Kara M Young1, Michael K Wong2, Myles M Mitsunaga3, Hyo-Chun Yoon4. 1. Senior at Bryn Mawr College and was a Summer Research Associate in Diagnostic Imaging at the Moanalua Medical Center in HI. tokmyoung@sbcglobal.net. 2. Freshman at Yale College at Yale University and was a Summer Research Associate in Diagnostic Imaging at the Moanalua Medical Center in HI. mwong15@punahou.edu. 3. Resident in Radiology at the University of California, Davis Medical Center in CA. mylesm@hawaii.edu. 4. Associate Chief of Diagnostic Imaging at the Moanalua Medical Center in HI. hyo-chun.yoon@kp.org.
Abstract
INTRODUCTION: Low incidence of adrenal cortical carcinoma in the general adult population has prompted a reevaluation of current protocol for the assessment of adrenal incidentalomas. OBJECTIVE: To determine whether follow-up imaging for small (≤ 4 cm) incidental adrenal nodules is necessary for patients without known cancer. METHODS: We performed a retrospective analysis of all patients found to have an incidental adrenal nodule on abdominal computed tomography (CT) scan during a 27-month period. The electronic medical record was reviewed to determine clinical outcomes in all patients with a minimum of 3 years of follow-up (mean follow-up = 6.7 years). Patients with a known primary cancer were excluded from the analysis unless they had a prior CT scan that documented an incidental adrenal nodule. Unenhanced CT attenuation was measured for all nodules, if available. RESULTS: A total of 392 patients with an incidental adrenal nodule had a mean (standard deviation [SD]) clinical follow-up of 6.7 (2.7) years. There were 200 men and 192 women with a mean (SD) age of 66.0 (13.2) years. None of these patients developed primary adrenocortical carcinoma during the follow-up period.Two hundred forty of these patients also had a minimum 3 years of imaging follow-up (mean [SD], 6.4 [2.4] years; range, 3.1-13.6 years). There were 173 left-sided and 91 right-sided nodules on index CT scan. There was no significant difference in the mean (SD) rate of growth between left- and right-sided nodules (0.1 [0.8] mm/year vs 0.1 [0.8] mm/year, p = 0.58). Mean unenhanced CT attenuation of adrenal nodules did not affect the likelihood of adrenal malignancy during follow-up. CONCLUSION: Patients with small incidental adrenal nodules do not require additional imaging to exclude the possibility of adrenocortical carcinoma.
INTRODUCTION: Low incidence of adrenal cortical carcinoma in the general adult population has prompted a reevaluation of current protocol for the assessment of adrenal incidentalomas. OBJECTIVE: To determine whether follow-up imaging for small (≤ 4 cm) incidental adrenal nodules is necessary for patients without known cancer. METHODS: We performed a retrospective analysis of all patients found to have an incidental adrenal nodule on abdominal computed tomography (CT) scan during a 27-month period. The electronic medical record was reviewed to determine clinical outcomes in all patients with a minimum of 3 years of follow-up (mean follow-up = 6.7 years). Patients with a known primary cancer were excluded from the analysis unless they had a prior CT scan that documented an incidental adrenal nodule. Unenhanced CT attenuation was measured for all nodules, if available. RESULTS: A total of 392 patients with an incidental adrenal nodule had a mean (standard deviation [SD]) clinical follow-up of 6.7 (2.7) years. There were 200 men and 192 women with a mean (SD) age of 66.0 (13.2) years. None of these patients developed primary adrenocortical carcinoma during the follow-up period.Two hundred forty of these patients also had a minimum 3 years of imaging follow-up (mean [SD], 6.4 [2.4] years; range, 3.1-13.6 years). There were 173 left-sided and 91 right-sided nodules on index CT scan. There was no significant difference in the mean (SD) rate of growth between left- and right-sided nodules (0.1 [0.8] mm/year vs 0.1 [0.8] mm/year, p = 0.58). Mean unenhanced CT attenuation of adrenal nodules did not affect the likelihood of adrenal malignancy during follow-up. CONCLUSION:Patients with small incidental adrenal nodules do not require additional imaging to exclude the possibility of adrenocortical carcinoma.
Authors: Martha A Zeiger; Geoffrey B Thompson; Quan-Yang Duh; Amir H Hamrahian; Peter Angelos; Dina Elaraj; Elliott Fishman; Julia Kharlip Journal: Endocr Pract Date: 2009 Jul-Aug Impact factor: 3.443
Authors: Lincoln L Berland; Stuart G Silverman; Richard M Gore; William W Mayo-Smith; Alec J Megibow; Judy Yee; James A Brink; Mark E Baker; Michael P Federle; W Dennis Foley; Isaac R Francis; Brian R Herts; Gary M Israel; Glenn Krinsky; Joel F Platt; William P Shuman; Andrew J Taylor Journal: J Am Coll Radiol Date: 2010-10 Impact factor: 5.532
Authors: S Bovio; A Cataldi; G Reimondo; P Sperone; S Novello; A Berruti; P Borasio; C Fava; L Dogliotti; G V Scagliotti; A Angeli; M Terzolo Journal: J Endocrinol Invest Date: 2006-04 Impact factor: 4.256