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Adrenal Mass

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3701. Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. (PubMed)

Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. Although the left adrenal gland is readily visible by endoscopic ultrasound (EUS), there are few published data on the utility of EUS-guided fine-needle aspiration (EUS-FNA) of this site. The aim of this study was to report our experience of EUS-FNA of left adrenal gland masses.In this retrospective case series, we reviewed our EUS and cytology databases to identify consecutive patients who underwent EUS-FNA (...) of the left adrenal gland between January 1997 and January 2004. Medical records were reviewed and the results of EUS examinations and cytological investigations were abstracted.Our searches resulted in the identification of a series of 38 consecutive patients who underwent EUS for the evaluation of a lung mass (n = 14), a pancreatic mass (n = 14), obstructive jaundice (n = 1), dysphagia (n = 2), an ampullary adenoma (n = 1), celiac block (n = 1), or a left adrenal gland mass (n = 5). The mean maximal

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2007 Endoscopy

3702. The clinically inapparent adrenal mass: update in diagnosis and management. (PubMed)

The clinically inapparent adrenal mass: update in diagnosis and management. Clinically inapparent adrenal masses are incidentally detected after imaging studies conducted for reasons other than the evaluation of the adrenal glands. They have frequently been referred to as adrenal incidentalomas. In preparation for a National Institutes of Health State-of-the-Science Conference on this topic, extensive literature research, including Medline, BIOSIS, and Embase between 1966 and July 2002, as well

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2004 Endocrine Reviews

3703. Dual hormonal regulation of endocrine tissue mass and vasculature by adrenocorticotropin in the adrenal cortex. (PubMed)

Dual hormonal regulation of endocrine tissue mass and vasculature by adrenocorticotropin in the adrenal cortex. The mass of healthy adult tissues is stable and their vasculature is quiescent, but this equilibrium is disrupted under certain physiological or pathological situations. There is an emerging concept indicating that these trophic changes may be initiated by modifications of the vasculature. In the current study, we documented over a period of 14 d the serial alterations occurring (...) in both endocrine and endothelial compartments during adrenal atrophy induced by ACTH suppression in mice. After dexamethasone perfusion, a rapid fall of plasmatic ACTH and corticosterone concentrations was observed within the first 24 h. During the first 4 d of treatment, adrenal weight and adrenal cortex cellularity decreased rapidly. This was correlated with an inhibition of cell proliferation and a massive induction of endocrine cell apoptosis. Between d 4 and d 14, a slower but sustained decay

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2004 Endocrinology

3704. Steroid profiling by tandem mass spectrometry improves the positive predictive value of newborn screening for congenital adrenal hyperplasia. (PubMed)

Steroid profiling by tandem mass spectrometry improves the positive predictive value of newborn screening for congenital adrenal hyperplasia. Congenital adrenal hyperplasia (CAH) is primarily caused by 21-hydroxylase deficiency and leads to an accumulation of 17-hydroxyprogesterone and reduced cortisol levels. Newborn screening for CAH is traditionally based on measuring 17-hydroxyprogesterone by different immunoassays. Despite attempts to adjust cutoff levels for birth weight, gestational age (...) , and stress factors, the positive predictive value for CAH screening remains less than 1%. To improve this situation, we developed a method using liquid chromatography-tandem mass spectrometry to measure 17-hydroxyprogesterone, androstenedione, and cortisol simultaneously in blood spots. A total of 1222 leftover blood spots from six different screening programs using different immunoassays (fluorescent immunoassay and ELISA) were reanalyzed in a blinded fashion by liquid chromatography-tandem mass

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2004 Journal of Clinical Endocrinology and Metabolism

3705. Newborn screening for congenital adrenal hyperplasia: additional steroid profile using liquid chromatography-tandem mass spectrometry. (PubMed)

Newborn screening for congenital adrenal hyperplasia: additional steroid profile using liquid chromatography-tandem mass spectrometry. Neonatal screening programs for congenital adrenal hyperplasia (21-CAH) using an immunoassay for 17alpha-hydroxyprogesterone (17-OHP) generate a high rate of positive results attributable to physiological reasons and to cross-reactions with steroids other than 17alpha-OHP, especially in preterm neonates and in critically ill newborns.To increase the specificity (...) of the screening process, we applied a liquid chromatography-tandem mass spectrometry method quantifying 17alpha-OHP, 11-deoxycortisol, 21-deoxycortisol, cortisol, and androstenedione. The steroids were eluted in aqueous solution containing d8-17alpha-OHP and d2-cortisol and quantified in multiple reaction mode.Detection limit was below 1 nmol/liter, and recovery ranged from 64% (androstenedione) to 83% (cortisol). Linearity was proven within a range of 5-100 nmol/liter (cortisol, 12.5-200 nmol/liter

