Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group
Abstract
BACKGROUND: The incidental discovery of an adrenal mass raises the problem of distinguishing the frequent benign masses from the infrequent malignant ones that require surgery. At present, univocal guidelines to approach this problem are not available. The aim of the present study was to perform a multicentric retrospective analysis of adrenal masses incidentally discovered (adrenal incidentalomas). PATIENTS AND METHODS: Hospital records of adrenal incidentalomas diagnosed over a 15-year period in 29 surgical and medical centers in Italy were scrutinized. Collected cases were 1,013, and 887 were analyzed. RESULTS: The majority of patients were in the 5th and 6th decade and females were predominantly affected. The frequency of adrenocortical cancer was 12% among operated patients (316 cases). The tumor diameter was highly correlated with the risk of malignancy, as well as the CT characteristics such as density, shape and margins. The frequency of pheochromocytoma was 10% among operated patients. CONCLUSIONS: The occurrence of incidentally discovered adrenocortical carcinomas and pheochromocytomas is not rare. Evaluation of the mass size and CT characteristics are simple and effective methods to differentiate malignant lesions. Biochemical screening for pheochromocytoma is mandatory before surgery.
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Although the majority of adrenal incidentalomas are unilateral, bilateral adrenal incidentalomas may be found in 10% to 15% of cases.
“Although the majority of AIs are unilateral, bilateral AIs may be found in 10% to 15% of cases (169).”
From Adrenal incidentaloma (2020) · cites this paper as [169]
Two large studies found that the most common causes of bilateral adrenal incidentaloma were metastasis, primary bilateral macronodular adrenal hyperplasia, and bilateral cortical adenomas.
“Two large studies (169,170) found that the most common causes of bilateral AI were metastasis, primary bilateral macronodular adrenal hyperplasia (PBMAH), and bilateral cortical adenomas.”
From Adrenal incidentaloma (2020) · cites this paper as [169]
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The Incidentally Discovered Adrenal Mass
Young, W. F. (2007) · New England Journal of Medicine · doi:10.1056/nejmcp065470 · Cited by 1,090 · see citing works
“In a series of 887 patients who had adrenal incidentalomas, a diameter >4 cm was shown to have 90% sensitivity for the detection of adrenocortical carcinoma but low specificity; only 24% of lesions >4 cm in diameter were malignant [9].”
BackgroundZeiger, M. A., Thompson, G. B., Duh, Q.-Y., Hamrahian, A. H., Angelos, P., Elaraj, D., Fishman, E., Kharlip, J., Zeiger, M. A., Thompson, G. B., et al. (2009) · Endocrine Practice · doi:10.4158/ep.15.s1.1 · Cited by 499 · see citing works
“The size of the lesion can be a major predictor of an ACC in an incidentaloma with >10 HU attenuation on non - contrast CT. Multiple studies have addressed this relation - ship (125 [EL 3]) .”
MANAGEMENT APPROACHES TO ADRENAL INCIDENTALOMAS
Young, W. F. (2000) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70122-5 · Cited by 415 · see citing works
Dackiw, A. P. B., Lee, J. E., Gagel, R. F., & Evans, D. B. (2001) · World Journal of Surgery · doi:10.1007/s00268-001-0030-7 · Cited by 390 · see citing works
Incidental Adrenal Lesions: Principles, Techniques, and Algorithms for Imaging Characterization
Boland, G. W., Blake, M. A., Hahn, P. F., & Mayo-Smith, W. W. (2008) · Radiology · doi:10.1148/radiol.2493070976 · Cited by 381 · see citing works
“Other rare adrenal malignancies include primary lymphoma of the adrenal glands, hemangiosarcoma, and neuroblastoma (11).”
BackgroundSherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works
“Two large studies (169,170) found that the most common causes of bilateral AI were metastasis, primary bilateral macronodular adrenal hyperplasia (PBMAH), and bilateral cortical adenomas.”
BackgroundCawood, T. J., Hunt, P. J., O'Shea, D., Cole, D., & Soule, S. (2009) · European Journal of Endocrinology · doi:10.1530/eje-09-0234 · Cited by 300 · see citing works
Subclinical Cushing’s syndrome
Reincke, M. (2000) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70115-8 · Cited by 285 · see citing works
de Fraipont, F., El Atifi, M., Cherradi, N., Le Moigne, G., Defaye, G., Houlgatte, R., Bertherat, J., Bertagna, X., Plouin, P.-F., Baudin, E., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1075 · Cited by 261 · see citing works
“3 Introduction: Although adrenocortical tumors are highly prevalent in the human population (3 to 7% at autopsy and/or in radiological series), only a small proportion cause endocrine disorders and less than 5% are malignant (1, 2).”
