Incidentaloma history and symptoms: Difference between revisions
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{{Incidentaloma}} | {{Incidentaloma}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Subclinical [[Cushing's syndrome]] which includes [[diabetes]], and a high incidence of [[vertebral fractures]], [[dyslipidemia]], [[impaired glucose tolerance]] or [[Diabetes mellitus type 2|type 2 diabetes mellitus]], and evidence of [[atherosclerosis]]. [[Pheochromocytoma]]: Paroxysmal attacks of [[Hypertension|hypertension,]] [[palpitation]], [[diaphoresis]], [[headache]], [[pallor]], and [[Tremor|tremor.]] Primary [[hyperaldosteronism]] patients show [[hypertension]] and [[hypokalemia]]. Approximately 60 percent of [[Adrenocortical carcinoma|adrenocortical carcinomas]] (ACCs) are sufficiently secretory to present clinical [[syndrome]] of [[hormone]] excess. Family history of [[Li-Fraumeni syndrome]], [[Beckwith-Wiedemann syndrome]], and [[Multiple endocrine neoplasia type 1 (patient information)|multiple endocrine neoplasia type 1]] ([[MEN1]]). | |||
==History and Symptoms== | ==History and Symptoms== | ||
===History=== | ===History=== | ||
* Family history may include: | |||
**[[Li-Fraumeni syndrome]]: [[breast cancer]], soft tissue and [[bone sarcoma]], and [[brain tumors]] | |||
**[[Beckwith-Wiedemann syndrome]]: [[Wilms' tumor]], [[neuroblastoma]], [[Hepatoblastoma|and hepatoblastoma]] | |||
**[[Multiple endocrine neoplasia type 1 (patient information)|Multiple endocrine neoplasia type 1]] ([[MEN1]]): [[Parathyroid gland|parathyroid,]] [[Pituitary gland|pituitary]], and [[pancreatic]] [[neuroendocrine tumors]] and [[Adrenal adenoma|adrenal adenomas]], as well as [[Adrenal carcinoma|carcinomas]]. | |||
===Common Symptoms=== | ===Common Symptoms=== | ||
By definition, an [[Adrenal gland|adrenal]] incidentaloma is an [[Adrenal gland|adrenal]]<nowiki/>l [[mass]] detected on imaging not performed for any suspected [[Adrenal gland|adrenal]] disease. The imaging study is not done for symptoms related to [[Adrenal gland|adrenal]] [[hormone]] excess. Although, 10 to 15 percent secrete excess amounts of [[hormones]] such as [[cortisol]], [[catecholamines]], and [[aldosterone]] as follow: | |||
* The most common clinical presentation is called | |||
* [[ | ====Subclinical Cushing's syndrome==== | ||
* [[Cushing's syndrome]]: [[ | * The most common clinical presentation is called sub-clinical [[Cushing's syndrome]]. These patients lack many of the usual stigmata of [[Cushing's syndrome]]. The common symptoms of sub-clinical [[Cushing's syndrome]] include:<ref name="pmid2164335">{{cite journal| author=McLeod MK, Thompson NW, Gross MD, Bondeson AG, Bondeson L| title=Sub-clinical Cushing's syndrome in patients with adrenal gland incidentalomas. Pitfalls in diagnosis and management. | journal=Am Surg | year= 1990 | volume= 56 | issue= 7 | pages= 398-403 | pmid=2164335 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2164335 }}</ref><ref name="pmid25571880">{{cite journal| author=Ntali G, Grossman A, Karavitaki N| title=Clinical and biochemical manifestations of Cushing's. | journal=Pituitary | year= 2015 | volume= 18 | issue= 2 | pages= 181-7 | pmid=25571880 | doi=10.1007/s11102-014-0631-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25571880 }}</ref> | ||
**[[Central obesity]] | |||
** [[Muscle weakness|Proximal muscle weakness]] | |||
** Supra-[[Clavicle|clavicular]] [[fat]] pad | |||
**Facial [[plethora]] | |||
**[[Vertebral fractures]] | |||
====Pheochromocytoma:==== | |||
*The common symptoms of [[pheochromocytoma]] syndrome include:<ref name="pmid21826022">{{cite journal| author=Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A| title=Cardiovascular manifestations of phaeochromocytoma. | journal=J Hypertens | year= 2011 | volume= 29 | issue= 11 | pages= 2049-60 | pmid=21826022 | doi=10.1097/HJH.0b013e32834a4ce9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21826022 }}</ref> | |||
