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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to determine the patterns of iodine-131 6 beta-iodomethylnorcholesterol (NP-59) imaging and the correlation with computed tomography (CT)-guided adrenal biopsy and follow-up in patients with bilateral adrenal masses. To this end we investigated a consecutive sample of 29 euadrenal patients with bilateral adrenal masses discovered on CT for reasons other than suspected adrenal disease. Adrenal scintigraphy was performed using 1 mCi of NP-59 injected intravenously, with gamma camera imaging 5-7 days later. In 13 of the 29 patients bilateral adrenal masses were the result of metastatic involvement from lung carcinoma (5), lymphoma (3), adrenocarcinoma of the colon (3), squamous cell carcinoma of the larynx (1), and anaplastic carcinoma of unknown primary (1). Among these cases the NP-59 scan demonstrated either bilaterally absent tracer accumulation (in eight, all with bilateral metastases proven by CT-guided biopsy or progression on follow-up CT) or marked asymmetry of adrenocortical NP-59 uptake (in five). Biopsy of the adrenal demonstrating the least NP-59 uptake documented malignant involvement of that gland in five of five patients. In two patients an adenoma was found simultaneously in one adrenal with a contralateral malignant adrenal mass. In each of these cases, the adenoma demonstrated the greatest NP-59 uptake. In 16 patients diagnosis of adenoma was made on the basis of (a) CT-guided adrenal biopsy of the gland with the greatest NP-59 uptake of the pair (n = 4), or (b) adrenalectomy (n = 2), or (c) absence of change in the size of the adrenal mass on follow-up CT scanning performed 6 months to 3 years later (n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Scintigraphy of incidentally discovered bilateral adrenal masses. 760 61

Sonographic findings in 19 patients with proved adrenal pheochromocytomas observed over a 10 year period were evaluated retrospectively. Adrenal tumors were analyzed by number, size, echogenicity, internal echogenicity, and biologic behavior. There were 16 benign and 3 malignant pheochromocytomas, all of which were well marginated or encapsulated and ranged from 1.4 to 11 cm in greatest diameter (mean, 4.8 +/- 2.2 cm). A broad spectrum of sonographic appearances has been noted, including purely solid tumors (68%), complex masses (16%), and cystic lesions (16%). Compared with renal parenchyma as a reference tissue, 10 (77%) of 13 solid pheochromocytomas were isoechoic or hypoechoic, whereas three (23%) were hyperechoic. Six (46%) of the solid tumors were homogeneously echogenic, and seven (54%) were heterogeneous. Ultrasonic discrimination between benign and malignant pheochromocytoma on the basis of acoustic features alone has proved impossible. Abdominal sonography, however, provided evidence of malignancy in all three patients with malignant tumors by disclosing regional or distant metastases. In conclusion, rather than showing a specific uniform ultrasonographic appearance, pheochromocytoma is associated with a broad spectrum of possible sonographic presentations.
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PMID:Adrenal pheochromocytomas: a broad spectrum of sonographic presentation. 793 13

Adrenal diseases are uncommon in older patients but can present insidiously. Adrenal masses are often discovered incidentally on abdominal CT scans and are usually benign, but they should be assessed for hormone production. Cushing's syndrome, or cortisol excess, is usually due to exogenous corticosteroids or a hormonally active tumor. The overnight dexamethasone suppression test is an excellent screening test. Adrenal insufficiency can be caused by hemorrhage, tuberculosis, or metastatic cancer. Maintaining a high index of suspicion of hidden adrenal disease, the primary care physician should apply an efficient approach to the diagnosis and initial management of adrenal diseases in older patients.
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PMID:Adrenal disorders: know when to act and what tests to give. 802 Jul 60

The purpose of this study was to investigate the ability of MR imaging with a 0.5-T apparatus to distinguish adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 non-hyperfunctioning adenomas, 5 hyperfunctioning) and 23 adrenal metastases (14 from lung, 5 liver, 3 colon, and 1 stomach cancer). The signal intensity (SI) ratio (adrenal tumor/liver) on T1-, T2-, and T2*-weighted MR images was calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21/23, 91%) than on T2-weighted images (15/23, 65%). In conclusion, T2*-weighted images were better than routine T2-weighted images in distinguishing adrenal adenomas from adrenal metastases. The reason could be that the total signal intensity of adrenal adenomas which contained some fat components decreased on T2*-weighted images due to an out-of-phase effect.
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PMID:[Distinction between adrenal adenomas and metastases using 0.5 Telsa MR imaging: diagnosis with out-of-phase T2*-weighted gradient-field-echo image]. 817 96

