Accidental finding of incidentaloma (Adrenal mass) on USG is detected. Following is/are to be ruled out:
Ans is All Widespread use of imaging tests such as abdominal ultrasonography, CT, and magnetic resonance imaging (MRI) is causing increased detections of incidental adrenal masses k/a adrenal incidentalomas . The below given table lists the most common histologic types of adrenal incidentalomas: Causes of adrenal incidentalomas Adrenal coical tumors Cysts and pseudocysts Adenoma Hematoma and hemorrhage Nodular hyperplasia Infections, granulomas Adrenocoical carcinoma Metastases Adrenal medullary tumors Pheochromocytoma Other adrenal tumors Myelolipoma Lipoma TWO IMPOANT QUESTIONS ? While evaluating an adrenal incidentaloma, two questions are asked 1. Is it malignant? If so, is it primary or metastatic cancer? 2. Is it functional (ie, is it secreting hormones)? Benign or Malignant The two major predictors of malignancy are the tumor's size and its features on imaging Size: Size is an impoant factor in differentiating benign tumors such as adrenal adenomas and hyperplasias from malignant lesions such as adrenal carcinomas and metastases from other primary sites. The larger an adrenal mass, the more likely it is malignant. However, significant overlap exists. 6 cm can be taken as the cut-off value. Features on imaging studies: The noncontrast CT attenuation coefficient On noncontrast CT if the mass has an attenuation value of < 10 HU (Hounsfield units) and is homogenous with a smooth border, it is very likely that the mass is benign . Enhancement washout is valuable in differentiating lipid-poor adrenal adenomas (noncontrast HU > 10) from nonadenomas. A CT scan with contrast is performed, the attenuation coefficent of the mass is measured 1 minute after contrast administration and again 15 minutes after contrast administration, and the percentage of enhancement washout is calculated. An absolute enhancement washout percentage of less than 60% at 15 minutes after giving contrast strongly suggests a nonadenoma. Fine-needle aspiration biopsy Cytologic study of a specimen obtained by imaging-guided fine-needle aspiration may help in evaluating an adrenal mass suspected of being metastatic that has a noncontrast CT attenuation value of more than 10 HU. It cannot, however, always differentiate an adrenocoical carcinoma from an adrenal adenoma. To avoid causing a possible hypeensive crisis, pheochromocytoma should always be excluded before fine-needle aspiration of an adrenal mass is attempted. Is it functional: About 6% to 20% of patients with adrenal incidentalomas have hormonal abnormalities, showing that the mass is functional. Patients should be evaluated for the following conditions: Pheochromocytoma Cushing syndrome (including subclinical disease) Primary aldosteronism (only if hypeensive).
Cushing's disease
Metastasis
Adrenal adenoma
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