tomography) may be helpful in demonstrating or localizing an adrenal tumor. Doppler flow studies or magnetic resonance angiography can reveal renal artery stenosis (3).
Management of a multiple endocrine neoplasia type 1 during pregnancy: a case with primary hypertension
Published in Gynecological Endocrinology, 2022
Jianyi Li, Dabao Xu, Xinli Liu
From first trimester to 22 weeks gestation, the pregnancy was uneventful, amniocentesis was refused. At 23 weeks, the patient was hospitalized to our clinic again for elevation of blood pressure. Blood pressure at that time was 180/117 mmHg, serum prolactin and phosphorus level were 2.08 mmol/L and 0.82 mmol/l, PRL at that time was measured as 135.8 ng/ml, HbA1C level was 5.8%, 24-h proteinuria value was 3331.2 mg, the levels of thyroid function, PTH, hepatorenal function were all in normal range. Aldosterone, angiotensinI/II,renin activity, cortisol, ACTH, abdominal CT were performed to examine whether left adrenal tumor developed from nonfunctioning to functioning or new lesion in adrenal gland existed, results showed that the biochemical tests were all in normal range and abdominal CT showed the same as before. Chronic hypertension with severe preeclampsia was diagnosed and induced abortion was suggested, the patient declined, nifedipine controlled release tablet and oral protein powder were added, 24-h proteinuria and liver function were monitored, one week later, Blood pressure was controlled at normal level, serum albumin and 24-h proteinuria levels were 32.1 g/l and 1082 mg, another 10 days passed, serum albumin and 24-h proteinuria levels were tested again and the results were 30.7 g/l and 1953 mg. At 29 weeks gestation, serum prolactin and phosphorus levels were 2.22 mmol/L and 0.66 mmol/l, serum albumin and 24-h proteinuria levels were 30.7 g/l and 2603 mg, steroid injections for fetal lung maturity was used.
Survival benefits of computed tomography-guided thermal ablation for adrenal metastases from hepatocellular carcinoma
Published in International Journal of Hyperthermia, 2019
Ning Lyu, Yanan Kong, Tao Pan, Luwen Mu, Xuqi Sun, Shaolong Li, Haijing Deng, Jinfa Lai, Ming Zhao
Evaluations of technical success, effectiveness, and complications were based on per-lesion ablation. Adrenal tumor progression rates and survival outcomes were assessed on a per-patient basis. Survival was estimated using the Kaplan–Meier method and compared using log-rank tests. A Cox regression model was used for the evaluation of factors predicting survival. Statistically significant variables in the univariate analysis were included in the multivariate analysis. A p values of <.05 was considered statistically significant. All statistical analyses were performed using SPSS version 17.0 (SPSS, Chicago, IL). All data were recorded at Sun Yat-Sen University Cancer Center (number: RDDA2018000952).
Hyperthecosis: an underestimated nontumorous cause of hyperandrogenism
Published in Gynecological Endocrinology, 2021
Blazej Meczekalski, Anna Szeliga, Marzena Maciejewska-Jeske, Agnieszka Podfigurna, Paulina Cornetti, Gregory Bala, Eli Y. Adashi
Rapid progression in the clinical symptoms of hyperandrogenism and highly elevated levels of androgens can also suggest the presence of a pure androgen-secreting adrenal tumor (PASAT). In most cases of PASATs, testosterone is not elevated in isolation but rather in conjunction with other adrenal androgens such as DHEAS, DHEA, and androstenedione [45]. Pure androgen-secreting adrenal tumors are very rare but clinical suspicion should remain high when considering a postmenopausal woman with severe hyperandrogenism.
Related Knowledge Centers
- Pheochromocytoma
- Endocrine System
- Neoplasm
- Neuroblastoma
- Cancer
- Malignancy
- Adrenal Gland
- Hormone
- Adrenocortical Carcinoma
- Adrenocortical Adenoma