Adrenal androgens contribute 40% of total androgens in adult men. The inactive precursor steroids dehydroepiandrosterone (DHEA) and DHEA-sulfate are secreted in large amounts by the adrenals and reach the prostate and other peripheral target tissues, where they are transformed into the potent androgen dihydrotestosterone (DHT). We have cloned and sequenced the cDNAs and/or genes which encode the enzymes responsible for the transformation of DHEA into DHT, namely 3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4 isomerase, 17 beta-hydroxysteroid dehydrogenase and 5 alpha-reductase. Blockade of DHT synthesized by these enzymes, with a pure antiandrogen of the class of flutamide, prolongs life in advanced prostate cancer, the effect being much more important when a small number of metastases is present. Most importantly, 3-month combination therapy reduces cancer-positive margins at radical prostatectomy, from 38.5% in control patients to only 13% in those who received combination therapy. Combined with an efficient strategy for detection of early-stage prostate cancer, the present approach could offer the possibility of a cure to more than 80% of prostate cancer patients, compared with the present situation where a cure can be offered to less than 20% of patients, since the first diagnosis of prostate cancer is usually made at a late stage of the disease.
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PMID:Intracrinology: the basis for the rational design of endocrine therapy at all stages of prostate cancer. 826 32

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor-liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.
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PMID:Adrenal tissue characterization with 0.5-T MR imaging: value of T2*-weighted images. 840 May 60

We describe a patient affected by adrenal insufficiency due to metastases of breast cancer. Adrenal involvement became clinically evident 20 years after radical mastectomy and it was the only secondary localization of the tumor. There is still no evidence of other metastases after a two year follow-up. This case suggests that adrenal function evaluation should be included in periodical follow-ups of patients who underwent radical mastectomy for breast cancer.
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PMID:An unusual case of adrenal failure due to isolated metastases of breast cancer. 888 45

Adrenal masses are more and more frequently detected by adrenal ultrasound, computed tomography or nuclear magnetic resonance carried out for a reason other than the suspicion of adrenal disease (incidentalomas). The findings of an incidentaloma still leaves many diagnostic and therapeutic questions open. We report the results of a multicentric retrospective evaluation of patients with adrenal incidentalomas, performed by a Study Group of the Italian Society of Endocrinology. According to the definition of incidentaloma, exclusion criteria a priori were: severe or paroxysmal hypertension, frank hypokalemia and clinical signs of hypercortisolism or hyperandrogenism. 29 centers participated in the study and the data obtained by questionnaire were collected in 2 centers for final elaboration. Center 1 carried out the epidemiological and clinical evaluation. Basal and dynamic hormonal evaluation of 786 among the 1013 cases recruited were performed in our center (center 2). Functional studies included: diurnal rhythm of cortisol, urinary free cortisol (UFC), ACTH, DHEAS, 17-OH progesterone, testosterone, androstenedione, supine and upright plasma renin activity (PRA) and aldosterone, urinary aldosterone, urinary catecholamines and VMA. The hormonal dynamic evaluation included the overnight dexamethasone suppression test (1 mg), CRH test and ACTH test. In our study, 89% (702 patients) of adrenal incidentalomas were non-hypersecretory masses; 6.2% (49 patients) showed a preclinical Cushing's syndrome (PCS) (at least two altered parameters of pituitary-adrenal axis); 3.4% (27 patients) were pheochromocytomas; 0.89% (7 patients) were aldosteronomas. One tumor was a masculinizing adrenocortical carcinoma. Two hundred sixty patients underwent surgical exploration and the histological diagnosis showed: 138 adenomas (53%), 32 carcinomas (12%), 26 pheochromocytomas (10%). 16 myelolipomas (8%), 13 cystic lesions (5.5%), 7 tumors of neuronal lineage (3%). 12 metastases (4%), 13 others (5%). The 138 patients with adenomas had the following hormonal diagnosis: 103 nonfunctional adenomas (74%), 31 PCS (23%) and 4 cases of hyperaldosteronism (3%). In the patients with PCS an abnormal dexamethasone suppression test was found in 86% of cases (37/41 patients). Values for ACTH were low in 78% (32/41 patients). UFC was elevated in 64% of patients, the diurnal rhythm of cortisol evaluated in 14 patients was absent in 7. Only in 50% of cases DHEAS values (12/24 patients) were decreased, whereas they were normal in the other 50%. Interestingly, 8 patients with normal DHEAS and normal UFC showed nonsuppressible cortisol by dexamethasone test (1 mg). Blunted ACTH response to CRH was detected in 9 of 14 patients (64%). Thus our data suggest that the best parameter for evaluating subclinical hypercortisolism seems to be the overnight dexamethasone suppression test. In 27 patients with pheochromocytoma 24-hour urinary catecholamine and VMA levels were elevated in 86 and 46% of cases respectively. In 7 patients with hyperaldosteronism upright PRA was suppressed in 100% of cases and aldosterone plasma levels were elevated in 6 patients (86%); serum potassium level was slightly decreased in 60% of cases. In 86 of 138 histologically proven adenomas, DHEAS levels were: normal in 59% of patients, decreased in 36% and elevated in 4.6%, whereas in 22 of 32 cortical carcinomas evaluated. DHEAS levels were normal in 63% of cases, decreased in 18% and elevated 18%. Post-ACTH 17-OH progesterone levels were elevated in 52% (62/118 patients) of non-functioning adenomas and in 2 of 4 carcinomas. Not enough data are yet available postoperatively. In summary, endocrine evaluation can lead to the identification of a nonnegligible number of cases of clinically unsuspected pheochromocytomas and subtle hypercortisolism (about 3.4 and 6.2%, respectively of all adrenal incidentalomas), while cases of primary subclinical aldosteronism are rarely found. (ABSTRACT TRUNCATED)
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PMID:Adrenal incidentaloma: an overview of hormonal data from the National Italian Study Group. 916 66

