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Clinical Detection and Treatment of Adrenal Disease

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Molecular Pathology of Endocrine Diseases

Part of the book series: Molecular Pathology Library ((MPLB,volume 3))

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Abstract

Diagnosis and treatment of patients with adrenal lesions is both challenging and fascinating owing to the wide range of biologically important compounds produced by these small glands. Tumors of the adrenal cortex may produce mineralocorticoids, glucocorticoids, sex steroids or in specific cases, combinations of these. Tumors of the adrenal medulla may produce catecholamines and other related compounds making them particularly challenging to diagnose and treat. Malignant disease of the adrenal glands may also be hormonally active.

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References

  1. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006;367(9522):1605–1617.

    Article  PubMed  CAS  Google Scholar 

  2. Charbonnel B, Chatal JF, Ozanne P. Does the corticoadrenal adenoma with “pre-Cushing’s syndrome” exist? J Nucl Med. 1981;22(12):1059–1061.

    PubMed  CAS  Google Scholar 

  3. Barzon L, Fallo F, Sonino N, Boscaro M. Development of overt Cushing’s syndrome in patients with adrenal incidentaloma. Eur J Endocrinol. 2002;146(1):61–66.

    Article  PubMed  CAS  Google Scholar 

  4. Ilias I, Torpy DJ, Pacak K, Mullen N, Wesley RA, Nieman LK. Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the National Institutes of Health. J Clin Endocrinol Metab. 2005;90(8):4955–4962.

    Article  PubMed  CAS  Google Scholar 

  5. Lindholm J, Juul S, Jorgensen JO, et al. Incidence and late prognosis of Cushing’s syndrome: a population-based study. J Clin Endocrinol Metab. 2001;86(1):117–123.

    Article  PubMed  CAS  Google Scholar 

  6. Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88(12):5593–5602.

    Article  PubMed  CAS  Google Scholar 

  7. Findling JW, Kehoe ME, Raff H. Identification of patients with Cushing’s disease with negative pituitary adrenocorticotropin gradients during inferior petrosal sinus sampling: prolactin as an index of pituitary venous effluent. J Clin Endocrinol Metab. 2004;89(12):6005–6009.

    Article  PubMed  CAS  Google Scholar 

  8. Rockall AG, Babar SA, Sohaib SA, et al. CT and MR imaging of the adrenal glands in ACTH-independent Cushing syndrome. Radiographics. 2004;24(2):435–452.

    Article  PubMed  Google Scholar 

  9. Invitti C, Pecori GF, de Martin M, Cavagnini F. Diagnosis and management of Cushing’s syndrome: results of an Italian multicentre study. Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis. J Clin Endocrinol Metab. 1999;84(2):440–448.

    Article  PubMed  CAS  Google Scholar 

  10. Lindsay JR, Nieman LK. Differential diagnosis and imaging in Cushing’s syndrome. Endocrinol Metab Clin North Am. 2005;34(2):403-421, x.

    Article  PubMed  CAS  Google Scholar 

  11. Iacobone M, Mantero F, Basso SM, Lumachi F, Favia G. Results and long-term follow-up after unilateral adrenalectomy for ACTH-independent hypercortisolism in a series of fifty patients. J Endocrinol Invest. 2005;28(4):327–332.

    PubMed  CAS  Google Scholar 

  12. Mishra AK, Agarwal A, Gupta S, Agarwal G, Verma AK, Mishra SK. Outcome of adrenalectomy for Cushing’s syndrome: experience from a tertiary care center. World J Surg. 2007;31(7):1425–1432.

    Article  PubMed  Google Scholar 

  13. Gumbs AA, Gagner M. Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab. 2006;20(3):483–499.

    Article  PubMed  Google Scholar 

  14. Sonino N, Boscaro M, Fallo F. Pharmacologic management of Cushing syndrome: new targets for therapy. Treat Endocrinol. 2005;4(2):87–94.

    Article  PubMed  CAS  Google Scholar 

  15. Sonino N, Zielezny M, Fava GA, Fallo F, Boscaro M. Risk factors and long-term outcome in pituitary-dependent Cushing’s disease. J Clin Endocrinol Metab. 1996;81(7):2647–2652.

