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Adrenal Lesions

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Surgical Oncology

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Abstract

The adrenal glands are complex and consist of the outer cortex and inner medulla. The cortex produces steroid hormones such as cortisol, aldosterone, and testosterone, while the medulla produces norepinephrine and epinephrine. The cortex and medulla can give rise to a variety of benign and malignant tumors, which include adrenocortical adenoma (ACA), pheochromocytoma (PC), sympathetic paraganglioma or “extra-adrenal pheochromocytoma” (SP), neuroblastoma (NB), aldosteronoma, Cushing’s syndrome, and adrenocortical carcinoma (ACC). Furthermore, the adrenals are common sites of metastasis for many cancers. Because of the skyrocketing number of high-resolution imaging modalities being performed for non-adrenal causes, the diagnosis of adrenal incidentalomas (adrenalomas) is increasing. In essence, the diagnosis of adrenal incidentalomas is a disease of modern technology and a public health problem because of the resources that are required to properly evaluate lesions that are for the most part benign. A tailored strategy is necessary to distinguish high-risk patients who may require an extensive and close follow-up from the overwhelming majority of patients who may only require a simplified follow-up.

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References

  1. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149(4):273–85.

    Article  PubMed  CAS  Google Scholar 

  2. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev. 1995;16(4):460–84.

    PubMed  CAS  Google Scholar 

  3. Arnaldi G, Boscaro M. Adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab. 2012;26(4): 405–19.

    Article  PubMed  CAS  Google Scholar 

  4. Terzolo M, Stigliano A, Chiodini I, et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol. 2011;164(6):851–70.

    Article  PubMed  CAS  Google Scholar 

  5. Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med. 2003;138(5): 424–9.

    Article  PubMed  Google Scholar 

  6. Aron DC. The adrenal incidentaloma: disease of modern technology and public health problem. Rev Endocr Metab Disord. 2001;2(3):335–42.

    Article  PubMed  CAS  Google Scholar 

  7. Mazzaglia P, Miner TJ. Adrenal incidentaloma. In: Cameron JLCA, editor. Current surgical therapy. 10th ed. Philadelphia: Elsevier; 2011. p. 565–70.

    Chapter  Google Scholar 

  8. Groussin L, Bonardel G, Silvéra S, et al. 18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients. J Clin Endocrinol Metab. 2009;94(5):1713–22.

    Article  PubMed  CAS  Google Scholar 

  9. Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000;85(2): 637–44.

    PubMed  CAS  Google Scholar 

  10. Cawood TJ, Hunt PJ, O’Shea D, Cole D, Soule S. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur J Endocrinol. 2009;161(4):513–27.

    Article  PubMed  CAS  Google Scholar 

  11. Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A. Management of adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab. 2009;23(2):233–43.

    Article  PubMed  Google Scholar 

  12. Nieman LK. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab. 2010;95(9): 4106–13.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Kim HY, Kim SG, Lee KW, et al. Clinical study of adrenal incidentaloma in Korea. Korean J Intern Med. 2005;20(4):303–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lenders JW, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005;366(9486):665–75.

    Article  PubMed  Google Scholar 

  15. Mannelli M, Ianni L, Cilotti A, Conti A. Pheochromocytoma in Italy: a multicentric retrospective study. Eur J Endocrinol. 1999;141(6):619–24.

    Article  PubMed  CAS  Google Scholar 

  16. Kopetschke R, Slisko M, Kilisli A, et al. Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. Eur J Endocrinol. 2009;161(2):355–61.

    Article  PubMed  CAS  Google Scholar 

  17. Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab. 2005;90(4):2110–6.

    Article  PubMed  CAS  Google Scholar 

  18. Loh KC, Fitzgerald PA, Matthay KK, Yeo PP, Price DC. The treatment of malignant pheochromocytoma with iodine-131 metaiodobenzylguanidine (131I-MIBG): a comprehensive review of 116 reported patients. J Endocrinol Invest. 1997;20(11):648–58.

    Article  PubMed  CAS  Google Scholar 

  19. Carr JC, Spanheimer PM, Rajput M, et al. Discriminating pheochromocytomas from other adrenal lesions: the dilemma of elevated catecholamines. Ann Surg Oncol. 2013;20(12):3855–61.

