CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma
Open accessAbstract
Background: Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with CT characteristics of an adrenocortical adenoma (ACA). Aim: To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT. Methods: For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield units (HU), absolute percentage washout (APW), and relative percentage washout (RPW) were collected in addition to clinical parameters. Results: Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0.5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU > 10 and available washout data, 22 (28.9%) had a high APW and/or RPW, suggestive of ACA. Conclusion: Based on the lack of PCCs with an unenhanced attenuation of <10 HU and the low proportion (0.5%) of PCCs with an attenuation of 10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation of ≤10 HU. The assessment of contrast washout, however, is unreliable for ruling out PCC.
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Canu et al. identified 2 (0.5%) of 376 histologically proven pheochromocytomas with an unenhanced CT attenuation value of exactly 10 HU, and 99.5% had a HU greater than 10.
“Canu et al. (188) identified 2 (0.5%) of 376 histologically proven pheochromocytomas with unenhanced CT attenuation value of exactly 10 HU, 99.5% (n = 374) had a HU > 10.”
From Adrenal incidentaloma (2020) · cites this paper as [188]
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Pheochromocytoma and Paraganglioma
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“As a general principle, every patient with AI should be screened for adrenal catecholamine (although recent data has suggested this may not need to be the case in low Hounsfield unit lesions (188)) and glucocorticoid excess.”
BackgroundApproach to the Patient With Adrenal Incidentaloma
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Self-citation
- Authors
- Canu, L., Van Hemert, J. A. W., Kerstens, M. N., Hartman, R. P., Khanna, A., Kraljevic, I., Kastelan, D., Badiu, C., Ambroziak, U., Tabarin, A., Haissaguerre, M., Buitenwerf, E., Visser, A., Mannelli, M., Arlt, W., Chortis, V., Bourdeau, I., Gagnon, N., Buchy, M., Borson-Chazot, F., Deutschbein, T., Fassnacht, M., Hubalewska-Dydejczyk, A., Motyka, M., Rzepka, E., Casey, R. T., Challis, B. G., Quinkler, M., Vroonen, L., Spyroglou, A., Beuschlein, F., Lamas, C., Young, W. F., Bancos, I., & Timmers, H. J. L. M.
- Affiliations
- Radboud University Medical Center (NL)
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
- University Medical Center Groningen (NL)
- Mayo Clinic (US)
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
- Carol Davila University of Medicine and Pharmacy (RO)
- Medical University of Warsaw (PL)
- Centre Hospitalier Universitaire de Bordeaux (FR)
- University of Florence (IT)
- University of Birmingham (GB)
- Centre Hospitalier de l’Université de Montréal (CA)
- Hospices Civils de Lyon (FR)
- Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- University of Würzburg (DE)
- Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Jagiellonian University (PL)
- University of Cambridge (GB)
- Endocrinology in Charlottenburg, Berlin, Germany
- Centre Hospitalier Universitaire de Liège (BE)
- University Hospital Zurich (CH)
- Hospital General Universitario de Albacete (ES)
- Corresponding author
- Timmers, Henri J L M
- ORCID
- Canu, Letizia
- Hartman, Robert P
- Badiu, Corin
- Ambroziak, Urszula
- Tabarin, Antoine
- Haissaguerre, Magalie
- Buitenwerf, Edward
- Mannelli, Massimo
- Arlt, Wiebke
- Chortis, Vasileios
- Bourdeau, Isabelle
- Gagnon, Nadia
- Deutschbein, Timo
- Fassnacht, Martin
- Rzepka, Ewelina
- Casey, Ruth T
- Challis, Benjamin G
- Quinkler, Marcus
- Vroonen, Laurent
- Spyroglou, Ariadni
- Beuschlein, Felix
- Lamas, Cristina
- Young, William F
- Bancos, Irina
- Timmers, Henri J L M
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2018-10-31
- Volume
- 104
- Issue
- 2
- Pages
- 312-318
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2899051779
- Cited by
- 131
- References
- 24
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 17 · 2023: 18 · 2022: 23 · 2021: 20 · 2020: 20 · 2019: 14
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- RUIdeRA - Institutional University Repository (University of Castilla-La Mancha) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Apollo
- Funders
- European Society of Endocrinology
- Cancer Research UK (15622)
- Radboud Universiteit
- Radboud Universitair Medisch Centrum
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Keywords
- pheochromocytoma, adrenal incidentaloma, adrenal adenoma, CT attenuation, contrast washout, metanephrine, adrenal imaging
- MeSH terms
- Adrenal Gland Neoplasms, Adult, Aged, Contrast Media, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Pheochromocytoma, Retrospective Studies, Tomography, X-Ray Computed
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