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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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.
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.
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.
EUS-FNA is a safe and effective method for evaluating etiology of PUO in patients with adrenal enlargement.
KeywordsAdrenals EUS-FNA Pyrexia of unknown origin
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.
Compliance with ethical standards
Conflict of interests
RKB, NSC, SKP, AA, GK, HS, and RP declare that they have no conflict of interest.
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.
- 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
- 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.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.Google Scholar
- 26.Hansali A, Das S, Dutta P. Adrenal histoplasmosis: Unusual presentations. J Assoc Physicians India. 2012;60:54–8.Google Scholar