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2007 Journal of Clinical Endocrinology and Metabolism

3706. Imaging evaluation of the non-functioning indeterminate adrenal mass. (PubMed)

Imaging evaluation of the non-functioning indeterminate adrenal mass. With the increasing use of abdominal cross-sectional imaging in the investigation of patient symptoms and in cancer staging, incidental adrenal masses are frequently detected. The most common clinical question is whether these masses are benign or malignant. Benign adrenal masses such as myelolipomas, lipid-rich adenomas, adrenal cysts and adrenal haemorrhage have pathognomonic imaging findings. However, there remains (...) a significant overlap between the imaging appearances of some lipid-poor adenomas and malignant lesions, particularly metastases and small adrenal carcinomas. Our review looks at the recent advances in computed tomography, magnetic resonance imaging and positron emission tomography, which can be used to assist in the distinction between benign adenomas and malignant lesions of the adrenal gland.

2004 Trends in Endocrinology and Metabolism

3707. CT-scan, MRI and image-guided FNA cytology of incidental adrenal masses. (PubMed)

CT-scan, MRI and image-guided FNA cytology of incidental adrenal masses. The aim of this study was to compare the usefulness of computed tomography (CT)-scan, magnetic resonance imaging (MRI), and fine-needle aspiration (FNA) cytology in patients with incidentally discovered adrenal masses.Thirty-four consecutive patients (six men and 28 women, median age of 47 years, range 26-80) with non-functioning adrenal masses of 2 cm or more (median 3.5 cm, range 2-9) were studied. All patients underwent (...) CT-scan, MRI, and image-guided FNA cytology using spinal-type narrow-gauge needles prior to further procedures. Nineteen patients underwent adrenalectomy.Final pathology showed 13 benign adrenal lesions, four adrenocortical carcinomas, and two unsuspected adrenal metastases. Fifteen patients who did not have surgery were considered definitively as having benign adrenal lesions since the mass was unchanged on CT-scans performed during follow-up. The sensitivity, specificity, and positive

2003 European Journal of Surgical Oncology

3708. Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. (PubMed)

Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. Radiofrequency ablation (RFA) is an effective therapeutic intervention for a variety of neoplastic lesions. Many of these procedures are conducted with patients under general anesthesia. Although RFA is associated with infrequent complications, it is not without risk. Injury to adjacent normal structures is a major concern during RFA of cancerous lesions. Unintended (...) injury to normal adrenal tissue during RFA of adrenal tumors can lead to hypertensive crisis, a potentially catastrophic complication. Hemodynamic consequences of RFA of primary or metastatic adrenal masses have not been reported. We report a case of hypertensive crisis (249/140 mm Hg), tachycardia, and ventricular arrhythmia in an 82-yr-old woman undergoing RFA of renal cell carcinoma metastatic to the adrenal gland. Anesthesiologists should be aware of this potentially catastrophic complication

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2004 Anesthesia and Analgesia

3709. Management of clinically inapparent adrenal mass. (PubMed)

Management of clinically inapparent adrenal mass. 12945556 2003 08 29 2016 03 23 1530-440X 56 2002 Feb Evidence report/technology assessment (Summary) Evid Rep Technol Assess (Summ) Management of clinically inapparent adrenal mass. 1-5 Lau J J Balk E E Rothberg M M Ioannidis J P A JP DeVine D D Chew P P Kupelnick B B Miller K K eng Journal Article Meta-Analysis United States Evid Rep Technol Assess (Summ) 100890218 1530-440X IM Adrenal Gland Neoplasms diagnosis epidemiology physiopathology (...) therapy Adrenal Glands pathology Diagnosis, Differential Evidence-Based Medicine Humans Patient Care Management Prevalence 2003 8 30 5 0 2003 8 30 5 1 2003 8 30 5 0 ppublish 12945556 PMC4781357

2003 Evidence report/technology assessment (Summary)

3710. Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass. (PubMed)

Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass. Pheochromocytomas are neoplasms generally characterized by the autonomous production of catecholamines. This study compared various biochemical parameters for the diagnosis of adrenal pheochromocytoma in patients with adrenal mass.One hundred and fifty subjects were studied, including 24 histologically proven pheochromocytomas, 17 aldosterone-secreting and 21 cortisol (...) -secreting adrenal adenomas and 30 nonfunctioning adrenal masses, 16 patients with essential hypertension and 42 healthy normotensive volunteers. Spontaneous blood samples and 24-h urine samples were collected prospectively.Plasma and urinary epinephrine and norepinephrine levels were measured by high performance liquid chromatography, whereas plasma and urinary metanephrine and normetanephrine levels were determined by radioimmunoassay (RIA). Putative ratio thresholds were calculated by receiver

