Is Preoperative Biochemical Testing for Pheochromocytoma Necessary for All Adrenal Incidentalomas?

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2015 Nov 13

PMID 26559265

Citations 8

Authors

Joo Hyun Jun

Hyun Joo Ahn

Sangmin M Lee

Jie Ae Kim

Byung Kwan Park

Jee Soo Kim

Jung Han Kim

Affiliations

Soon will be listed here.

Abstract

This study examined whether imaging phenotypes obtained from computed tomography (CT) can replace biochemical tests to exclude pheochromocytoma among adrenal incidentalomas (AIs) in the preoperative setting.We retrospectively reviewed the medical records of all patients (n = 251) who were admitted for operations and underwent adrenal-protocol CT for an incidentally discovered adrenal mass from January 2011 to December 2012. Various imaging phenotypes were assessed for their screening power for pheochromocytoma. Final diagnosis was confirmed by biopsy, biochemical tests, and follow-up CT.Pheochromocytomas showed similar imaging phenotypes as malignancies, but were significantly different from adenomas. Unenhanced attenuation values ≤10 Hounsfield units (HU) showed the highest specificity (97%) for excluding pheochromocytoma as a single phenotype. A combination of size ≤3 cm, unenhanced attenuation values ≤ 10 HU, and absence of suspicious morphology showed 100% specificity for excluding pheochromocytoma.Routine noncontrast CT can be used as a screening tool for pheochromocytoma by combining 3 imaging phenotypes: size ≤3 cm, unenhanced attenuation values ≤10 HU, and absence of suspicious morphology, and may substitute for biochemical testing in the preoperative setting.

Citing Articles

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References

Sane T, Schalin-Jantti C, Raade M . Is biochemical screening for pheochromocytoma in adrenal incidentalomas expressing low unenhanced attenuation on computed tomography necessary?. J Clin Endocrinol Metab. 2012; 97(6):2077-83. DOI: 10.1210/jc.2012-1061. View

Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A . Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006; 29(4):298-302. DOI: 10.1007/BF03344099. View

. NIH state-of-the-science statement on management of the clinically inapparent adrenal mass ("incidentaloma"). NIH Consens State Sci Statements. 2004; 19(2):1-25. View

Pena C, Boland G, Hahn P, Lee M, Mueller P . Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology. 2000; 217(3):798-802. DOI: 10.1148/radiology.217.3.r00dc29798. View

Korobkin M, Giordano T, Brodeur F, Francis I, Siegelman E, Quint L . Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology. 1996; 200(3):743-7. DOI: 10.1148/radiology.200.3.8756925. View

Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein S . The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004; 25(2):309-40. DOI: 10.1210/er.2002-0031. View

Barzon L, Sonino N, Fallo F, Palu G, Boscaro M . Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003; 149(4):273-85. DOI: 10.1530/eje.0.1490273. View

Caoili E, Korobkin M, Francis I, Cohan R, Dunnick N . Delayed enhanced CT of lipid-poor adrenal adenomas. AJR Am J Roentgenol. 2000; 175(5):1411-5. DOI: 10.2214/ajr.175.5.1751411. View

Park S, Kim T, Yoon J, Kim T, Chung J, Jeon U . The washout rate on the delayed CT image as a diagnostic tool for adrenal adenoma verified by pathology: a multicenter study. Int Urol Nephrol. 2012; 44(5):1397-402. DOI: 10.1007/s11255-012-0202-4. View

10.

Korobkin M, Brodeur F, Francis I, Quint L, Dunnick N, Londy F . CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR Am J Roentgenol. 1998; 170(3):747-52. DOI: 10.2214/ajr.170.3.9490968. View

11.

Szolar D, Korobkin M, Reittner P, Berghold A, Bauernhofer T, Trummer H . Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology. 2005; 234(2):479-85. DOI: 10.1148/radiol.2342031876. View

12.

Lenders J, Eisenhofer G, Mannelli M, Pacak K . Phaeochromocytoma. Lancet. 2005; 366(9486):665-75. DOI: 10.1016/S0140-6736(05)67139-5. View

13.

Bujawansa S, Bowen-Jones D . Low investigation rate for adrenal incidentalomas. Endocrine. 2011; 40(1):134-6. DOI: 10.1007/s12020-011-9487-9. View

14.

Barzon L, Scaroni C, Sonino N, Fallo F, Paoletta A, Boscaro M . Risk factors and long-term follow-up of adrenal incidentalomas. J Clin Endocrinol Metab. 1999; 84(2):520-6. DOI: 10.1210/jcem.84.2.5444. View

15.

Zeiger M, Thompson G, Duh Q, Hamrahian A, Angelos P, Elaraj D . The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract. 2009; 15 Suppl 1:1-20. DOI: 10.4158/EP.15.S1.1. View

16.

Hamrahian A, Ioachimescu A, Remer E, Motta-Ramirez G, Bogabathina H, Levin H . Clinical utility of noncontrast computed tomography attenuation value (hounsfield units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience. J Clin Endocrinol Metab. 2004; 90(2):871-7. DOI: 10.1210/jc.2004-1627. View

17.

Blake M, Kalra M, Sweeney A, Lucey B, Maher M, Sahani D . Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. Radiology. 2005; 238(2):578-85. DOI: 10.1148/radiol.2382041514. View

18.

Boland G, Blake M, Hahn P, Mayo-Smith W . Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology. 2008; 249(3):756-75. DOI: 10.1148/radiol.2493070976. View

19.

Sturgeon C, Shen W, Clark O, Duh Q, Kebebew E . Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy?. J Am Coll Surg. 2006; 202(3):423-30. DOI: 10.1016/j.jamcollsurg.2005.11.005. View

20.

Yu R, Pitts A, Wei M . Small pheochromocytomas: significance, diagnosis, and outcome. J Clin Hypertens (Greenwich). 2012; 14(5):307-15. PMC: 8108784. DOI: 10.1111/j.1751-7176.2012.00604.x. View