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A Rare Differential Diagnosis of an AdrenalMass: A Case Report Ten years after his last treatment for diffuse large B-cell lymphoma, a seemingly healthy, 64-year-old man presented for his lymphoma-related follow-up. Ultrasound revealed an impressive tumor in the right adrenal gland. Due to recurrent cancer therapies in the past, this seemed highly suspicious of a second malignancy, such as primary adrenal carcinoma. Surprisingly, histology disclosed a very different but rare cause
A Rare AdrenalMass in a 3-Month-Old: A Case Report and Literature Review A three-month-old female infant presented with abdominal distention for 2 months. A large palpable mass in right upper quadrant was noted on physical exam. Abdominal ultrasound revealed a large heterogeneous mass with multiple cystic components. Mass was surgically excised and pathology was consistent with mature adrenal teratoma. Teratoma is a germ cell tumor mainly found in gonadal tissues. Occurrence of adrenal gland (...) teratoma in children is very rare with less than 10 pediatric case reports in English literature. We present a rare case of primary adrenal tumor in an infant and a review of the literature.
Extramedullary Haematopoiesis Presenting as an AdrenalMass 28511479 2018 11 13 2249-782X 11 3 2017 Mar Journal of clinical and diagnostic research : JCDR J Clin Diagn Res Extramedullary Haematopoiesis Presenting as an AdrenalMass. TJ01 10.7860/JCDR/2017/25086.9448 Kannan Subramanian S Consultant, Department of Endocrinology, Diabetes and Metabolism, Narayana Health City, Bengaluru, Karanataka, India. Kulkarni Prashant P Consultant, Department of Urology, Narayana Health City, Bengaluru
Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height-age To evaluate obesity and overweight in children with congenital adrenal hyperplasia (CAH) and associations with glucocorticoids, fludrocortisone and disease control. Adjusting body mass index-for-height-age (BMIHA ) percentile is proposed to correct misclassification of obese/overweight status in CAH children with advanced bone age and tall-for-age (...) stature.Longitudinal.One hundred and ninety-four children with CAH seen from 1970 to 2013: 124 salt wasting (SW); 70 simple virilizing (SV); 102 females.Body mass index (BMI) end-points were overweight (85-94 percentile) and obese (≥95 percentile).Approximately 50% of the children had at least one BMI measurement ≥95 percentile and about 70% had at least one ≥85 percentile. Using BMIHA percentiles, obesity incidence decreased slightly in SW children (47-43%) and markedly in SV children (50-33%); however, overweight
Adrenalmass of unusual etiology: Ewing sarcoma in a young man Ewing sarcoma and peripheral primitive neuroectodermal tumor belong to the Ewing sarcoma (ES) family of tumors originating from a primitive neural tube. We report a 31-year-old man who was admitted to the urology clinic with complaints of fever, nausea, and dysuria. A right-sided adrenalmass was detected during ultrasonography. The lesion was then evaluated with magnetic resonance imaging, which showed areas of necrosis amid (...) heterogeneous solid areas. Whole body scan with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography and bone scan studies showed pulmonary and osseous metastatic foci. The mass and right kidney were removed by an open approach. An immunohistochemical and molecular workup enabled the diagnosis of ES. The patient also underwent radiotherapy and chemotherapy. The patient remained in fairly good health during the 18-month follow-up period, but showed progression of all metastatic foci
A Giant AdrenalMass in a Super Obese Patient Giant pheochromocytomas (Pheo) are rare entities requiring clinical suspicion coupled with strategic diagnostic evaluation to confirm the diagnosis. The majority of cases are discovered incidentally. The diagnosis consists of biochemical evaluation and imaging study to localize the mass. Pathological examination confirms the diagnosis. The female patient in this case report presented with chest pain, palpitation of three weeks duration and was found (...) on evaluation to have an abdominal mass concerning for pheochromocytoma. She was treated with surgical resection. The pheo measured 20.5 x 18 x 10 cm and weighed 2,582 grams. Pathological examination confirmed the diagnosis of pheochromocytoma.
