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[Subclinical adrenal diseases: silent pheochromocytoma and subclinical Addison's disease].
[adrenal incidentaloma]
The
silent
pheochromocytoma
,
a
hidden
form
of
pheochromocytoma
,
exposes
the
patient
to
an
increased
risk
of
mortality
if
the
diagnosis
is
not
established
on
time
.
Biological
diagnosis
of
pheochromocytoma
can
be
difficult
.
Catecholamine
secretion
is
dependent
on
tumor
size
and
a
large
number
of
physiological
,
pharmacological
,
lifestyle
modifications
and
sampling
conditions
influence
the
measurement
of
urinary
and
plasma
metanephrines
.
The
prevalence
of
pheochromocytoma
is
2
%
among
adrenal
incidentaloma
smaller
than
3
cm
(
2
/
3
of
tumors
)
.
Recent
studies
suggest
the
almost
zero
risk
of
pheochromocytoma
among
these
tumors
if
they
are
hypodense
(
<
10
housefield
units
)
on
adrenal
tomography
.
Addison
's
disease
is
a
pathology
affecting
about
1
in
8000
.
Immunopathology
is
still
unknown
,
but
some
elements
advocated
the
hypothesis
of
a
predominant
cell-mediated
immunity
in
particular
Interferon-gamma
production
by
CD
4
T
lymphocytes
in
the
presence
of
an
epitope
from
the
21
-
hydroxylase
,
as
well
as
IgG
1
subtype
produced
by
activated
B
lymphocytes
,
autoantibodies
do
appear
to
be
a
simple
marker
of
the
disease
.
Subclinical
Addison
's
disease
is
defined
by
the
presence
of
anti-
21
-
hydroxylase
autoantibodies
,
without
clinical
symptoms
.
It
evolves
faster
to
the
clinical
phase
in
young
subjects
,
male
,
having
high
levels
of
autoantibodies
and
with
an
initially
impaired
adrenal
function
.
Dosage
of
ACTH
,
plasma
renin
active
,
and
basal
cortisol
and
after
Synacthen
allow
to
discriminate
the
subjects
with
low
or
high
risk
of
evolution
and
establish
an
appropriate
monitoring
.
Diseases
Validation
Diseases presenting
"hidden form of pheochromocytoma, exposes the patient"
symptom
adrenal incidentaloma
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