    Article  PubMed  CAS  Google Scholar 

  16. Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians. 1955;68:215–231.

    PubMed  CAS  Google Scholar 

  17. Lim PO, Dow E, Brennan G, Jung RT, Macdonald TM. High prevalence of primary aldosteronism in the Tayside hypertension clinic population. J Hum Hypertens. 2000;14(5):311–315.

    Article  PubMed  CAS  Google Scholar 

  18. Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1, 125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293–2300.

    Article  PubMed  CAS  Google Scholar 

  19. Kaplan NM. Hypokalemia in the hypertensive patient, with observations on the incidence of primary aldosteronism. Ann Intern Med. 1967;66(6):1079–1090.

    PubMed  CAS  Google Scholar 

  20. Sinclair AM, Isles CG, Brown I, Cameron H, Murray GD, Robertson JW. Secondary hypertension in a blood pressure clinic. Arch Intern Med. 1987;147(7):1289–1293.

    Article  PubMed  CAS  Google Scholar 

  21. Young WF Jr. Minireview: primary aldosteronism - changing concepts in diagnosis and treatment. Endocrinology. 2003;144(6):2208–2213.

    Article  PubMed  CAS  Google Scholar 

  22. Gordon RD, Stowasser M. Primary aldosteronism: the case for screening. Nat Clin Pract Nephrol. 2007;3(11):582–583.

    Article  PubMed  Google Scholar 

  23. Mulatero P, Milan A, Fallo F, et al. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab. 2006;91(7):2618–2623.

    Article  PubMed  CAS  Google Scholar 

  24. Lingam RK, Sohaib SA, Rockall AG, et al. Diagnostic performance of CT versus MR in detecting aldosterone-producing adenoma in primary hyperaldosteronism (Conn’s syndrome). Eur Radiol. 2004;14(10):1787–1792.

    Article  PubMed  CAS  Google Scholar 

  25. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136(6):1227–1235.

    Article  PubMed  Google Scholar 

  26. Harvey A, Kline G, Pasieka JL. Adrenal venous sampling in primary hyperaldosteronism: comparison of radiographic with biochemical success and the clinical decision-making with “less than ideal” testing. Surgery. 2006;140(6):847–853.

    Article  PubMed  Google Scholar 

  27. Rossi GP, Sacchetto A, Chiesura-Corona M, et al. Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab. 2001;86(3):1083–1090.

    Article  PubMed  CAS  Google Scholar 

  28. Sawka AM, Young WF, Thompson GB, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med. 2001;135(4):258–261.

    PubMed  CAS  Google Scholar 

  29. Sywak M, Pasieka JL. Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism. Br J Surg. 2002;89(12):1587–1593.

    Article  PubMed  CAS  Google Scholar 

  30. Sheps SG, Jiang NS, Klee GG. Diagnostic evaluation of pheochromocytoma. Endocrinol Metab Clin North Am. 1988;17(2):397–414.

    PubMed  CAS  Google Scholar 

  31. Yeo H, Roman S. Pheochromocytoma and functional paraganglioma. Curr Opin Oncol. 2005;17(1):13–18.

    Article  PubMed  Google Scholar 

  32. Kudva YC, Sawka AM, Young WF Jr. Clinical review 164: the laboratory diagnosis of adrenal pheochromocytoma: the Mayo Clinic experience. J Clin Endocrinol Metab. 2003;88(10):4533–4539.

    Article  PubMed  CAS  Google Scholar 

  33. Elder EE, Elder G, Larsson C. Pheochromocytoma and functional paraganglioma syndrome: no longer the 10% tumor. J Surg Oncol. 2005;89(3):193–201.

    Article  PubMed  Google Scholar 

  34. Madani R, Al Hashmi M, Bliss R, Lennard TW. Ectopic pheochromocytoma: does the rule of tens apply? World J Surg. 2007;31(4):849–854.

    Article  PubMed  CAS  Google Scholar 

  35. Neumann HP, Bausch B, McWhinney SR, et al. Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med. 2002;346(19):1459–1466.