    Article  PubMed  Google Scholar 

  20. Engel A, von Euler US. Diagnostic value of increased urinary output of pheochromocytoma. Lancet. 1950; 2(6630):387.

    Article  PubMed  CAS  Google Scholar 

  21. Goldenberg M, Serlin I, Edwards T, Rapport MM. Chemical screening methods for the diagnosis of pheochromocytoma. I Nor-epinephrine and epinephrine in human urine. Am J Med. 1954;16(3): 310–27.

    Article  PubMed  CAS  Google Scholar 

  22. Zeiger MA, Thompson GB, Duh QY, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009;15(5):450–3.

    Article  PubMed  Google Scholar 

  23. Lenders JW, Pacak K, Eisenhofer G. New advances in the biochemical diagnosis of pheochromocytoma: moving beyond catecholamines. Ann N Y Acad Sci. 2002;970:29–40.

    Article  PubMed  CAS  Google Scholar 

  24. Eisenhofer G, Goldstein DS, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab. 2003;88(6):2656–66.

    Article  PubMed  CAS  Google Scholar 

  25. Welander J, Söderkvist P, Gimm O. Genetics and clinical characteristics of hereditary pheochromocytomas and paragangliomas. Endocr Relat Cancer. 2011;18(6):R253–76.

    Article  PubMed  CAS  Google Scholar 

  26. Rao JU, Engelke UF, Rodenburg RJ, et al. Genotype-specific abnormalities in mitochondrial function associate with distinct profiles of energy metabolism and catecholamine content in pheochromocytoma and paraganglioma. Clin Cancer Res. 2013;19(14):3787–95.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Burnichon N, Buffet A, Parfait B, et al. Somatic NF1 inactivation is a frequent event in sporadic pheochromocytoma. Hum Mol Genet. 2012;21(26):5397–405.

    Article  PubMed  CAS  Google Scholar 

  28. Burnichon N, Vescovo L, Amar L, et al. Integrative genomic analysis reveals somatic mutations in pheochromocytoma and paraganglioma. Hum Mol Genet. 2011;20(20):3974–85.

    Article  PubMed  CAS  Google Scholar 

  29. Zhuang Z, Yang C, Lorenzo F, et al. Somatic HIF2A gain-of-function mutations in paraganglioma with polycythemia. N Engl J Med. 2012;367(10):922–30.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Favier J, Brière JJ, Burnichon N, et al. The Warburg effect is genetically determined in inherited pheochromocytomas. PLoS One. 2009;4(9):e7094.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gimenez-Roqueplo AP, Favier J, Rustin P, et al. The R22X mutation of the SDHD gene in hereditary paraganglioma abolishes the enzymatic activity of complex II in the mitochondrial respiratory chain and activates the hypoxia pathway. Am J Hum Genet. 2001;69(6):1186–97.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Gimenez-Roqueplo AP, Favier J, Rustin P, et al. Functional consequences of a SDHB gene mutation in an apparently sporadic pheochromocytoma. J Clin Endocrinol Metab. 2002;87(10):4771–4.

    Article  PubMed  CAS  Google Scholar 

  33. Rapizzi E, Ercolino T, Canu L, et al. Mitochondrial function and content in pheochromocytoma/paraganglioma of succinate dehydrogenase mutation carriers. Endocr Relat Cancer. 2012;19(3):261–9.

    Article  PubMed  CAS  Google Scholar 

  34. Mayo C. Paroxysmal hypertension with tumor of retroperitoneal nerve: report of case. JAMA. 1927;89: 1047–50.

    Article  Google Scholar 

  35. Kvale WF, Manger WM, Priestley JT, Roth GM. Pheochromocytoma. Circulation. 1956;14(4 (Part 1)): 622–30.

    Article  PubMed  CAS  Google Scholar 

  36. 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 

  37. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327(14):1033.

    Article  PubMed  CAS  Google Scholar 

  38. Silberfein E, Perrier N. Management of pheochromocytomas. In: Cameron JLCA, editor. Current surgical therapy. 10th ed. Philadelphia: Elsevier; 2011. p. 579–84.

    Chapter  Google Scholar 

  39. Filipponi S, Guerrieri M, Arnaldi G, et al. Laparoscopic adrenalectomy: a report on 50 operations. Eur J Endocrinol. 1998;138(5):548–53.