A review was performed of ultrasonographic findings in 26 dogs with confirmed adrenal lesions. Adrenal shape, size, echogenicity, laterality, and the presence of vascular invasion were evaluated. Histopathologic diagnoses were obtained in all dogs. Adrenal lesions were confirmed as pheochromocytomas (9), adenocarcinomas (6), a poorly differentiated blastoma (1), bilateral adrenal metastases of a carcinoma (1), adenomas--one of which was bilateral--(4) and hyperplasia (6). Size and shape were extremely variable and not specific to lesion type. There was a tendency for pheochromocytomas (7), adenocarcinomas (5) and poorly differentiated blastoma (1) to be rounded masses. Adenomas (4), hyperplasia (7) and adrenal metastases (2) presented predominantly as nodules. No specificity in echogenicity was noted. Mineralization and bilaterality were present in both benign and malignant lesions. Vascular extension or the presence of a thrombus were suggestive but not specific signs of malignancy. Based on our preliminary study, ultrasonography is an effective method for localizing adrenal lesions and is helpful in assessing their extension. However, no definitive differentiation between benign and malignant lesions was possible using ultrasonographic criteria alone.
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PMID:Retrospective ultrasonographic evaluation of adrenal lesions in 26 dogs. 940 12

Adrenal masses are a relatively common finding on computed tomography (CT) and magnetic resonance imaging (MRI). Until recently, adrenal biopsy, resection, or clinical follow-up were the only methods of distinguishing benign adenomas from malignancies. On the basis of their higher lipid content, adenomas have characteristics appearances on CT and MRI that can be used to separate them from non-lipid-containing lesions such as metastases. CT densitometry with or without contrast media and chemical shift MRI (CSI) are two examples of techniques with adequate sensitivity (50-90%) and excellent specificity (> 95%) for adrenal adenomas. While the need for invasive tissue sampling is reduced because of these techniques, it is eliminated because lesions not meeting the criteria for adenomas are not always malignant. However, CT densitometry and CSI are likely to reduce significantly the need for histology sampling of incidentally discovered adrenal masses due to the high specificity of these new techniques.
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PMID:From needles to numbers: can noninvasive imaging distinguish benign and malignant adrenal lesions? 954 12


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