BackgroundIncidentally Discovered Adrenal Tumors: Endocrine and Scintigraphic Correlates1
Barzon, L., Scaroni, C. M., Sonino, N., Fallo, F., Gregianin, M., Macrì, C., & Boscaro, M. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.83.1.4501 · Cited by 184 · see citing works
Adrenocortical Tumors: Recent Advances in Basic Concepts and Clinical Management
Bornstein, S. R., Stratakis, C. A., & Chrousos, G. P. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-9-199905040-00017 · Cited by 156 · see citing works
Clinical guidelines for the management of adrenal incidentaloma
Lee, J.-M., Kim, M. K., Ko, S.-H., Koh, J.-M., Kim, B.-Y., Kim, S. W., Kim, S.-K., Kim, H. J., Ryu, O.-H., Park, J., et al. (2017) · Endocrinology and Metabolism · doi:10.3803/enm.2017.32.2.200 · Cited by 147 · see citing works
Bancos, I., Tamhane, S., Shah, M., Delivanis, D. A., Alahdab, F., Arlt, W., Fassnacht, M., & Murad, M. H. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0297 · Cited by 144 · see citing works
Adrenal tumors: How to establish malignancy?
Faßnacht, M., Kenn, W., & Allolio, B. (2004) · Journal of Endocrinological Investigation · doi:10.1007/bf03351068 · Cited by 141 · see citing works
Comparative Genomic Hybridization Analysis of Adrenocortical Tumors
Sidhu, S. B., Marsh, D. J., Theodosopoulos, G., Philips, J. N., Bambach, C. P., Campbell, P. R., Magarey, C. J., Russell, C. F. J., Schulte, K., Röher, H. D., et al. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.7.8697 · Cited by 144 · see citing works
Brunt, L. M., & Moley, J. F. (2001) · World Journal of Surgery · doi:10.1007/s00268-001-0029-0 · Cited by 137 · see citing works
“relative frequency are shown in Table 11 [9-27].”
BackgroundGuidelines for the management of the incidentally discovered adrenal mass
Kapoor, A., Morris, T., & Rebello, R. (2011) · Canadian Urological Association Journal · doi:10.5489/cuaj.11135 · Cited by 137 · see citing works
Medical and Surgical Evaluation and Treatment of Adrenal Incidentalomas
Zeiger, M. A., Siegelman, S. S., & Hamrahian, A. H. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0085 · Cited by 134 · see citing works
“Adrenal incidentalomas are bilateral in less than 15% of cases (60, 122).”
BackgroundThe improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection
Midorikawa, S., Sanada, H., Hashimoto, S., Suzuki, T., & Watanabe, T. (2001) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2001.01274.x · Cited by 134 · see citing works
Thompson, G. B., & Young, W. F. (2003) · Current Opinion in Oncology · doi:10.1097/00001622-200301000-00013 · Cited by 131 · see citing works
Iñiguez‐Ariza, N. M., Kohlenberg, J. D., Delivanis, D. A., Hartman, R. P., Dean, D. S., Thomas, M. A., Shah, M. Z., Herndon, J. S., McKenzie, T. J., Arlt, W., et al. (2017) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2017.11.002 · Cited by 116 · see citing works
“Incidental 472 (67) 86 (54) 184 (85) 104 (90) 37 (42) 61 (48) Hormone excess 107 (15) 62 (39) 18 (8) 0 (0) 27 (31) 0 (0) Cancer staging 61 (9) 3 (2) 6 (3) 3 (3) 5 (6) 48 (38) Mass effect 51 (7) 6 (4) 6 (3) 9 (7) 18 (20) 12 (9) B symptoms 14 (2) 1 (1) 2 (1) 0 (0) 1 (1) 6 (5)”
Paulsen, S. D., Nghiem, H. V., KOROBKIN, M. T., Caoili, E. M., & Higgins, E. J. (2004) · American Journal of Roentgenology · doi:10.2214/ajr.182.4.1821033 · Cited by 112 · see citing works
Adrenal oncocytic neoplasm: a systematic review.