    Article  PubMed  CAS  Google Scholar 

  40. Gagner M, Breton G, Pharand D, Pomp A. Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery. 1996;120(6):1076–9. discussion 1079–1080.

    Article  PubMed  CAS  Google Scholar 

  41. Janetschek G, Finkenstedt G, Gasser R, et al. Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol. 1998;160(2):330–4.

    Article  PubMed  CAS  Google Scholar 

  42. Aliyev S, Karabulut K, Agcaoglu O, et al. Robotic versus laparoscopic adrenalectomy for pheochromocytoma. Ann Surg Oncol. 2013;20(13):4190–4.

    Article  PubMed  Google Scholar 

  43. Manny TB, Pompeo AS, Hemal AK. Robotic partial adrenalectomy using indocyanine green dye with near-infrared imaging: the initial clinical experience. Urology. 2013;82(3):738–42.

    Article  PubMed  Google Scholar 

  44. Dackiw AP, Lee JE, Gagel RF, Evans DB. Adrenal cortical carcinoma. World J Surg. 2001;25(7): 914–26.

    Article  PubMed  CAS  Google Scholar 

  45. Norton J. Adrenal tumors. In: DeVita VTHS, Rosenberg SA, editors. Cancer: principles and practice of oncology. Philadelphia: Lippincott-Raven; 1997. p. 1659–77.

    Google Scholar 

  46. Strosberg JR. Update on the management of unusual neuroendocrine tumors: pheochromocytoma and paraganglioma, medullary thyroid cancer and adrenocortical carcinoma. Semin Oncol. 2013;40(1):120–33.

    Article  PubMed  Google Scholar 

  47. Koch CA, Pacak K, Chrousos GP. The molecular pathogenesis of hereditary and sporadic adrenocortical and adrenomedullary tumors. J Clin Endocrinol Metab. 2002;87(12):5367–84.

    Article  PubMed  CAS  Google Scholar 

  48. Delellis R, Lloyd R, Heitz P, Eing C, editors. World Health Organization classification of tumors. Pathology and genetics of tumors of endocrine organs. Lyon: Arc Press; 2004.

    Google Scholar 

  49. Alaoui OA, Ehirchiou A, Ahallat M, Sabbah F, Mahassini N, Tounsi A. Malignant adrenocortical tumour with inferior vena cava invasion. Ann Chir. 2003;128(4):262–4.

    Article  PubMed  CAS  Google Scholar 

  50. Reibetanz J, Jurowich C, Erdogan I, et al. Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg. 2012;255(2):363–9.

    Article  PubMed  Google Scholar 

  51. Hedican SP, Marshall FF. Adrenocortical carcinoma with intracaval extension. J Urol. 1997;158(6):2056–61.

    Article  PubMed  CAS  Google Scholar 

  52. Vanderveen KA, Thompson SM, Callstrom MR, et al. Biopsy of pheochromocytomas and paragangliomas: potential for disaster. Surgery. 2009;146(6):1158–66.

    Article  PubMed  Google Scholar 

  53. Barry MK, van Heerden JA, Farley DR, Grant CS, Thompson GB, Ilstrup DM. Can adrenal incidentalomas be safely observed? World J Surg. 1998;22(6): 599–603. discussion 603–594.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. John C. McDonald Regional Transplant Center, Willis Knighton Health System, 2751 Albert Bicknell Dr., Suite 4A, Shreveport, LA, 71103, USA

    Gazi B. Zibari M.D. & Hosein Shokouh-Amiri M.D.

  2. Department of Surgery, LSUHSC-Shreveport, 1501 Kings Hwy, Shreveport, LA, 71130, USA

    Matthew Sanders M.D.

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  1. Gazi B. Zibari M.D.
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  2. Matthew Sanders M.D.
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  3. Hosein Shokouh-Amiri M.D.
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Correspondence to Gazi B. Zibari M.D. .

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Editors and Affiliations

  1. Department of Surgery, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana, USA

    Quyen D. Chu

  2. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, USA

    John F. Gibbs

  3. John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, Louisiana, USA

    Gazi B. Zibari

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Zibari, G.B., Sanders, M., Shokouh-Amiri, H. (2015). Adrenal Lesions. In: Chu, Q., Gibbs, J., Zibari, G. (eds) Surgical Oncology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1423-4_14

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  • DOI: https://doi.org/10.1007/978-1-4939-1423-4_14

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