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Endoscopic ultrasound-guided fine-needle aspiration of enlarged adrenals in patients with pyrexia of unknown origin: A single-center experience of 52 cases

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Abstract

Background

Fine-needle aspiration (FNA) of adrenals is needed in patients with pyrexia of unknown origin (PUO) and adrenal enlargement in absence of other diagnostic clues. Adrenals are easily accessible by endoscopic ultrasound (EUS) due to proximity; however, there is no systemic study available on FNA of adrenals in patients with PUO. The aim of this study was to evaluate the diagnostic yield and safety of EUS-FNA of enlarged adrenal in patients with PUO.

Methods

Data was analyzed from October 2010 to September 2016 at a single tertiary care center in northern India. EUS-FNA of enlarged adrenals was done in 52 patients for the etiological diagnosis of PUO in whom a definitive diagnosis could not be made with other means.

Results

The mean age was 48±14 years; 36 were males and 16 were females. EUS-FNA was done from the left adrenal in 50 patients and from the right sample in 2 patients. A technical success was achieved in 100% cases. The 19-G needle was used in the majority (75%) to the presence of necrotic areas in adrenals; median numbers of passes were 2. The cytopathological diagnoses were tuberculosis (n = 36), histoplasmosis (n = 13), lymphoma (n = 2), and metastasis from undiagnosed neuroendocrine tumor of lung (n = 1). Thus, a diagnosis could be made in 52/52 (100%) patients. None of the patients had any procedure-related complications.

Conclusions

EUS-FNA is a safe and effective method for evaluating etiology of PUO in patients with adrenal enlargement.

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References

  1. Ergönül O, Willke A, Azap A, et al. Revised definition of ‘fever of unknown origin’: limitations and opportunities. J Inf Secur. 2005;50:1–5.

    Google Scholar 

  2. Cunha BA. Fever of unknown origin. Informa Healthcare: New York; 2007. https://doi.org/10.3109/9781420019582.

    Book  Google Scholar 

  3. Cunha BA. Fever of unknown origin. In: Longo D, Fauci A, Kasper D. Eds. Principles of Internal Medicine, 18th edn. McGraw-Hill, 2012. pp.158–64.

  4. Sharma KV, Venkatesan AM, Swerdlow D, et al. Image-guided adrenal and renal biopsy. Tech Vasc Interv Radiol. 2010;13:100–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Choudhary NS, Bansal RK, Puri R, et al. Impact and safety of endoscopic ultrasound-guided fine needle aspiration on patients with cirrhosis and pyrexia. Endosc Int Open. 2016;4:E953–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dhiman RK, Saraswat VA, Rajekar H, Reddy C, Chawla YK. A guide to the management of tuberculosis in patients with chronic liver disease. J Clin Exp Hepatol. 2012;2:260–70.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Puri R, Thandaserry R, Choudhary N, et al. Endoscopic ultrasoundguided fine-needle aspiration of the adrenal glands: analysis of 21 patients. Clin Endosc. 2015;48:165–70.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Arellano RS, Garcia RG, Gervais DA, Mueller PR. Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 2009;193:1686–90.

    Article  PubMed  Google Scholar 

  9. Eloubeidi MA, Beydoun M, Jurdi N, Husari A. Transduodenal EUS guided FNA of the right adrenal gland to diagnose lung cancer where percutaneous approach was not possible. J Med Liban. 2011;59:173–5.

    PubMed  Google Scholar 

  10. Bang JY, Hebert-Magee S, Varadarajulu S. Diagnosis of bilateral adrenal metastases secondary to malignant melanoma by EUS-guided FNA. Am J Gastroenterol. 2011;106:1862–3.

    Article  PubMed  Google Scholar 

  11. DeWitt JM. Endoscopic ultrasound-guided fine-needle aspiration of right adrenal masses: report of 2 cases. J Ultrasound Med. 2008;27:261–7.

    Article  PubMed  Google Scholar 

  12. Choudhary NS, Puri R, Kotecha H, et al. An uncommon etiology of adrenal enlargement and fever in a patient of cirrhosis diagnosed with EUS guided FNAC. Trop Gastroenterol. 2014;35:260–1.

    Article  Google Scholar 

  13. Uemura S, Yasuda I, Kato T, et al. Preoperative routine evaluation of bilateral adrenal glands by endoscopic ultrasound and fine-needle aspiration in patients with potentially resectable lung cancer. Endoscopy. 2013;45:195–201.

    Article  PubMed  CAS  Google Scholar 

  14. HH W, Cramer HM, Kho J, et al. Fine needle aspiration cytology of benign adrenal cortical nodules. A comparison of cytologic findings with those of primary and metastatic adrenal malignancies. Acta Cytol. 1998;42:1352–8.