Mearini, L., Sordo, R. D., Costantini, E., et al. (2013) · PubMed · doi:10.1159/000345141 · Cited by 113 · see citing works
DIAGNOSIS AND MANAGEMENT OF ADRENAL INCIDENTALOMAS
Barzon, L., & Boscaro, M. (2000) · The Journal of Urology · doi:10.1016/s0022-5347(05)67888-3 · Cited by 111 · see citing works
Laparoscopic adrenalectomy—indications and technique
Lal, G., & Duh, Q. (2003) · Surgical Oncology · doi:10.1016/s0960-7404(03)00036-7 · Cited by 107 · see citing works
“By definition, these patients do not have clinical signs or symptoms of Cushing’s syndrome, but may have subtle evidence of cortisol excess manifested by weight gain, skin atrophy, facial fullness, diabetes and hypertension [76].”
BackgroundEMRAL, R., UYSAL, A. R., ASIK, M., GULLU, S., CORAPCIOGLU, D., TONYUKUK, V., & ERDOGAN, G. (2003) · Endocrine Journal · doi:10.1507/endocrj.50.399 · Cited by 104 · see citing works
“found that of 887 patients, 42% were hypertensive, 28% were obese, and 10% were diabetic [46].”
BackgroundPartial Adrenalectomy: Underused First Line Therapy for Small Adrenal Tumors
Kaye, D. R., Storey, B., Pacák, K., Pinto, P. A., Linehan, W. M., & Bratslavsky, G. (2010) · The Journal of Urology · doi:10.1016/j.juro.2010.03.052 · Cited by 105 · see citing works
“In the study of adrenal incidentalomas by Angeli et al size most closely correlated with malignancy risk with 4 cm an appropriate cutoff to differentiate adrenal carcinoma from other histologies.(22) In our review average tumor size for adrenal sparing surgery was 2.”
BackgroundBourdeau, I., El Ghorayeb, N., Gagnon, N., & Lacroix, A. (2018) · European Journal of Endocrinology · doi:10.1530/eje-18-0296 · Cited by 98 · see citing works
Limitations of size as a criterion in the evaluation of adrenal tumors
Barnett, C. C., Varma, D. G. K., El‐Naggar, A. K., Dackiw, A. P. B., Porter, G. A., Pearson, A. S., Kudelka, A. P., Gagel, R. F., Evans, D. B., & Lee, J. E. (2000) · Surgery · doi:10.1067/msy.2000.110237 · Cited by 96 · see citing works
Torlontano, M., Chiodini, I., Pileri, M., Guglielmi, G., Cammisa, M., Modoni, S., Carnevale, V., Trischitta, V., & Scillitani, A. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.7.5856 · Cited by 91 · see citing works
The Role of Laparoscopic Surgery in Adrenal Disease
Wells, S. A. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.83.9.5068-1 · Cited by 84 · see citing works
Adrenal incidentaloma: a diagnostic challenge
Anagnostis, P. G., Karagiannis, A. I., Τζιόμαλος, Κ., Kakafika, A. I., Athyros, V. G., & Mikhailidis, D. P. (2009) · HORMONES · doi:10.14310/horm.2002.1233 · Cited by 79 · see citing works
“The most widely accepted threshold is 4cm,(1-3) demonstrating a sensitivity of 90% but low specificity.(82) Lower cut-offs correspond to higher sensitivity but lower specificity, and vice versa.”
BackgroundCyclic AMP‐Dependent Signaling Aberrations in Macronodular Adrenal Disease
Bourdeau, I., & Stratakis, C. A. (2002) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2002.tb04339.x · Cited by 72 · see citing works
Luton, J., Martinez, M., Coste, J., & Bertherat, J. Y. (2000) · European Journal of Endocrinology · doi:10.1530/eje.0.1430111 · Cited by 70 · see citing works
Adrenal incidentaloma: evaluation and management
Singh, P. K., & Buch, H. (2008) · Journal of Clinical Pathology · doi:10.1136/jcp.2006.044313 · Cited by 70 · see citing works
Change in Adrenal Mass Size as a Predictor of a Malignant Tumor
Pantalone, K. M., Gopan, T., Remer, E. M., Faiman, C., Ioachimescu, A. G., Levin, H. S., SIPERSTEIN, A. E., Berber, E., Shepardson, L. B., Bravo, E. L., et al. (2010) · Endocrine Practice · doi:10.4158/ep09351.or · Cited by 68 · see citing works
Bone loss rate in adrenal incidentalomas: a longitudinal study
Chiodini, I., Torlontano, M., Carnevale, V., Guglielmi, G., Cammisa, M., Trischitta, V., & Scillitani, A. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.11.8022 · Cited by 69 · see citing works
“In fact, the knowledge of reduced bone mass may help in making decisions about the need for surgical excision in AI tumors smaller than 4 cm (4, 7).”
