Should all Adrenal Mass have functional evaluation irrespective of Imaging findings ?
Asking in general in a asymptomatic patient ... Can the need for functional test be decided based on image findings as well ?
In the European Society of
Endocrinology Clinical Practice Guidelines, 2018, it is mentioned even in the
beginning that every patient with (suspected) ACC should undergo careful
clinical assessment, detailed endocrine work-up to identify autonomous hormone
excess and adrenal-focused imaging.
They suggest that all suspected ACC should be reviewed by an
expert adrenal pathologist using the Weiss score and providing Ki67 index. Manoj
Jain et al (2010) has provided an article explaining the various criteria used
in Weiss Score.
Felix Beuschlein et al (2015) have provided
information regarding Ki67 and its usefulness.
Ki67 staining is not available, a low (<20
mitoses/50 high power fields) or a high mitotic rate (>20 mitoses/50 high power fields) may be used for
of adrenal masses to differentiate Benign from Malignant is of utmost
importance. This has been well explained by Domenico
Albano* et al (2019) and is worth reading and understanding.
am also providing the 2018 Version of ‘European Society of Endocrinology Clinical Practice Guidelines on the
management of adrenocortical carcinoma in adults’.
I am sure these materials provided will be of considerable
help in our understanding of the subject.
With warm Regards,
All adrenal solid and cystic masses irrespective of their imaging findings and functional status should be prepared in the usual protocol before surgery