    Article  Google Scholar 

  15. Schuurbiers OC, Tournoy KG, Schoppers HJ, et al. EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer. Lung Cancer. 2011;73:310–5.

    Article  PubMed  Google Scholar 

  16. Sood SK, Balasubramanian SP, Harrison BJ. Percutaneous biopsy of adrenal and extra-adrenal retroperitoneal lesions: beware of catecholamine secreting tumours. Surgeon. 2007;5:279–81.

    Article  PubMed  CAS  Google Scholar 

  17. Patil R, Ona MA, Papafragkakis C, Duddempudi S, Anand S, Jamil LH. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions. Ann Gastroenterol. 2016;29:307–11.

    PubMed  PubMed Central  Google Scholar 

  18. Mody MK, Kazerooni EA, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr. 1995;19:434–9.

    Article  PubMed  CAS  Google Scholar 

  19. Welch TJ, Sheedy PF, Johnson CD, et al. CT-guided biopsy: prospective analysis of 1,000 procedures. Radiology. 1989;171:493–6.

    Article  PubMed  CAS  Google Scholar 

  20. Casola G, Nicolet V, vanSonnenberg E, et al. Unsuspected pheochromocytoma: risk of blood-pressure alterations during percutaneous adrenal biopsy. Radiology. 1986;159:733–5.

    Article  PubMed  CAS  Google Scholar 

  21. Sharma R, Ou S, Ullah A, Kaul V. Endoscopic ultrasound (EUS)- guided fine needle aspiration (FNA) of the right adrenal gland. Endoscopy. 2012;44Suppl 2:UCTN:E385–6.

  22. Ang TL, Chua TS, Fock KM, Tee AK, Teo EK, Mancer K. EUS-FNA of the left adrenal gland is safe and useful. Ann Acad Med Singap. 2007;36:954–7.

    PubMed  Google Scholar 

  23. Grover SB, Midha N, Gupta M, Sharma V, Talib VH. Imaging spectrum in disseminated histoplasmosis- case report and brief review. Australas Radiol. 2005;49:175–8.

    Article  PubMed  CAS  Google Scholar 

  24. Rozenblit AM, Kim A, Tuvia J, Wenig BM. Adrenal histoplasmosis manifested as Addison's disease: unusual CT features with magnetic resonance imaging correlation. Clin Radiol. 2001;56:682–4.

    Article  PubMed  CAS  Google Scholar 

  25. Kawashima A, Sandler CM, Fishman EK, et al. Spectrum of CT findings in non-malignant disease of the adrenal gland. Radiographics. 1998;18:393–412.

    Article  PubMed  CAS  Google Scholar 

  26. Hansali A, Das S, Dutta P. Adrenal histoplasmosis: Unusual presentations. J Assoc Physicians India. 2012;60:54–8.

    Google Scholar 

  27. De D, Nath UK. Disseminated histoplasmosis in immunocompetent individuals—not a so rare entity, in India. Mediterr J Hematol Infect Dis. 2015;7:e2015028.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rashidi A, Fisher SI. Primary adrenal lymphoma: a systematic review. Ann Hematol. 2013;92:1583–93.

    Article  PubMed  CAS  Google Scholar 

  29. DeWitt J, Alsatie M, LeBlanc J, McHenry L, Sherman S. Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. Endoscopy. 2007;39:65–71.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the assistance of Mr. Chandra Prabha and Dr. Sweety Bansal (Research Coordinator), Mr. Manish K Singh (Statistician) and Mr. Aswani Kumar and Mr. Faruq Khan helped in the storage of images.

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Authors and Affiliations

  1. Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India

    Rinkesh K. Bansal, Narendra S. Choudhary, Saurabh K. Patle, Amit Agarwal & Rajesh Puri

  2. Department of Cytopathology, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India

    Gagandeep Kaur & Haimanti Sarin

Authors
  1. Rinkesh K. Bansal
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  2. Narendra S. Choudhary
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  3. Saurabh K. Patle
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  4. Amit Agarwal
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  5. Gagandeep Kaur
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  6. Haimanti Sarin
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  7. Rajesh Puri
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Correspondence to Rajesh Puri.

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Conflict of interests

RKB, NSC, SKP, AA, GK, HS, and RP declare that they have no conflict of interest.

Ethical Approval

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Bansal, R.K., Choudhary, N.S., Patle, S.K. et al. Endoscopic ultrasound-guided fine-needle aspiration of enlarged adrenals in patients with pyrexia of unknown origin: A single-center experience of 52 cases. Indian J Gastroenterol 37, 108–112 (2018). https://doi.org/10.1007/s12664-018-0825-1

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  • DOI: https://doi.org/10.1007/s12664-018-0825-1

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