Adrenal Nodules Flashcards
The risk of malignancy increases significantly with a tumor size greater than __ cm
4 cm
What is the recommended primary adrenal imaging procedure?
CT
3 most important criteria on CT when looking at masses
Unenhanced attenuation in HU (<10 indicate benign)
Contrast washout (more than 50% points to benign)
Lesion size
MRI for imaging masses
T1 and T2 weighted imaging can distinguish benign adneomas from malignancy and pheos
Adenomas show rapid washout of contrast
Fine needle aspiration biopsy
Cannot distinguish a benign adrenal mass from adrenal carcinoma
But it can distinguish between an adrenal tumor and a metastatic tumor
Indicated when there is a suspicion of cancer outside the adrenal gland
Pheos should always be excluded before attempting FNA!! (Can precipitate a hypertensive crisis)
- Suggestive clinical features
- Lab tests
for pheochromocytoma
- HTN, paroxysmal symptoms (palpitations, diaphroesis, headache, pallor, tremor)
- 24 hour urine: fractionated metanephrines and fractionated catecholamines
- Suggestive clinical features
- Lab tests
for Cushing’s syndrome
- Central obesity, proximal muscle weakness, thin skin, supraclavicular fat, facial plethora
- 24 hour UFC, midnight salivary, 1mg dexamethasone
- Suggestive clinical features
- Lab tests
for primary aldosteronism
- Hypertension, hypokalemia
2. Plasma aldosterone concentration, plasma renin activity
- Suggestive clinical features
- Lab tests
for adrenocortical carcinoma
- Mass effect symptoms, symptoms related to excess GC, mineralocorticoid, androgen/estrogen secretion
- Serum DHEAS, measures of clinically-indicated steroid
Treatment for functioning adrenal adenomas, adrenocortical cancer, and adrenal masses
Surgical intervention
What does the ratio between left and right aldosterone:cortisol need to be in order to prove lateralization
Over 4