BackgroundPrimary aldosteronism in normokalemic patients with adrenal incidentalomas
Bernini, G., Moretti, A., Argenio, G., & Salvetti, A. (2002) · European Journal of Endocrinology · doi:10.1530/eje.0.1460523 · Cited by 64 · see citing works
“For these reasons, detection of PA in patients with adrenal incidentalomas, who according to the criteria of the Italian Study Group on Adrenal Tumors are normokalemic ( 1 , 2, 4), is not surprising.”
BackgroundLaparoscopic adrenalectomy: a report on 50 operations
Filipponi, S., Guerrieri, M., Arnaldi, G., et al. (1998) · European Journal of Endocrinology · doi:10.1530/eje.0.1380548 · Cited by 66 · see citing works
“These incidentalomas require diagnostic and therapeutic attention; they are usually benign, but up to 10‐20% of them may be primary or secondary malignancies ( 16 ).”
BackgroundChiodini, I., Tauchmanovà, L., Torlontano, M., Battista, C., Guglielmi, G., Cammisa, M., Colao, A., Carnevale, V., Rossi, R., Di Lembo, S., et al. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-020399 · Cited by 63 · see citing works
The clinical significance of adrenal incidentalomas
Androulakis, I. I., Kaltsas, G., Piaditis, G. P., & Grossman, A. B. (2011) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2010.02436.x · Cited by 61 · see citing works
Machine intelligence in non-invasive endocrine cancer diagnostics
Thomasian, N. M., Kamel, I. R., & Bai, H. X. (2021) · Nature Reviews Endocrinology · doi:10.1038/s41574-021-00543-9 · Cited by 60 · see citing works
“However, this risk factor should not be taken in isolation as ~70% of these large adrenal tumours have been shown to be non-malignant lesions 46,47 .”
BackgroundLee, J. A. (2007) · Archives of Surgery · doi:10.1001/archsurg.142.9.870 · Cited by 58 · see citing works
“Finally, there were fewer patients with subclinical Cushing syndrome in our sample (5%) compared with most other large series that found rates of approximately 10%.(3,7,13,14)”
ResultPerogamvros, I., Vassiliadi, D. A., Karapanou, O., Botoula, E., Tzanela, M., & Tsagarakis, S. (2015) · European Journal of Endocrinology · doi:10.1530/eje-15-0566 · Cited by 57 · see citing works
Adrenal incidentalomas — a continuing management dilemma
Nawar, R., & Aron, D. C. (2005) · Endocrine Related Cancer · doi:10.1677/erc.1.00951 · Cited by 56 · see citing works
“Large size, irregular shapes, vague contour, invasion into surrounding structures and high signal intensity usually denote malignancy (Angeli et al. 1997).”
BackgroundDiagnosis and management of pheochromocytoma
Hodin, R. A., Lubitz, C. C., Phitayakorn, R., & Stephen, A. E. (2014) · Current Problems in Surgery · doi:10.1067/j.cpsurg.2013.12.001 · Cited by 55 · see citing works
“The classic constellation of signs and symptoms in patients with a PCC consists of paroxysmal hypertension with episodes of severe headache, diaphoresis, and flushing (Table 2).(7,8)”
BackgroundImaging Techniques for Adrenal Lesion Characterization
Blake, M. A., Holalkere, N.-S., & Boland, G. W. (2008) · Radiologic Clinics of North America · doi:10.1016/j.rcl.2008.01.003 · Cited by 55 · see citing works
“Other rare adrenal malignancies include primary lymphoma of the adrenal, hemangiosarcoma, and neuroblastoma [11].”
BackgroundClinical and molecular aspects of adrenocortical tumourigenesis
Sidhu, S. B., Gicquel, C., Bambach, C. P., Campbell, P. R., Magarey, C. J., Robinson, B. G., & Delbridge, L. (2003) · ANZ Journal of Surgery · doi:10.1046/j.1445-2197.2003.02746.x · Cited by 56 · see citing works
“(2) Alterations in chromosome number: gain or loss of whole chromosome(s) are found in nearly all human cancers.”
