This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barzon, L. Articles by Boscaro, M. Search for Related Content PubMed PubMed Citation Articles by Barzon, L. Articles by Boscaro, M.

Incidentally Discovered Adrenal Tumors: Endocrine and Scintigraphic Correlates¹

Divisions of Endocrinology (L.B., C.S., N.S., F.F., M.B.) and Nuclear Medicine (M.G., C.M.), University of Padova, Padova, Italy

Address all correspondence and requests for reprints to: Luisa Barzon, M.D., Division of Endocrinology, University of Padova, Via Ospedale 105, 35128 Padova, Italy.

Hormonal and morphological data were investigated in 202 consecutive patients with adrenal incidentalomas (171 unilateral and 31 bilateral) in an attempt to assess subclinical hyperfunction or malignancy. In addition to the classical evaluation, scintiscan was carried out in a large number of these patients. In unilateral incidentalomas, 83% showed normal hormonal function, whereas 17% had biochemical signs of adrenal overactivity (hyperaldosteronism in 3, hypercortisolism in 17, medullary hyperfunction in 9). [⁷⁵Se]Methylnorcholesterol scintigraphy depicted malignant, space-occupying lesions as decreased or absent radiotracer uptake by the mass, and cortical adenomas as increased or normal uptake. In cortical adenomas a relationship between radiocholesterol uptake and degree of functional autonomy was demonstrated. [¹²³I]Metaiodobenzilguanidine scintiscan visualized 7 of 8 pheochromocytomas. In bilateral incidentalomas, abnormal adrenal function was more frequent, accounting for 29% of cases (hyperaldosteronism in 3, hypercortisolism in 3, adrenal insufficiency in 2, and congenital adrenal hyperplasia in 1). Malignant lesions were not scintigraphically visualized. [⁷⁵Se]-Methylnorcholesterol scan also provided functional information in the case of a cortisol-secreting adenoma and an aldosteronoma with a concomitant contralateral nonhypersecreting adenoma, showing the greatest uptake in the hyperfunctioning adenomas. In both unilateral and bilateral lesions, endocrine testing failed to differentiate benign from malignant tumors. Although hormonal assessment is mandatory to clarify the functional patterns, only morphofunctional examination by scintiscan seems to provide more data about the likelihood of malignancy.

This article has been cited by other articles:

				J. Majnik, A. Patocs, K. Balogh, M. Toth, P. Gergics, A. Szappanos, A. Mondok, G. Borgulya, P. Panczel, Z. Prohaszka, et al. Overrepresentation of the N363S Variant of the Glucocorticoid Receptor Gene in Patients with Bilateral Adrenal Incidentalomas J. Clin. Endocrinol. Metab., July 1, 2006; 91(7): 2796 - 2799. [Abstract] [Full Text] [PDF]

				R Nawar and D Aron Adrenal incidentalomas -- a continuing management dilemma Endocr. Relat. Cancer, September 1, 2005; 12(3): 585 - 598. [Abstract] [Full Text] [PDF]

				R. G. Dluhy, M. M. Maher, and C.-L. Wu Case 7-2005 - A 59-Year-Old Woman with an Incidentally Discovered Adrenal Nodule N. Engl. J. Med., March 10, 2005; 352(10): 1025 - 1032. [Full Text] [PDF]

				G. Mansmann, J. Lau, E. Balk, M. Rothberg, Y. Miyachi, and S. R. Bornstein The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management Endocr. Rev., April 1, 2004; 25(2): 309 - 340. [Abstract] [Full Text] [PDF]

				P. H. Kann, B. Wirkus, T. Behr, K.-J. Klose, and S. Meyer Endosonographic Imaging of Benign and Malignant Pheochromocytomas J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1694 - 1697. [Abstract] [Full Text] [PDF]

				B. Catargi, V. Rigalleau, A. Poussin, N. Ronci-Chaix, V. Bex, V. Vergnot, H. Gin, P. Roger, and A. Tabarin Occult Cushing's Syndrome in Type-2 Diabetes J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5808 - 5813. [Abstract] [Full Text] [PDF]

				S. Minowada, T. Fujimura, N. Takahashi, H. Kishi, K. Hasuo, and M. Minami Computed Tomography-Guided Percutaneous Acetic Acid Injection Therapy for Functioning Adrenocortical Adenoma J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5814 - 5817. [Abstract] [Full Text] [PDF]

				G. La Cava, A. Imperiale, C. Olianti, G. R. Gheri, C. Ladu, M. Mannelli, and A. Pupi SPECT Semiquantitative Analysis of Adrenocortical 131I-6{beta}-Iodomethyl-Norcholesterol Uptake to Discriminate Subclinical and Preclinical Functioning Adrenal Incidentaloma J. Nucl. Med., July 1, 2003; 44(7): 1057 - 1064. [Abstract] [Full Text] [PDF]

				A. Angeli and M. Terzolo Adrenal Incidentaloma--A Modern Disease with Old Complications J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4869 - 4871. [Full Text] [PDF]

				E. Charmandari, M. Weise, S. R. Bornstein, G. Eisenhofer, M. F. Keil, G. P. Chrousos, and D. P. Merke Children with Classic Congenital Adrenal Hyperplasia Have Elevated Serum Leptin Concentrations and Insulin Resistance: Potential Clinical Implications J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2114 - 2120. [Abstract] [Full Text] [PDF]

				E Charmandari, C G D Brook, and P C Hindmarsh Why is management of patients with classical congenital adrenal hyperplasia more difficult at puberty? Arch. Dis. Child., April 1, 2002; 86(4): 266 - 269. [Abstract] [Full Text] [PDF]

				S. Maurea, M. Klain, C. Mainolfi, M. Ziviello, and M. Salvatore The Diagnostic Role of Radionuclide Imaging in Evaluation of Patients with Nonhypersecreting Adrenal Masses J. Nucl. Med., June 1, 2001; 42(6): 884 - 892. [Abstract] [Full Text] [PDF]

				G. Osella, G. Reimondo, P. Peretti, A. Alì, P. Paccotti, A. Angeli, and M. Terzolo The Patients with Incidentally Discovered Adrenal Adenoma (Incidentaloma) Are Not at Increased Risk of Osteoporosis J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 604 - 607. [Abstract] [Full Text]

				M. Boscaro, L. Barzon, and N. Sonino The Diagnosis of Cushing's Syndrome: Atypical Presentations and Laboratory Shortcomings Arch Intern Med, November 13, 2000; 160(20): 3045 - 3053. [Abstract] [Full Text] [PDF]

				R. Rossi, L. Tauchmanova, A. Luciano, M. Di Martino, C. Battista, L. Del Viscovo, V. Nuzzo, and G. Lombardi Subclinical Cushing's Syndrome in Patients with Adrenal Incidentaloma: Clinical and Biochemical Features J. Clin. Endocrinol. Metab., April 1, 2000; 85(4): 1440 - 1448. [Abstract] [Full Text]

				F. Mantero, M. Terzolo, G. Arnaldi, G. Osella, A. M. Masini, A. Alì, M. Giovagnetti, G. Opocher, and A. Angeli A Survey on Adrenal Incidentaloma in Italy J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 637 - 644. [Abstract] [Full Text]

				C. Pilon, M. Pistorello, A. Moscon, G. Altavilla, U. Pagotto, M. Boscaro, and F. Fallo Inactivation of the p16 Tumor Suppressor Gene in Adrenocortical Tumors J. Clin. Endocrinol. Metab., August 1, 1999; 84(8): 2776 - 2779. [Abstract] [Full Text]

				S. R. Bornstein, C. A. Stratakis, and G. P. Chrousos Adrenocortical Tumors: Recent Advances in Basic Concepts and Clinical Management Ann Intern Med, May 4, 1999; 130(9): 759 - 771. [Abstract] [Full Text] [PDF]

				L. Barzon, C. Scaroni, N. Sonino, F. Fallo, A. Paoletta, and M. Boscaro Risk Factors and Long-Term Follow-Up of Adrenal Incidentalomas J. Clin. Endocrinol. Metab., February 1, 1999; 84(2): 520 - 526. [Abstract] [Full Text]

				M. Tóth, K. Rácz, and E. Gláz Increased Plasma 17-Hydroxyprogesterone Response to ACTH in Patients with Nonhyperfunctioning Adrenal Adenomas Is Not Due to a Deficiency in 21-Hydroxylase Activityd J. Clin. Endocrinol. Metab., October 1, 1998; 83(10): 3756 - 3757. [Full Text]