Diagnosis of adrenal glands incidentaloma.

O. B. Kutovoy, E. V. Zhmurenko, L. V. Kunyk

Abstract


In this study the results of examination and treatment of 91 patients with adrenal glands incidentaloma were analyzed. According to the results of the morphological study, adenomas were the most common (n=60). Among malignant tumors, ACC was detected in 7 patients, low and undifferentiated cancer – in 3 patients, sarcoma – in 2 patients and metastasis of cancer – in 4 patients. To assess the nature of the tumor, the following criteria were used: size and density according to CT. In 43 patients with neoplasms less than4 cmin 9,3% of cases malignant adrenalomas occurred, at 4-6 cm(n=29) - in 17,2% of cases, more than6 cm(n=19) - in 31,6%. In patients with ACC, 71,4% of tumors exceeded6 cm, 28,5% - were within 4-6 cm, 14,1% - less than4 cm. The frequency of detection of malignant incidentalomas increases in proportion to the growth of tumor size, and with a diameter of more than4 cmit was 27,1%. Adrenal adenomas in 31.6% of cases were from 4 to6 cm, and in 10% - more than6 cm. Thus, the orientation only on the size of tumors did not provide enough convincing grounds for determining its malignant potential. High native density was noted in ACC (33.4±2.8 HU), ganglioneuroma (36.6 НU) and metastases of cancer (43.6±9.0 HU). Low density was found in adenomas (0.4±10.7 HU) and adrenal cysts (6.0±8.2 HU), p<0.05. The most informative method of investigation in adrenal incidentalomas was CT, with sensitivity in adenomas and cancers – 98,3% and 94,4% respectively, specificity – 82,4% and 84,6%.


Keywords


incidentaloma diagnosis; computed tomography; ultrasound examination of the adrenal glands

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References


1. Arablinsky AV. [Computer and magnetic reso­nance tomography in the diagnosis of adrenal diseases]. Sibirskij onkologicheskij zhurnal. 2011;8-9. Russian.

2. Beltsevich DG. [Incidental adrenal gland]. Jen­dokrinnaja hirurgija. 2009;19-23. Russian.

3. Kvachenyuk AN. [Clinical and laboratory cha­racteristics of adrenal insulin-adenomas]. Klіnіchna hіrurgіya. 2011;59-61. Russian.

4. Klyushin DA, Petunin Yu. [Evidence-based me­dicine. Application of statistical methods]. Dialektika. 2007;320. Russian.

5. Kotelnikova LP. [Computer tomography in dif­ferential diagnosis of adrenal incidents]. Sovrem. proble­my nauki i obrazovanija. 2008;129-33. Russian.

6. Lutsenko LA. [Inciydentalomas of the adrenal glands, aspects of diagnosis and choice of tactics for pa­tients]. Jendokrinologija. 2014;19(2):126-129. Ukrainian.

7. Molashenko NV. [Volume formations of adrenal glands (diagnosis and differential diagnosis)]. Problemy endokrinologii. 2010;48-52. Russian.

8. Soldatova ТV. [Differential diagnosis of random­ly detected tumors of the adrenal gland]. Mezhdunarodnyj jendokrinologicheskij zhurnal. 2011;8. Russian.

9. Zeiger MA, Thompson GB, Quan-Yang Duh, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Inciden­taloma. Endocrine practice. 2009;15:1-20.

10. Boland GW, Blake MA, Hahn PF, et al. In­ciden­tal adrenal lesions: principles, techniques, and algo­rithms for imaging characterization. Radiology. 2008;756-775.

11. NIH State of the Science Statement of mana­ge­ment of the clinically in apparent adrenal mass (inciden­taloma). NIH Consens. State Sci. Stats. 2002;19(2):1-25.

12. Pacak K, Eisenhofer G, Ahlman H, et al. Pheo­chromocytoma: recommendations for clinical practice from the First International Symposium. Nat. Clin. Pract. Endocrinol. 2007;3:92-102.

13. Bovio S, Cataldi A, Reimondo G, et al. Pre­va­len­ce of adrenal incidentaloma in a contemporary compu­te­rized tomography series. Endocrinol Invest. 2006;29:298–302.