Large Unilateral AdrenalMass with Surrounding Brown Fat: A Case Report Pheochromocytomas are rare tumors derived from chromaffin cells located in the adrenal and extra adrenal tissues. Pheochromocytomas are diagnosed biochemically and localized using different imaging modalities. The definitive management is surgical resection. Brown adipose tissues are normally present during fetal development, with regression over time. Brown adipose tissues are thermogenic and usually located in the neck
Reference intervals for plasma concentrations of adrenal steroids measured by LC-MS/MS: Impact of gender, age, oral contraceptives, body mass index and blood pressure status Mass spectrometric-based measurements of the steroid metabolome have been introduced to diagnose disorders featuring abnormal steroidogenesis. Defined reference intervals are important for interpreting such data.Liquid chromatography-tandem mass spectrometry was used to establish reference intervals for 16 steroids (...) phase, menopause and oral contraceptive use. Progesterone was higher in females than males, but most other steroids were higher in males than females and almost all declined with advancing age. Using models that corrected for age and gender, body mass index showed weak negative relationships with corticosterone, 21-deoxycortisol, cortisol, cortisone, testosterone, progesterone, 17-hydroxyprogesterone and 11-deoxycorticosterone, but a positive relationship with 18-hydroxycortisol. Hypertensives
tumours or masses of the adrenal gland, which were assessed by both laboratory and imaging studies.Two review authors independently extracted data, assessed trials for risk of bias, and evaluated overall study quality using GRADE criteria. We calculated the risk ratio (RR) for dichotomous outcomes, or the mean difference (MD) for continuous variables, and corresponding 95% confidence interval (CI). We primarily used a random-effects model for pooling data.We examined 1069 publications, scrutinized 42 (...) Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults. Laparoscopic adrenalectomy is an accepted treatment worldwide for adrenal gland disease in adults. The transperitoneal approach is more common. The retroperitoneal approach may be preferred, to avoid entering the peritoneum, but no clear advantage has been demonstrated so far.To assess the effects of laparoscopic transperitoneal adrenalectomy (LTPA) versus laparoscopic retroperitoneal adrenalectomy
Incidentally Discovered AdrenalMass Date of origin: 1996 Last review date: 2012 ACR Appropriateness Criteria ® 1 Incidentally Discovered AdrenalMass American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Incidentally Discovered AdrenalMass Variant 1: No history of malignancy; mass 1-4 cm in diameter. Initial evaluation. Radiologic Procedure Rating Comments RRL* CT abdomen without IV contrast 8 Presumes that a noncontrast CT has not already been performed (...) Only for suspicion of pheochromocytoma. ??? MRI abdomen without and with IV contrast 2 O US adrenal gland 1 O Biopsy adrenal gland 1 Varies CT abdomen with IV contrast 1 ??? X-ray abdomen 1 ?? Iodocholesterol scan 1 This agent may be used to detect functionally active adenomas. ???? FDG-PET/CT skull base to mid-thigh 1 ???? Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level Variant 2: No history of malignancy; mass 1–4 cm
) to improve the positive predictive value of congenital adrenal hyperplasia screening. (1|⊕⊕○○) Technical remark: Laboratories utilizing liquid chromatography–tandem mass spectrometry should participate in an appropriate quality assurance program. Additionally, clinicians should realize that immunoassays lead to more false-positive results. Thus, if laboratory resources do not include liquid chromatography–tandem mass spectrometry, a cosyntropin stimulation test should be performed to confirm diagnosis (...) and mineralocorticoid. (1|⊕⊕○○) 4.14 In pediatric patients with congenital adrenal hyperplasia under the age of 2 years, we advise annual bone age assessment until near-adult height is attained. (Ungraded Good Practice Statement) 4.15 In adults with congenital adrenal hyperplasia, we recommend annual physical examinations, which include assessments of blood pressure, body mass index, and Cushingoid features in addition to obtaining biochemical measurements to assess the adequacy of glucocorticoid
