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In The Name Of God

In The Name Of God. Adrenal Incidentaloma by Elham Faghihimani Endocrinologist. What is the frequency of an incidental adrenal mass?. In radiological studies, the frequency of

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In The Name Of God

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  1. In The Name Of God

  2. Adrenal Incidentaloma by ElhamFaghihimani Endocrinologist

  3. What is the frequency of an incidental adrenal mass? In radiological studies, the frequency of adrenal incidentalomas was estimated at 4% in middle age and increases up to more than 10% in the elderly, peaking around the fifth and seventh decade . Adrenal incidentalomas are slightly more frequent in women as a result of a referral bias

  4. Causes of adrenal masses • Hormone excess—up to 15% • Adenoma (aldosterone or cortisol) • Carcinoma (any adrenal hormone) • Pheochromocytoma • Congenital adrenal hyperplasia • Massive macronodular adrenal disease • Nodular variant of Cushing’s disease

  5. No hormonal excess • Adenoma • Myelolipoma • Neuroblastoma • Ganglioneuroma • Hemangioma • Carcinoma • Metastasis • Cyst • Hemorrhage • Granuloma • Amyloidosis • Infiltrative disease

  6. Radiologic Imaging The primary goal of imaging is to distinguish among adrenal adenoma, adrenal carcinoma, pheochromocytoma,and metastatic lesions. The diagnosis of an adenoma relies on the presence of intracellular lipid in the adrenal lesion, which can be identified by density measurement on non contrast CT or MRI.

  7. The differential diagnosis can be further delineated by CT scans done immediately after intravenous administration of a contrast agent and then again after a 10- to 15-minute delay. Benign adrenal lesions will commonly enhance up to 80 to 90 HU and wash out more than 50% on the delayed scan, whereas lesions such as metastatic tumors,carcinomas, or pheochromocytomas will not

  8. Natural history and management Adrenal incidentaloma is not a uniform disease and its natural history varies depending on the pathological classification of the adrenal mass. It is obvious that primary malignant adrenal tumors, and pheochromocytomas, can significantly affect patients’ health

  9. What is the risk of malignant transformation ofan adrenal incidentaloma? ACC typically displays a rapid growth rate(>2cm/year) and a poor outcome with a 5-year survival of <50% . the risk of an untreated adrenal incidentaloma, qualified as a benign lesion, subsequently developing malignancy appears to be very low, about 1 out of 1000

  10. What is the surgical technique for adrenalectomy? Laparoscopic adrenalectomy is a safe and effective procedure in skilled hands and it has become the surgical technique of choice for benign masses Controversy remains regarding the safety and effectiveness of laparoscopic adrenalectomy for large lesions and lesions presumed to be malignant.

  11. What is the risk of evolution toward overthypersecretion? Abnormal adrenal function that is not present at baseline may be detected during the follow-up. The most common disorder reported during follow-up is the occurrence of autonomous cortisol secretion eventually leading to subclinical cortisol excess. The onset of catecholamine overproduction or hyperaldosteronism during long-term follow-up is very rare

  12. How to perform follow-up? The NIH suggested repeating the hormonal screening, with an overnight 1 mg DST and measurement of urine catecholamines and metabolites, annually for 4 years, as the risk of hyperfunction seems to plateau after that period. in patients whose lesions have not been excised to repeat CT 6–12 months after the initial study and to discontinue radiological evaluation of lesions that do not increase in Size

  13. In the AACE/AAES Guidelines it is stated that patients with adrenal incidentalomas who do not fulfill the criteria for surgical resection need to have radiographic reevaluation at 3–6 months and then annually for 1–2 years. Hormonal evaluation should be performed at the time of diagnosis and then annually for 5 years

  14. Thank You For Your Attention

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