BackgroundShariq, O. A., & McKenzie, T. J. (2021) · Therapeutic Advances in Chronic Disease · doi:10.1177/20406223211033103 · Cited by 59 · see citing works
DIAGNOSIS AND TREATMENT OF ADRENAL INCIDENTALOMA
Kievit, J., & Haak, H. R. (2000) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70117-1 · Cited by 52 · see citing works
Friedrich‐Rust, M., Schneider, G. K., Bohle, R. M., Herrmann, E. M., Sarrazin, C., Zeuzem, S., & Bojunga, J. (2008) · American Journal of Roentgenology · doi:10.2214/ajr.07.3565 · Cited by 48 · see citing works
“In a study involving 887 patients with adrenal incidentaloma, a diameter greater than 4 cm was found to have 90% sensitivity and 24% specificity in the detection of adrenocortical carcinoma [ 22 ].”
BackgroundResultBoushey, R. P., & Dackiw, A. P. B. (2001) · Current Treatment Options in Oncology · doi:10.1007/s11864-001-0029-1 · Cited by 47 · see citing works
Heinz‐Peer, G., Memarsadeghi, M., & Niederle, B. (2006) · Current Opinion in Urology · doi:10.1097/mou.0b013e328011ea00 · Cited by 44 · see citing works
Technical and Interpretive Pitfalls in Adrenal Imaging
Nandra, G., Duxbury, O., Patel, P., Patel, J. H., Patel, N. N., & Vlahos, I. (2020) · Radiographics · doi:10.1148/rg.2020190080 · Cited by 45 · see citing works
Waldmann, J., Feldmann, G., Slater, E. P., Langer, P., Buchholz, M., Ramaswamy, A., Saeger, W., Rothmund, Μ., & Fendrich, V. (2008) · British Journal of Cancer · doi:10.1038/sj.bjc.6604755 · Cited by 43 · see citing works
“Tumours of more than 4 cm in diameter carry an B24% risk of being an ACC (Angeli et al, 1997).”
BackgroundTsvetov, G., Shimon, I., & Benbassat, C. A. (2007) · Journal of Endocrinological Investigation · doi:10.1007/bf03347444 · Cited by 42 · see citing works
A new risk stratification algorithm for the management of patients with adrenal incidentalomas
Birsen, O., Akyüz, M., Dural, A. C., Aksoy, E., Aliyev, S., Mitchell, J. C., SIPERSTEIN, A. E., & Berber, E. (2014) · Surgery · doi:10.1016/j.surg.2014.06.042 · Cited by 39 · see citing works
“0001) on logistic regression.(31) However, the details of whether this was on univariate or multivariate analysis and what other parameters used for analysis were not reported.”
BackgroundEndoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions
Patil, R. (2016) · Annals of Gastroenterology · doi:10.20524/aog.2016.0047 · Cited by 40 · see citing works
“In a recent study, a lesion with a diameter greater than 4 cm was shown to have 90% sensitivity for the detection of adrenocortical carcinoma [23].”
Background1,161 patients with adrenal incidentalomas: indications for surgery
Kasperlik-Zaluska, A. A., Otto, M., Cichocki, A. S., Rosłonowska, E., Slowinska-Srzednicka, J., Zgliczyński, W., Jeske, W., Papierska, L., Tołłoczko, T., Polański, J., et al. (2007) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-007-0238-6 · Cited by 38 · see citing works
Surgical strategy in adrenal masses
Prager, G., Heinz‐Peer, G., Passler, C., et al. (2002) · European Journal of Radiology · doi:10.1016/s0720-048x(01)00441-7 · Cited by 38 · see citing works
“Inactive tumors between 3 and 5 cm present a relative indication for surgery, because malignancy rarely occurs [35–49] The patient’s age, comorbidities and the patients’ requests influence the therapeutic concept.”