14. El-Hefnawy AS, El Garba M, Osman Y, et al. Surgical management of adrenal cysts: single-institution experience. Endocrinol Invest. 2009;104:847-850.

15. Funder JW, Carey RM, Fardella C, еt al. The Dia­gnosis of Cushing’s Syndrome: аn endocrine society clinical practice guideline. Сlin. Еndocrinol. 2008;5:1526-1540.


GOST Style Citations


  1. Араблинский А.В. Компьютерная и магнитно–резонансная томография в диагностике заболеваний надпочечников / А.В. Араблинский, Ю.В. Сидорова // Сибир. онкол. журнал. – 2011. – Прил. 2. – С. 8-9.
  2. Бельцевич Д.Г. Инциденталома надпочеч­ников / Д.Г. Бельцевич, Н.С. Кузнецов, В.Э. Ванушко // Эндокрин. хирургия. – 2009. – № 1 (4). – С. 19-23
  3. Кваченюк А.Н. Клинико-лабораторная ха­рактеристика инсиденталом надпочечников / А.Н. Ква­ченюк, Л.А. Луценко, О.И. Галузинская // Клініч. хірургія. – 2011. – № 8. – С. 59-61.
  4. Клюшин Д.А. Доказательная медицина / Д.А. Клю­шин, Ю.И. Петунин. – Москва: Диалектика, 2007. – 320 с.
  5. Котельникова Л.П. Компьютерная томография в дифференциальной диагностике инциденталом над­почечников / Л.П. Котельникова, О.С. Каменева, А.М. Дмитриева // Соврем. проблемы науки и образо­вания. – 2008. – № 6. – С. 129 - 133.
  6. Луценко Л.А Інсиденталоми надниркових за­лоз: аспекти діагностики та вибору тактики ведення хворих / Л.А. Луценко, А.М. Кваченюк // Ендокри­нологія. – 2014. – Т. 19, № 2. – С. 126 -129.
  7. Молашенко Н.В. Объемные образования над­почечников (диагностика и дифференциальная диа­гностика) / Н.В. Молашенко, М.Ю. Юкина, Е.А. Ро­галь // Проблемы эндокринологии. – 2010. – № 1. – C. 48-52.
  8. Солдатова Т.В. Дифференциальная диагности­ка случайно выявленных опухолей надпочечника // Т.В. Солдатова // Междунар. эндокринол. журнал. – 2011. – № 8. – С. 8.
  9. American Association of Clinical Endocrino­lo­gists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentaloma / M.A. Zeiger, G.B. Thompson, Quan-Yang Duh [et al.]// Endocrine practice. – 2009. – Vol. 15. – P. 1-20.
  10. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization / G.W. Bo­land, M.A. Blake, P.F. Hahn [et al.] // Radiology. – 2008. – Р. 756–775.
  11. NIHStateof the Science Statement of mana­gement of the clinically in apparent adrenal mass (inci­dentaloma). NIH Consens // State Sci. Stats. – 2002. – Vol. 19, N 2. – Р. 1-25.
  12. Pheochromocytoma: recommendations for cli­nical practice from the First International Symposium / K. Pa­cak, G. Eisenhofer, H. Ahlman [et al.] // Nat. Clin. Pract. Endocrinol. – 2007. – N 3. – P. 92-102.
  13. Prevalence of adrenal incidentaloma in a contem­porary computerized tomography series / S. Bovio, A. Cataldi , G. Reimondo [et al.]// Endocrinol Invest. -2006. – Vol. 29. – Р. 298-302.
  14. Surgical management of adrenal cysts: single-institution experience / A.S. El-Hefnawy, M.El. Garba, Y. Osman [et al.] // Endocrinol Invest. – 2009. – Vol. 104. – Р. 847-850.
  15. The Diagnosis of Cushing’s Syndrome: аn en­docrine society clinical practice guideline / J.W. Funder, R.M. Carey, C. Fardella [еt al.] // Сlin. Еndocrinol. – 2008. – N 5. – P. 1526-1540.




DOI: https://doi.org/10.26641/2307-0404.2017.3.111925

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