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2006 European Journal of Endocrinology

3711. Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? (PubMed)

Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? To evaluate chemical shift magnetic resonance (MR) imaging for the characterization of hyperattenuating adrenal masses.Adrenal MR images obtained from January 1998 to February 2003 were reviewed. Patients were excluded if they did not undergo unenhanced computed tomography or did not have an adrenal mass with attenuation higher than 10 HU, adequate follow-up, or pathologic diagnosis for use (...) as a reference standard. A diagnosis of adenoma required at least 24 weeks of stability on images. Thirty-eight masses in 36 patients were identified (27 adenomas, nine metastases, one adrenocortical oncocytoma, and one pheochromocytoma). Signal intensity (SI) decrease between in-phase and opposed-phase MR images was measured for the entire mass and normalized to the renal parenchymal SI. In 21 of 36 (58%) patients, dual-echo single-breath-hold MR imaging was used to eliminate misregistration.The attenuation

2004 Radiology

3712. Development and performance evaluation of a tandem mass spectrometry assay for 4 adrenal steroids. (PubMed)

Development and performance evaluation of a tandem mass spectrometry assay for 4 adrenal steroids. Congenital adrenal hyperplasia is a group of autosomal recessive disorders caused by a deficiency of 1 of 4 enzymes required for the synthesis of glucocorticoids, mineralocorticoids, and sex hormones. Analysis of 11-deoxycortisol (11DC), 17-hydroxyprogesterone (17OHP), 17-hydroxypregnenolone (17OHPr), and pregnenolone (Pr) in blood allows detection of these enzyme defects.The steroids were (...) extracted from 200 microL of serum or plasma by solid-phase extraction, derivatized to form oximes, and extracted again with methyl t-butyl ether. Instrumental analysis was performed on an API 4000 tandem mass spectrometer with electrospray ionization in positive mode and multiple reaction-monitoring acquisition.The limits of detection were 0.025 microg/L for 11DC, 17OHP, and Pr and 0.10 microg/L for 17OHPr. The method was linear to 100 microg/L for 11DC, 17OHP, and Pr, respectively, and to 40 microg/L

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2006 Clinical Chemistry

3713. Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. (PubMed)

Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. To retrospectively measure the adrenal gland attenuation and the percentage loss of adrenal gland enhancement at delayed contrast medium-enhanced computed tomography (CT) in patients with adrenocortical carcinomas and pheochromocytomas and to compare these data with those in patients with adenomas and metastases.The study protocol was approved by the ethics committee (...) , which waived informed consent. Eleven patients with proved adrenocortical carcinoma, 17 with proved pheochromocytoma, 23 with adrenal adenoma, and 16 with metastasis to the adrenal gland underwent helical CT. Nonenhanced CT was followed by contrast-enhanced CT 1 minute and 10 minutes later. Attenuation and enhancement loss values were calculated.The mean attenuation of adenomas (8 HU +/- 18 [standard deviation]) was significantly lower than those of adrenocortical carcinomas (39 HU +/- 14

2005 Radiology

3714. Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. (PubMed)

Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. To retrospectively evaluate the accuracy of precontrast attenuation, relative percentage washout (RPW), and absolute percentage washout (APW) in distinguishing benign from malignant adrenal masses at multi-detector row computed tomography (CT).This HIPAA-compliant retrospective study had institutional review board approval; the need for informed consent was waived. One hundred twenty-two (...) adrenal masses were evaluated in 99 patients (51 men, 48 women; age range, 37-86 years) who had undergone CT performed according to the study protocol and who either were given a pathologic diagnosis or underwent follow-up imaging. Unenhanced images were obtained before administration of 120 mL of an intravenous contrast agent with a 75-second scan delay. Delayed images were obtained after 10 minutes. RPW and APW were computed. Receiver operating characteristic (ROC) analysis was performed to compare

2006 Radiology

3715. Adrenal masses: characterization with in vivo proton MR spectroscopy--initial experience. (PubMed)

Adrenal masses: characterization with in vivo proton MR spectroscopy--initial experience. To prospectively determine the accuracy of in vivo proton ((1)H) magnetic resonance (MR) spectroscopy in distinguishing adrenal adenomas, pheochromocytomas, adrenocortical carcinomas, and metastases, with histologic or computed tomographic findings and follow-up data as the reference standards.This study was approved by the institutional ethics committee, and informed consent was obtained. Sixty (...) were measured. Metabolite ratios (choline-creatine, choline-lipid, lipid-creatine, and 4.0-4.3 ppm/creatine) and cutoff values (obtained by using receiver operating characteristic analyses) were obtained and compared for each type of adrenal mass, which was identified previously on the basis of clinical, hormonal, and pathologic evidence. Results were evaluated with chi(2) and Student t tests. Significance was inferred at P < .05.Cutoff values of 1.20 for the choline-creatine ratio (92% sensitivity