BackgroundCT sensitivities for large (≥3 cm) adrenal adenoma and cortical carcinoma
Park, S. Y., Park, B. K., Park, J. J., & Kim, C. K. (2014) · Abdominal Imaging · doi:10.1007/s00261-014-0202-1 · Cited by 36 · see citing works
Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series
Chavez-Rodriguez, J., & Pasieka, J. L. (2005) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2005.02.003 · Cited by 36 · see citing works
Laparoscopic Adrenalectomy for Primary and Secondary Malignant Adrenal Tumors
Tsuru, N., Ushiyama, T., & Suzuki, K. T. (2005) · Journal of Endourology · doi:10.1089/end.2005.19.702 · Cited by 36 · see citing works
The molecular basis of adrenocortical cancer
Lehmann, T. P., & Wrzesiński, T. (2012) · Cancer Genetics · doi:10.1016/j.cancergen.2012.02.009 · Cited by 34 · see citing works
ACR Appropriateness Criteria® Adrenal Mass Evaluation: 2021 Update
Mody, R. N., Remer, E. M., Nikolaidis, P., Khatri, G., Dogra, V. S., Ganeshan, D., Gore, J. L., Gupta, R. T., Heilbrun, M. E., Lyshchik, A. P., et al. (2021) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2021.08.010 · Cited by 37 · see citing works
Incidentally Discovered Adrenal Mass
Song, J. H., & Mayo-Smith, W. W. (2010) · Radiologic Clinics of North America · doi:10.1016/j.rcl.2010.10.006 · Cited by 32 · see citing works
“In a series of 887 patients who had adrenal incidentalomas, a diameter >4 cm was shown to have 90% sensitivity for the detection of adrenocortical carcinoma but low specificity; only 24% of lesions >4 cm in diameter were malignant [9].”
BackgroundEvaluating and managing adrenal incidentalomas.
Gopan, T., Remer, E. M., & Hamrahian, A. H. (2006) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.73.6.561 · Cited by 31 · see citing works
“…and experts disagree about the threshold that should trigger resection of a nonfunctional adrenal tumor: recommendations range from 4 to 6 cm. 1,3,7,10 Hamrahian et al (our group), 11 in a retrospective review of 299 adrenalectomies in 290 patients and using surgical histopathology as the…”
MethodAmaya, J. M., Suidgeest, E., Sahut‐Barnola, I., Dumontet, T., Montanier, N., Pagés, G., Keller, C., van der Weerd, L., Pereira, A. M., Martinez, A., et al. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.604103 · Cited by 33 · see citing works
Dickson, P. V., Kim, L., Yen, T. W. F., Yang, A. D., Grubbs, E. G., Patel, D., & Solórzano, C. C. (2018) · Annals of Surgical Oncology · doi:10.1245/s10434-018-6749-2 · Cited by 32 · see citing works
Management of adrenal incidentaloma: the role of adrenalectomy may be underestimated
Ye, Y., Yuan, X., Chen, M., Dai, Y., Qin, Z., & Zheng, F. (2016) · BMC Surgery · doi:10.1186/s12893-016-0154-1 · Cited by 33 · see citing works
“For patients with pathologic pheochromocytoma, a preoperative evaluation revealed that approximately 43 % patients with pheochromocytoma were not diagnosed before their operations, which was similar to other reports [15, 17].”
BackgroundResultInvestigation protocol: adrenal enlargement
Mantero, F., & Arnaldi, G. (1999) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1999.00642.x · Cited by 30 · see citing works
Midorikawa, S., Sanada, H., Hashimoto, S., Suzuki, T., Watanabe, T., & Sasano, H. (2001) · Endocrine Journal · doi:10.1507/endocrj.48.167 · Cited by 31 · see citing works
“Recently, adrenal incidentalomas have been increasing in number because of the development of imaging technologies such as CT scanning, ultrasonography and MR imaging [1-4, 18].”
BackgroundCan Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?
Tu, W., Verma, R., Krishna, S., McInnes, M. D. F., Flood, T. A., & Schieda, N. (2018) · American Journal of Roentgenology · doi:10.2214/ajr.17.19276 · Cited by 30 · see citing works
“The risk of malignancy increases with adrenal mass size [25, 39]; however, adenomas may also be atypically large [38, 40].”
BackgroundPathophysiology, Evaluation, and Medical Management of Adrenal Disorders
Kutikov, A., Crispen, P. L., & Uzzo, R. G. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4160-6911-9.00057-8 · Cited by 31 · see citing works
Kutikov, A., Mallin, K., Canter, D. J., Wong, Y., & Uzzo, R. G. (2011) · The Journal of Urology · doi:10.1016/j.juro.2011.04.072 · Cited by 30 · see citing works
“As such, we analyzed data from the NCDB, the largest cohort of patients with ACC that has been accumulated to date, to better understand historical trends in diagnosis and outcome in patients with ACC.”
InfluentialAdrenal Teratoma: a Case Series and Review of the Literature
Kuo, E. J., Sisk, A. E. J., Yang, Z., et al. (2017) · Endocrine Pathology · doi:10.1007/s12022-017-9468-5 · Cited by 29 · see citing works
“are larger than 4–6 cm in size are generally recommended to undergo resection due to the increased risk of adrenocortical carcinoma [19].”