other methods ( e.g. , genotyping) to improve the positive predictive value of congenital adrenal hyperplasia screening. (1|⊕⊕○○) Technical remark: Laboratories utilizing liquid chromatography–tandem mass spectrometry should participate in an appropriate quality assurance program. Additionally, clinicians should realize that immunoassays lead to more false-positive results. Thus, if laboratory resources do not include liquid chromatography–tandem mass spectrometry, a cosyntropin stimulation test (...) newborn screens for congenital adrenal hyperplasia we recommend referral to pediatric endocrinologists (if regionally available) and evaluation by cosyntropin stimulation testing as needed. (1|⊕⊕⊕○) 3.2 In symptomatic individuals past infancy, we recommend screening with an early-morning (before 8 am ) baseline serum 17-hydroxyprogesterone measurement by liquid chromatography–tandem mass spectrometry. (1|⊕⊕⊕○) 3.3 In individuals with borderline 17-hydroxyprogesterone levels, we recommend obtaining
Young male with left adrenalmass 27432826 2017 02 17 2018 11 13 1757-790X 2016 2016 Jul 15 BMJ case reports BMJ Case Rep Young male with left adrenalmass. 10.1136/bcr-2016-215669 bcr2016215669 Meshikhes Abdul-Wahed Nasir AW Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia. Abdel Gawad Wael M WM Department of Surgical Oncology, National Cancer Institute, Cairo, Egypt. Al-Saeed Jamal Youssef JY Department of Endocrinology, King Fahad Specialist Hospital, Dammam, Saudi (...) Arabia. eng Case Reports Journal Article 2016 07 15 England BMJ Case Rep 101526291 1757-790X IM Adrenal Gland Neoplasms diagnostic imaging pathology surgery Adrenal Glands diagnostic imaging surgery Adrenocortical Carcinoma diagnostic imaging pathology surgery Adult Fatal Outcome Humans Image-Guided Biopsy Magnetic Resonance Imaging Male Tomography, X-Ray Computed Ultrasonography, Interventional Young Adult 2016 7 20 6 0 2016 7 20 6 0 2017 2 18 6 0 epublish 27432826 bcr-2016-215669 10.1136/bcr-2016
Incidentally Solitary, Synchronous, Metastatic Left AdrenalMass From Colon Cancer The authors report the case of a 63-year-old man who underwent an open adrenalectomy for a synchronous, malignant, metastatic left adrenal tumor and a total colectomy for T3N0M1 (stage 4) primary, malignant colon cancer. Two polypoid lesions, one measuring 40 mm × 30 mm × 30 mm and the other measuring 20 mm × 10 mm × 10 mm, were found in the ascending colon and rectosigmoid (RS) junction, respectively (...) , and a synchronous, malignant, left adrenal gland lesion measuring 70 mm × 50 mm × 30 mm was incidentally found on abdominal computed tomography scan. Histological examination revealed a metastatic, necrotic adenocarcinoma of the left adrenalmass, an adenocarcinoma of the cecal mass, and an adenomatous polyp (tubulovillous type) of the smallest polypoid lesion in RS junction that had invaded deeply into the submucosal layer. The patient recovered uneventfully, and his condition is now stable, with no evidence
Adrenalmasses: A urological perspective Adrenalmasses have become increasingly common due to widespread use of sectional imaging. Urologists are commonly faced with management decisions in patients with adrenalmasses. Systemic review of available literature related to surgical adrenal disease was performed to summarise the most pertinent information related to adrenalmasses, diagnostic evaluation and surgical treatment. Detailed hormonal evaluation of adrenal disease was not included, being (...) part of endocrinological rather than urological practice. Adrenalmasses exhibit a wide spectrum of presentation and pathology, and treatment requires different surgical techniques. Full understanding of the pathology and management of such masses should be completely familiar to practicing urologists.
MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenalmasses - a systematic review and meta-analysis. Adrenalmasses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant (...) screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n=16), MRI (n=15), and FDG-PET (n=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, that is, masses with ≤10HU are unlikely to be malignant. All other estimates of test performance are based
Bilateral adrenalmasses: a single-centre experience Bilateral adrenalmasses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenalmasses are limited.To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal (...) masses.Retrospective analysis of 70 patients with bilateral adrenalmasses presenting to a single tertiary care endocrine centre from western India (2002-2015).The most common aetiology was pheochromocytoma (40%), followed by tuberculosis (27.1%), primary adrenal lymphoma (PAL) (10%), metastases (5.7%), non-functioning adenomas (4.3%), primary bilateral macronodular adrenal hyperplasia (4.3%), and others (8.6%). Age at presentation was less in patients with pheochromocytoma (33 years) and tuberculosis (41 years