2007 Radiology

3716. Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. (PubMed)

Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. To retrospectively compare the accuracy of delayed enhanced computed tomography (CT) and chemical shift magnetic resonance (MR) imaging for characterizing hyperattenuating adrenal masses at CT, with either follow-up imaging or pathologic review as the reference standard.The institutional review board approved this retrospective study with a waiver of patient informed consent. Forty (...) -three hyperattenuating adrenal masses (>10 HU) on unenhanced CT images were found in 34 patients (23 men and 11 women; mean age, 52.7 years) by reviewing radiologic reports. These lesions were retrospectively analyzed with delayed enhanced CT and chemical shift MR. The diagnostic accuracy of CT by using absolute percentage loss of enhancement (PLE) and relative PLE and of chemical shift MR by using adrenal-to-spleen ratio (ASR) or signal intensity index (SII) were obtained to determine which

2007 Radiology

3717. Correlation between radiologic and pathologic dimensions of adrenal masses. (PubMed)

Correlation between radiologic and pathologic dimensions of adrenal masses. The size of adrenal tumors has been shown to be a good predictor of malignancy. There is still some controversy about the concordance between radiologic and real pathologic measurements. The aim of this study is to determine the correlation between direct and corrected radiologic computed tomography scan dimensions and the measurements of the resected specimen. A total of 41 adrenal tumors were included. Direct (...) variables showed r = 0.82 (p < 0.0001) when direct and pathologic measurements were compared and r = 0.83 (p < 0.0001) when the corrected values were compared with the real dimensions. In this study, we demonstrate good correlation between radiologic and pathologic measurements of adrenal tumors. The Linos formula turned out to be significantly more accurate than direct radiologic measurements when means of the groups were compared, whereas when individual correlations were determined the two were

2004 World Journal of Surgery

3718. Adrenocortical carcinoma arising from a long-standing adrenal mass. (PubMed)

Adrenocortical carcinoma arising from a long-standing adrenal mass. Adrenocortical carcinoma is a rare tumor with a dismal prognosis. In stark contrast, benign incidental adrenal lesions are detected commonly on routine abdominal imaging. We report a case of a 74-year-old man with a history of germ cell testicular carcinoma who presented with a 4.8-cm left adrenal lesion. The lesion remained stable for 8 years, at which time the patient became symptomatic from an excess of cortisol hormone

2005 Mayo Clinic Proceedings

3719. Is surgery necessary for incidentally discovered adrenal masses in children? (PubMed)

Is surgery necessary for incidentally discovered adrenal masses in children? There are no guidelines that exist to direct the management of incidental adrenal masses (IAM) in children. The aim of this study was to determine if there is a subset of IAMs that could be safely observed.A retrospective analysis was conducted of all adrenal masses that were either resected or biopsied between 1990 and 2002 (n = 91) at the Hospital for Sick Children, Toronto. IAM was defined as a solitary adrenal mass (...) discovered by either physical examination (n = 6; 23.1%) or diagnostic imaging for other indications (n = 20; 76.9%), without metastases or biochemical activity.Twenty-six (28.6%) IAMs were detected (mean age, 4.6 years [range, antenatal to 17 years]; 11 boys, 15 girls). Pathologic diagnoses included neuroblastoma (n = 7), ganglioneuroma (n = 6), adrenocortical adenoma (n = 4), adrenal cyst/pseudocyst (n = 3), adrenal hemorrhage (n = 3), ganglioneuroblastoma (n = 1), nodular cortical hyperplasia (n = 1

2004 Journal of Pediatric Surgery

3720. Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. (PubMed)

Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. Plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is an established screening test for primary hyperaldosteronism. Due to the increased recognition of adrenal incidentalomas, reliable parameters are required. Determination of active renin concentration (ARC) in contrast to PRA offers advantages with regard to processing (...) and standardization. The present study compared PRA and ARC under random conditions to establish thresholds for the diagnosis of primary hyperaldosteronism.Fifty patients with various adrenal tumors, including ten patients with aldosterone-secreting adrenal adenomas, as well as ten hypertensive patients and 23 normotensive volunteers were studied. PAC and PRA were measured by radioimmunoassay. ARC was determined by an immunoluminometric assay.Receiver operating curve (ROC) analysis suggested a PAC to ARC ratio

2004 European journal of endocrinology / European Federation of Endocrine Societies Controlled trial quality: uncertain

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