Dr. Anil Takvani
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10 Mar 2023 08:34:24 AMAdrenal Incidentaloma
This female patient of 55 years had CT chest for chronic respiratory issues. She is detected with bilateral pulmonary fibrosis of some extent. In that CT, radiologist picked up right supra renal mass... Adrenal incidentaloma.
Comments(5)
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Dr. Anil Takvani
07 Feb 2020 08:08:34 AMThanks Prof. Shammem.
I am attaching two more images and concluded report received from radiologist....thanks -
Nitesh Jain
07 Feb 2020 09:45:21 AMTwo main concern in case of adrenal Incidentlona is 1. Functional 2. Malignancy
Functional evaluation needs to be tailored based on symptomatologyHTN specially episodic or accelerated - 24 hours Urine meta and nor-meta nephreinesHTN + Hypokalemia + periodic paralysis - Aldosterone:renin ratioCushnogoid features + HTN + DM - overnight 1mg dexamerhasone restIf none than less than 4 cm can be observed and kept under follow upLarger than 6 cm if non functional can be malignant but can be benign or functional malignant tumorThe characteristic on imaging like enhancement , irregular border and shape , infiltration to surrounding structure can give a clue and suggest malignancyThis if possible needs to be respected if non respectable needs biopsyAdrenal are common sites for metastasis if any past history of malignancy than needs a PET scan and +\- biopsyIn this case mass looks enhancing, large and resectable , will do a functional study and will offer her removal of the same ... will prefer it laparoscopy -
Venugopal P
07 Feb 2020 10:39:25 AMDear All,
I am happy that this subject has initiated some discussion.
The rapid development and widespread application of modern imaging technologies has led to an increase in the diagnosed number of clinically silent adrenal masses. There are many guidelines available on the diagnosis and management of Adrenal Incidentalomas. Among the many, two recent guidelines are worth reading and understanding. M Fassnacht et al (2016) introduced the ESMO Clinical Practice Guidelines but I found the Korean Society Guideline by Jung-Min Lee, Young Kee Shong et al (2017) more useful and better scripted. I am providing the latter for our reading and understanding.
https://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-32-200.pdf
I am providing a PDF on ‘Adrenal Incidentalomas Workup Algorithm and CT and MRI findings’.
Recent studies have found a high incidence of Metastasis in Adrenals from malignancies at various sites. The adrenal gland is a common site for metastasis of some malignancies because of its rich sinusoidal blood supply. S Cingam et al (2017) reported that Adrenal Glands are the fourth most common site of metastases in malignant diseases. It has been reported that approximately 50–75% of clinically imperceptible adrenal masses of cancer patients were metastases. Hence when discussing on Adrenal Incidentalomas, this aspect cannot be ignored. Lei Tan, Zike Qin* et al (2019) has addressed this aspect well in their article.
https://bmccancer.biomedcentral.com/track/pdf/10.1186/s12885-019-6061-y
I hope these informations will enhance our knowledge appreciably.
With warm regards,
Venu
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Dr. Anil Takvani
11 Feb 2020 08:03:04 AMLaboratory investigation related to functionality of this adrenal incidentaloma: within normal level.
Dr. Isteaq Shameem
06 Feb 2020 09:22:23 PMThank you Dr Anil