Adrenal Mass

• 07 Mar 2020 08:50:27 AM
• |Lap/Robotic Urology

Should all Adrenal Mass have functional evaluation irrespective of Imaging findings ?

Comments(4)

• 

  Dr. Anil Takvani

  07 Mar 2020 01:09:41 PM

  Nitesh,

  Can you please provide details of symptoms/signs patient presented with you?

• 

  Nitesh Jain

  07 Mar 2020 04:51:19 PM

  Asking in general in a asymptomatic patient ... Can the need for functional test be decided based on image findings as well ?

  
  

  Nothing to do with this particular patient ... this patient have already undergone Lap Adrenalectomy 😊

• 

  Venugopal P

  08 Mar 2020 09:01:38 AM

  Dear All,

  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.

  http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2010;volume=53;issue=2;spage=222;epage=226;aulast=Jain (PDF available)

  http://www.ijpmonline.org/temp/IndianJPatholMicrobiol532222-1045011_025410.pdf

  Felix Beuschlein et al (2015) have provided information regarding Ki67 and its usefulness.

  https://academic.oup.com/jcem/article/100/3/841/2839088 (PDF available)

  If 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 risk stratification.

  Imaging 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.

  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349247/pdf/13244_2019_Article_688.pdf

  I am also providing the 2018 Version of ‘European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults’.

  https://eje.bioscientifica.com/view/journals/eje/179/4/EJE-18-0608.xml (PDF available)

  I am sure these materials provided will be of considerable help in our understanding of the subject.

  With warm Regards,

  Venu

   

• 

  Dr. Roy Chally

  09 Mar 2020 07:13:37 PM

  All adrenal solid and cystic masses irrespective of their imaging findings and functional status should be prepared in the usual protocol before surgery

  Roy Chally