**Paroxysmal attacks of [[Hypertension|hypertension]] | |||
**[[Palpitation]] | |||
**[[Diaphoresis]] | |||
**[[Headache]] | |||
** [[Pallor]] | |||
** [[Tremor|Tremor]] | |||
====Primary hyperaldosteronism:==== | |||
*The common symptoms of primary [[hyperaldosteronism]] syndrome include:<ref name="pmid24648805">{{cite journal| author=Kim SH, Ahn JH, Hong HC, Choi HY, Kim YJ, Kim NH et al.| title=Changes in the clinical manifestations of primary aldosteronism. | journal=Korean J Intern Med | year= 2014 | volume= 29 | issue= 2 | pages= 217-25 | pmid=24648805 | doi=10.3904/kjim.2014.29.2.217 | pmc=3956992 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24648805 }}</ref> | |||
**[[Hypertension]] | |||
**[[Hypokalemia]] | |||
====Nonfunctioning tumors==== | |||
* Most patients with nonfunctioning tumors present with clinical manifestations related to [[tumor]] growth or constitutional symptoms. | |||
** [[Weight loss|Weight loss]] | |||
** [[Anorexia]] | |||
====Adrenocortical carcinoma==== | |||
* Approximately 60 percent of [[Adrenocortical carcinoma|adrenocortical carcinomas]] (ACCs) are sufficiently secretory to present clinical [[syndrome]] of [[hormone]] excess.<ref name="pmid11571723">{{cite journal| author=Vassilopoulou-Sellin R, Schultz PN| title=Adrenocortical carcinoma. Clinical outcome at the end of the 20th century. | journal=Cancer | year= 2001 | volume= 92 | issue= 5 | pages= 1113-21 | pmid=11571723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11571723 }}</ref> | |||
** Adults with [[hormone]]-secreting ACCs usually present with [[Cushing's syndrome]] alone or a mixed [[Cushing's syndrome|Cushing's]] and [[virilization]] [[syndrome]], with overproduction of both [[glucocorticoids]] and [[androgens]].<ref name="pmid10679640">{{cite journal| author=Wajchenberg BL, Albergaria Pereira MA, Medonca BB, Latronico AC, Campos Carneiro P, Alves VA et al.| title=Adrenocortical carcinoma: clinical and laboratory observations. | journal=Cancer | year= 2000 | volume= 88 | issue= 4 | pages= 711-36 | pmid=10679640 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10679640 }}</ref> | |||
** Presence of [[virilization]] in a patient with an [[Adrenal gland|adrenal]] [[neoplasm]] suggests an ACC rather than an [[adenoma]]. | |||
===Less Common Symptoms=== | |||
====Subclinical Cushing's syndrome==== | |||
* The less common symptoms of subclinical [[Cushing's syndrome]] include:<ref name="pmid2164335">{{cite journal| author=McLeod MK, Thompson NW, Gross MD, Bondeson AG, Bondeson L| title=Sub-clinical Cushing's syndrome in patients with adrenal gland incidentalomas. Pitfalls in diagnosis and management. | journal=Am Surg | year= 1990 | volume= 56 | issue= 7 | pages= 398-403 | pmid=2164335 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2164335 }}</ref><ref name="pmid25571880">{{cite journal| author=Ntali G, Grossman A, Karavitaki N| title=Clinical and biochemical manifestations of Cushing's. | journal=Pituitary | year= 2015 | volume= 18 | issue= 2 | pages= 181-7 | pmid=25571880 | doi=10.1007/s11102-014-0631-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25571880 }}</ref> | |||
** [[Insomnia]] | |||
**Decreased [[libido]] | |||
** [[Amenorrhoea]] | |||
**[[Infertility]] | |||
**[[clinical depression|Depression]] | |||
====Pheochromocytoma:==== | |||