BackgroundMANAGEMENT APPROACHES TO ADRENAL INCIDENTALOMAS (ADRENALOMAS)
Linos, D. A. (2000) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70121-3 · Cited by 29 · see citing works
Endoscopic adrenalectomy in large adrenal tumors
Asari, R., Koperek, O., & Niederle, B. (2012) · Surgery · doi:10.1016/j.surg.2012.02.003 · Cited by 27 · see citing works
Preclinical Cushing’s syndrome: Report of seven cases and a review of the literature
Morioka, M., Fujii, T., Matsuki, T., Jo, Y., Kobayashi, T., Tanaka, H. Y., Ohashi, T., & Kondo, K. (2000) · International Journal of Urology · doi:10.1046/j.1442-2042.2000.00154.x · Cited by 28 · see citing works
Genetic background of adrenocortical tumor development
Kjellman, M., Larsson, C., & Bäckdahl, M. (2001) · World Journal of Surgery · doi:10.1007/s00268-001-0034-3 · Cited by 27 · see citing works
Mendiratta‐Lala, M., Avram, A. M., Turcu, A. F., & Dunnick, N. R. (2017) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2017.04.009 · Cited by 29 · see citing works
“AIs are most commonly unilateral, but up to 15% of patients may have bilateral nodules.(13,14) When an AI is found, 2 aspects are relevant in their clinical assessment: (1) their etiology and malignant potential and (2) their hormonal status.”
BackgroundIoachimescu, A. G., Remer, E. M., & Hamrahian, A. H. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2015.02.005 · Cited by 28 · see citing works
LAPAROSCOPIC APPROACH TO ADRENAL AND ENDOCRINE PANCREATIC TUMORS
Raeburn, C. D., & McIntyre, R. C. (2000) · Surgical Clinics of North America · doi:10.1016/s0039-6109(05)70237-1 · Cited by 27 · see citing works
No overrepresentation of congenital adrenal hyperplasia in patients with adrenocortical tumours
Kjellman, M., Holst, M., Bäckdahl, M., Larsson, C., Farnebo, L., & Wedell, A. (1999) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1999.00655.x · Cited by 26 · see citing works
“, 1972) and the interest in this tumour form has increased since they become a clinical dilemma when found incidentally using different image techniques on the upper abdomen (Angeli et al., 1997).”
BackgroundCurrent trends in partial adrenalectomy
Colleselli, D., & Janetschek, G. (2015) · Current Opinion in Urology · doi:10.1097/mou.0000000000000147 · Cited by 25 · see citing works
“Previously, a cut-off of 4 cm has been described to differentiate adrenal carcinomas from other histologies [17].”
BackgroundRadiologic evaluation of incidentally discovered adrenal masses.
Willatt, J., & Francis, I. R. (2010) · PubMed · Cited by 24 · see citing works
The clinical evaluation of silent adrenal masses
Ambrosi, B., Passini, E., Re, T., & Barbetta, L. (1997) · Journal of Endocrinological Investigation · doi:10.1007/bf03347983 · Cited by 23 · see citing works
Damjanovic, S. S., Antic, J. A., Ilic, B. B., Čokić, B. B., Ivović, M., Ognjanovic, S. I., Isailovic, T. V., Popovic, B. M., Antić, I. B., Tatic, S. B., et al. (2012) · Molecular Medicine · doi:10.2119/molmed.2012.00261 · Cited by 23 · see citing works
“In the case where one frequency was 0, we added the minimal positive value (1) in each of four cells in a 2 × 2 table and calculated the OR and corresponding 95% CI after this operation.”
BackgroundMethodWFUMB position paper on the management incidental findings: adrenal incidentaloma
Dietrich, C. F., Correas, J. M., Dong, Y., Nolsøe, C., Westerway, S. C., & Jenssen, C. (2019) · ULTRASONOGRAPHY · doi:10.14366/usg.19029 · Cited by 21 · see citing works
“Bilateral AIs are found in about 10%-15% of cases [17-19].”
BackgroundLaparoscopic Adrenalectomy: Tailoring Approaches for the Optimal Resection of Adrenal Tumors
Mihai, I., Boicean, A., Teodoru, C. A., Grigore, N., Iancu, G. M., Dura, H., Bratu, D. G., Roman, M. D., Mohor, C. I., Todor, S. B., et al. (2023) · Diagnostics · doi:10.3390/diagnostics13213351 · Cited by 22 · see citing works
Management of the Incidental Adrenal Mass
Thomas, A. Z., Blute, M. L., Seitz, C., Habra, M. A., & Karam, J. A. (2016) · European Urology Focus · doi:10.1016/j.euf.2015.12.006 · Cited by 22 · see citing works
“Adrenal masses with tumor diameter >4 cm were associated with 90% sensitivity in adrenal cortical carcinoma (ACC) detection [27].”
