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Hormonal activity in clinically silent adrenal incidentalomas.
[adrenal incidentaloma]
The
rapid
development
of
modern
imaging
techniques
,
has
led
to
an
increase
in
accidentally
discovered
adrenal
masses
without
clinically
apparent
hormonal
abnormalities
.
Such
tumours
have
been
termed
"
incidentalomas
"
.
The
diagnostic
work-up
in
patients
with
adrenal
incidentalomas
is
aimed
at
the
determination
of
hormonal
activity
of
the
tumour
and
identification
of
patients
with
potentially
malignant
tumours
.
The
aim
of
our
study
was
a
retrospective
analysis
of
selected
clinical
characteristics
and
hormonal
studies
in
accidentally
discovered
adrenal
tumours
.
Fourty
hundred
sixty-
three
patients
with
serendipitously
discovered
adrenal
masses
,
diagnosed
and
treated
in
the
Department
of
Endocrinology
and
Internal
Diseases
,
Medical
University
of
Gdansk
as
well
as
in
the
affiliated
Endocrinology
Clinic
between
1993
and
October
of
2009
were
included
in
the
analysis
.
Out
of
all
patients
,
245
were
referred
for
adrenalectomy
.
We
found
that
clinically
"
silent
"
tumours
often
demonstrate
subclinical
hormonal
activity
.
In
our
report
,
increased
24
-
h
urinary
excretion
of
cortisol
correlated
positively
with
tumour
size
(
p
<
0
.
001
)
.
Moreover
,
a
statistical
relationship
was
demonstrated
between
tumour
size
and
serum
cortisol
concentration
assessed
in
the
1
mg
dexamethasone
suppression
test
(
p
<
0
.
001
)
.
Increased
values
of
dehydroepiandrosterone
/
dehydroepiandrosterone
sulphate
were
more
often
found
in
malignant
than
in
benign
tumours
(
p
<
0
.
01
)
.
Urinary
concentrations
of
17
-
ketosteroids
correlate
positively
with
diagnosis
of
adrenocortical
cancer
(
p
=
0
.
02
)
.
We
found
that
clinically
"
silent
"
tumours
often
demonstrate
subclinical
hormonal
activity
(
subclinical
Cushing
syndrome
,
subclinical
pheochromocytoma
,
low
-symptomatic
adrenocortical
cancer
)
.
Diseases
Validation
Diseases presenting
"cancer"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
alpha-thalassemia
benign recurrent intrahepatic cholestasis
cadasil
canavan disease
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cowden syndrome
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
hirschsprung disease
hodgkin lymphoma, classical
inclusion body myositis
junctional epidermolysis bullosa
kabuki syndrome
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
pendred syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated