CC May 2018 Incidental Adrenal Mass

echoecho's version from 2018-05-01 07:26


Question Answer
As many as ___% to ___% of such scans will reveal an incidental adrenal mass?3; 4
Among patients with known malignancies, adrenal nodules are likely to be malignant ____% to ___% of the time?25; 35
In contrast, < ___% of these nodules are malignant in the population without known cancer?5
List types of cancers that are the more common primary tumors that metastasize to the adrenal?1) bronchogenic cancer 2) gastric cancer3) breast cancer 4) colon cancer 5) melanoma 6) renal cell carcinoma
True or false? Primary adrenal carcinoma is a rare, aggressive tumor with a poor prognosis?True
For most incidental adrenal masses, ________ (larger vs smaller) size is associated w/ a higher risk of malignancy? Larger
The American College of Radiology recommends evaluation for malignancy in lesions > ____ cm diameter?4
Such investigation involves what?Further imaging studies, biopsy or surgical excision
Another marker that has been proposed to r/o cancer is what? Unfortunately there is limited evidence fo support a specific growth rate that suggests malignancy?Increasing size of the mass on serial imaging tests
*** List the radiographic features that suggest, but are not diagnostic of malignancy?1) irregular margins 2) necrosis 3) heterogeneity of density 4) high attenuation on noncontrast CA
Why are sequential scans helpful in diagnosis?Because further investigation usually includes CT scan w/ contrast or MRI; adrenal adenomas typically exhibit > 50% washout of contrast on follow-up CT scans.
Lesions < ____ cm, or those of any size that are convincingly _____ or _____-rich adenomas, do not need further follow-up?1) myelolipomas 2)lipid rich adenomas
While most incidental adrenal masses are non functioning, about ____% have subclinical endocrine function associated with an increased risk of metabolic, cardiovascular and bone disease?20
The American Association of Clinical Endocrinologists (AACE) recommends that all patients found to have adrenal masses > ___ cm in diameter under biochemical evaluation?1 cm
List the4 biochemical tests to be done?1) dexamethasone suppression test 2) Plasma or 24 hour urinary metanephrines and catecholamines 3) plasma aldosterone and renin levels 4) serum dehydroepiandrosterone (DHEAS)
How is the Dexamethasone suppression test done?1) administer 1 mg of dexamethasone in the evening and draw a serum cortisol level in the morning. A cortisol level > 50 neologism/L or an increased 24 hour urinary free cortisol excretion, indicates hyperthyroidism
Plasma or 24 hour urinary metanephrines and catecholamines, excessive levels suggest what, which may be asymptomatic in up to 15% of patients?Pheochromocytoma
Plasma aldosterone and renin levels (mineralocorticoid receptor antagonists suc has spirolactone must be discontinued prior to the tests), elevated aldosterone-to-renin ratio and elevated aldosterone level suggest what?Primary hyperaldosteronism
Serum dehydroepiandrosterone (DHEAS) and 17-hydroxyprogesterone levels are elevated in ____ tumors?Rare
*** If biochemical testing is normal and radiographic features are benign, the AACE recommends repeat imaging w/ CT in ___ to ___ months, then annually if stable for ___ to ___ years, with annual biochemical testing for 5 years?3; 6; 1; 2
If biochemical testing is positive, patients should be medically stabilized and referred for what?adrenalectomy
If the adrenal mass is large, patients should be referred for what (regardless of biochemical function)?adrenalectomy
*** SUMMARY = Incidental adrenal lesions are common findings on abdominal ____ scan or _____ imaging and are reported in 3-4% of imaging tests?CT; MRI
*** SUMMARY = Are the majority of incidental adrenal masses benign? What are the characteristics of benign lesions?1) yes. 2) small size, smooth margins, homogenous density and low attenuation on noncontrast CT
*** SUMMARY = About ____% of incidental adrenal masses > 1 cm in diameter are biochemically functional and should be evaluated?20
*** SUMMARY = If biochemical testing is normal and radiographic features are benign, repeat imaging w/ CT is recommended in ___ to ___ months, then annually for 1-2 years, with annual biochemical testing for ____ years?3; 6; 5