BackgroundLaparoscopic Resection of an Adrenal Hydatid Cyst
Defêchereux, T. (2000) · The European Journal of Surgery · doi:10.1080/110241500447317 · Cited by 22 · see citing works
Adrenal schwannoma: CT, MR manifestations and pathological correlation
Tang, W., Yu, X.-R., Zhou, L.-P., Gao, H.-B., Wang, Q.-F., & Peng, W. (2018) · Clinical Hemorheology and Microcirculation · doi:10.3233/ch-170316 · Cited by 20 · see citing works
“To the best of our knowledge, total excision of benign schwannoma is associated with a favorable outcome [19, 20].”
Lehrberg, A. V., & Kharbutli, B. (2017) · Journal of Medical Case Reports · doi:10.1186/s13256-017-1506-x · Cited by 19 · see citing works
“We propose an interval CT follow-up at 1 to 4 months for large, > 4 cm, adrenal gland hemorrhage based on known likelihood of incidental adenomas < 4 cm, with typical radiologic findings, such as smooth and homogenous lesions, to have low risk of malignancy [22].”
MethodThomas, A. J., Habra, M. A., Bhosale, P., Qayyum, A., Ahmed, K., Vicens, R., & Elsayes, K. M. (2018) · Abdominal Radiology · doi:10.1007/s00261-018-1603-3 · Cited by 21 · see citing works
Nonfunctional adrenal incidentalomas may be related to bisphenol-A
Eker, F., Güngüneş, A., Durmaz, Ş. A., Kısa, Ü., & Celik, Z. R. (2020) · Endocrine · doi:10.1007/s12020-020-02502-2 · Cited by 18 · see citing works
Chagpar, R., SIPERSTEIN, A. E., & Berber, E. (2014) · Surgical Clinics of North America · doi:10.1016/j.suc.2014.02.009 · Cited by 18 · see citing works
Shirodkar, M. A., & Jabbour, S. A. (2008) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2008.01831.x · Cited by 18 · see citing works
Predicting malignancy in patients with adrenal tumors using 18F‐FDG‐PET/CT SUVmax
Vos, E. L., Grewal, R. K., Russo, A. E., Reidy‐Lagunes, D. L., Untch, B. R., Gavane, S. C., Boucai, L., Geer, E. B., Gopalan, A., Chou, J. F., et al. (2020) · Journal of Surgical Oncology · doi:10.1002/jso.26203 · Cited by 18 · see citing works
“The AACE/AAES guidelines advise resecting tumors larger than 4 cm, based on a retrospective study in which tumor size was highly correlated with malignancy.(24) We found that tumor size was similar between malignant and benign adrenal tumors, though this may reflect differences in patient population.”
Extramedullary plasmacytoma in the adrenal incidentaloma
Kahara, T., Nagai, Y., Yamashita, H., Nohara, E., KOBAYASHI, K. P., & Takamura, T. (2001) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2001.01191.x · Cited by 17 · see citing works
- Authors
- Angeli, A., Osella, G., Ali, A., & Terzolo, M.
- Affiliations
- University of Turin (IT)
- ORCID
- Terzolo, M.
- Venue
- Hormone Research
- Publisher
- S. Karger AG
- Published
- 1997
- Volume
- 47
- Issue
- 4-6
- Pages
- 279-283
- ISSN
- 0301-0163 (ISSN-L)
- 1423-0046
- OpenAlex
- W2023441974
- Cited by
- 259
- References
- 0
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 8 · 2022: 9 · 2021: 12 · 2020: 13 · 2019: 7 · 2018: 12 · 2017: 14 · 2016: 11 · 2015: 14 · 2014: 13 · 2013: 5 · 2012: 9
- FWCI
- 10.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hormone Research (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Keywords
- adrenal incidentaloma, adrenal mass, adrenocortical carcinoma, pheochromocytoma, tumor size, CT imaging characteristics, benign versus malignant differentiation, biochemical screening, surgical management
- MeSH terms
- Adolescent, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Female, Humans, Italy, Male, Middle Aged, Pheochromocytoma, Retrospective Studies
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