    Article  PubMed  CAS  Google Scholar 

  36. Young WF, Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000;29(1):159-185, x.

    Article  PubMed  Google Scholar 

  37. Sawka AM, Jaeschke R, Singh RJ, Young WF Jr. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab. 2003;88(2):553–558.

    Article  PubMed  CAS  Google Scholar 

  38. Pacak K, Eisenhofer G, Ahlman H, et al. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab. 2007;3(2):92–102.

    Article  PubMed  Google Scholar 

  39. Boyle JG, Davidson DF, Perry CG, Connell JM. Comparison of diagnostic accuracy of urinary free metanephrines, vanillyl mandelic Acid, and catecholamines and plasma catecholamines for diagnosis of pheochromocytoma. J Clin Endocrinol Metab. 2007;92(12):4602–4608.

    Article  PubMed  CAS  Google Scholar 

  40. Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: which test is best? JAMA. 2002;287(11):1427–1434.

    Article  PubMed  CAS  Google Scholar 

  41. Grossman A, Pacak K, Sawka A, et al. Biochemical diagnosis and localization of pheochromocytoma: can we reach a consensus? Ann N Y Acad Sci. 2006;1073:332–347.

    Article  PubMed  CAS  Google Scholar 

  42. Miskulin J, Shulkin BL, Doherty GM, Sisson JC, Burney RE, Gauger PG. Is preoperative iodine 123 meta-iodobenzylguanidine scintigraphy routinely necessary before initial adrenalectomy for pheochromocytoma? Surgery. 2003;134(6):918–922.

    Article  PubMed  Google Scholar 

  43. Lebuffe G, Dosseh ED, Tek G, et al. The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas. Anaesthesia. 2005;60(5):439–444.

    Article  PubMed  CAS  Google Scholar 

  44. Modlin IM, Farndon JR, Shepherd A, et al. Phaeochromocytomas in 72 patients: clinical and diagnostic features, treatment and long term results. Br J Surg. 1979;66(7):456–465.

    Article  PubMed  CAS  Google Scholar 

  45. Poulose BK, Holzman MD, Lao OB, Grogan EL, Goldstein RE. Laparoscopic adrenalectomy: 100 resections with clinical long-term follow-up. Surg Endosc. 2005;19(3):379–385.

    Article  PubMed  CAS  Google Scholar 

  46. Wilhelm SM, Prinz RA, Barbu AM, Onders RP, Solorzano CC. Analysis of large versus small pheochromocytomas: operative approaches and patient outcomes. Surgery. 2006;140(4):553–559.

    Article  PubMed  CAS  Google Scholar 

  47. Dimas S, Roukounakis N, Kafetzis I, et al. Feasibility of laparoscopic adrenalectomy for large pheochromocytomas. JSLS. 2007;11(1):30–33.

    PubMed  CAS  Google Scholar 

  48. Costello GT, Moorthy SS, Vane DW, Dierdorf SF. Hypoglycemia following bilateral adrenalectomy for pheochromocytoma. Crit Care Med. 1988;16(5):562–563.

    Article  PubMed  CAS  Google Scholar 

  49. Mannelli M. Management and treatment of pheochromocytomas and paragangliomas. Ann N Y Acad Sci. 2006;1073:405–416.

    Article  PubMed  Google Scholar 

  50. Nap RR, Meinardi JR, van den Berg G, Dullaart RP, de Vries J, Wolffenbuttel BH. [Long-term follow-up is indicated after surgery for a phaeochromocytoma]. Ned Tijdschr Geneeskd. 2006;150(19):1045–1049.

    PubMed  CAS  Google Scholar 

  51. Vaughan ED Jr. Diseases of the adrenal gland. Med Clin North Am. 2004;88(2):443–466.

    Article  PubMed  Google Scholar 

  52. Icard P, Goudet P, Charpenay C, et al. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg. 2001;25(7):891–897.

    Article  PubMed  CAS  Google Scholar 

  53. Tauchmanova L, Colao A, Marzano LA, et al. Andrenocortical carcinomas: twelve-year prospective experience. World J Surg. 2004;28(9):896–903.

    Article  PubMed  Google Scholar 

  54. Sturgeon C, Shen WT, Clark OH, Duh QY, Kebebew E. Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy? J Am Coll Surg. 2006;202(3):423–430.

    Article  PubMed  Google Scholar 

  55. Terzolo M, Ali A, Osella G, Mazza E. Prevalence of adrenal carcinoma among incidentally discovered adrenal masses. A retrospective study from 1989 to 1994. Gruppo Piemontese Incidentalomi Surrenalici. Arch Surg. 1997;132(8):914–919.

    PubMed  CAS  Google Scholar 

  56. Fajardo R, Montalvo J, Velazquez D, et al. Correlation between radiologic and pathologic dimensions of adrenal masses. World J Surg. 2004;28(5):494–497.

    Article  PubMed  Google Scholar 

  57. Meyer A, Niemann U, Behrend M. Experience with the surgical treatment of adrenal cortical carcinoma. Eur J Surg Oncol. 2004;30(4):444–449.

    Article  PubMed  CAS  Google Scholar 

  58. Duh QY. Laparoscopic adrenalectomy for isolated adrenal metastasis: the right thing to do and the right way to do it. Ann Surg Oncol. 2007;14(12):3288–3289.

    Article  PubMed  Google Scholar 

  59. Porpiglia F, Fiori C, Tarabuzzi R, et al. Is laparoscopic adrenalectomy feasible for adrenocortical carcinoma or metastasis? BJU Int. 2004;94(7):1026–1029.

    Article  PubMed  Google Scholar 

  60. Weitz J, Blumgart LH, Fong Y, et al. Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma. Ann Surg. 2005;241(2):269–276.

    Article  PubMed  Google Scholar 

  61. Decker RA, Elson P, Hogan TF, et al. Eastern Cooperative Oncology Group study 1879: mitotane and adriamycin in patients with advanced adrenocortical carcinoma. Surgery. 1991;110(6):1006–1013.

    PubMed  CAS  Google Scholar 

  62. Fassnacht M, Hahner S, Polat B, et al. Efficacy of adjuvant radiotherapy of the tumor bed on local recurrence of adrenocortical carcinoma. J Clin Endocrinol Metab. 2006;91(11):4501–4504.

    Article  PubMed  CAS  Google Scholar 

  63. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3(1):74–85.

    Article  PubMed  CAS  Google Scholar 

  64. Sarela AI, Murphy I, Coit DG, Conlon KC. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol. 2003;10(10):1191–1196.

    Article  PubMed  Google Scholar 

  65. Kim SH, Brennan MF, Russo P, Burt ME, Coit DG. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer. 1998;82(2):389–394.

    Article  PubMed  CAS  Google Scholar 

  66. Bovio S, Cataldi A, Reimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006;29(4):298–302.

    PubMed  CAS  Google Scholar 

  67. Angeli A, Osella G, Ali A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res. 1997;47(4-6):279–283.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Foothills Medical Center, Calgary, AB, Canada

    Adrian M. Harvey MD, MEd, MSC (Clinical Assistant Professor of Surgery and Oncology, Endocrine Surgeon)

  2. Department of Endocrine Surgery, Cleveland Clinic, Surgery Institute, Cleveland, OH, USA

    Allan A. Siperstein MD (Chair, Professor of Surgery)

  3. Division of Endocrine Surgery, Endocrine and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA

    Eren Berber MD (Staff Surgeon)

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  1. Adrian M. Harvey MD, MEd, MSC
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  2. Allan A. Siperstein MD
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  3. Eren Berber MD
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Editors and Affiliations

  1. Pathology Service, WRN202, Massachusetts General Hospital, Fruit Street 55, Boston, 02114, USA

    Jennifer L. Hunt

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Harvey, A.M., Siperstein, A.A., Berber, E. (2010). Clinical Detection and Treatment of Adrenal Disease. In: Hunt, J. (eds) Molecular Pathology of Endocrine Diseases. Molecular Pathology Library, vol 3. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1707-2_19

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  • DOI: https://doi.org/10.1007/978-1-4419-1707-2_19

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