*The less common symptoms of [[pheochromocytoma]] syndrome include:<ref name="pmid21826022">{{cite journal| author=Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A| title=Cardiovascular manifestations of phaeochromocytoma. | journal=J Hypertens | year= 2011 | volume= 29 | issue= 11 | pages= 2049-60 | pmid=21826022 | doi=10.1097/HJH.0b013e32834a4ce9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21826022 }}</ref><ref name="pmid8076587">{{cite journal| author=Bravo EL| title=Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma. | journal=Endocr Rev | year= 1994 | volume= 15 | issue= 3 | pages= 356-68 | pmid=8076587 | doi=10.1210/edrv-15-3-356 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8076587 }}</ref><ref name="pmid19158054">{{cite journal| author=Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM| title=Catecholamine-induced cardiomyopathy. | journal=Endocr Pract | year= 2008 | volume= 14 | issue= 9 | pages= 1137-49 | pmid=19158054 | doi=10.4158/EP.14.9.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19158054 }}</ref> | |||
** [[Cardiomyopathy]] | |||
** Episodic [[hypotension]] | |||
* | ====Primary hyperaldosteronism:==== | ||
*The less common symptoms of primary [[hyperaldosteronism]] syndrome include:<ref name="pmid24648805">{{cite journal| author=Kim SH, Ahn JH, Hong HC, Choi HY, Kim YJ, Kim NH et al.| title=Changes in the clinical manifestations of primary aldosteronism. | journal=Korean J Intern Med | year= 2014 | volume= 29 | issue= 2 | pages= 217-25 | pmid=24648805 | doi=10.3904/kjim.2014.29.2.217 | pmc=3956992 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24648805 }}</ref><ref name="pmid5596496">{{cite journal |vauthors=Moeller J, Muniz B |title=[Hypokalemic ileus and aldosteronism] |language=German |journal=Med Klin |volume=62 |issue=52 |pages=2019–24 |year=1967 |pmid=5596496 |doi= |url=}}</ref><ref name="pmid15024897">{{cite journal |vauthors=Failor RA, Capell PT |title=Hyperaldosteronism and pheochromocytoma: new tricks and tests |journal=Prim. Care |volume=30 |issue=4 |pages=801–20, viii |year=2003 |pmid=15024897 |doi= |url=}}</ref> | |||
** [[Paralysis]] | |||
** [[Ileus]] | |||
==References== | ==References== | ||
Latest revision as of 17:41, 7 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Subclinical Cushing's syndrome which includes diabetes, and a high incidence of vertebral fractures, dyslipidemia, impaired glucose tolerance or type 2 diabetes mellitus, and evidence of atherosclerosis. Pheochromocytoma: Paroxysmal attacks of hypertension, palpitation, diaphoresis, headache, pallor, and tremor. Primary hyperaldosteronism patients show hypertension and hypokalemia. Approximately 60 percent of adrenocortical carcinomas (ACCs) are sufficiently secretory to present clinical syndrome of hormone excess. Family history of Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and multiple endocrine neoplasia type 1 (MEN1).
History and Symptoms
History
- Family history may include:
- Li-Fraumeni syndrome: breast cancer, soft tissue and bone sarcoma, and brain tumors
- Beckwith-Wiedemann syndrome: Wilms' tumor, neuroblastoma, and hepatoblastoma
- Multiple endocrine neoplasia type 1 (MEN1): parathyroid, pituitary, and pancreatic neuroendocrine tumors and adrenal adenomas, as well as carcinomas.
Common Symptoms
By definition, an adrenal incidentaloma is an adrenall mass detected on imaging not performed for any suspected adrenal disease. The imaging study is not done for symptoms related to adrenal hormone excess. Although, 10 to 15 percent secrete excess amounts of hormones such as cortisol, catecholamines, and aldosterone as follow:
Subclinical Cushing's syndrome
- The most common clinical presentation is called sub-clinical Cushing's syndrome. These patients lack many of the usual stigmata of Cushing's syndrome. The common symptoms of sub-clinical Cushing's syndrome include:[1][2]
- Central obesity
- Proximal muscle weakness
- Supra-clavicular fat pad
- Facial plethora
- Vertebral fractures
Pheochromocytoma:
- The common symptoms of pheochromocytoma syndrome include:[3]
- Paroxysmal attacks of hypertension
- Palpitation
- Diaphoresis
- Headache
- Pallor
- Tremor
Primary hyperaldosteronism:
- The common symptoms of primary hyperaldosteronism syndrome include:[4]
Nonfunctioning tumors
- Most patients with nonfunctioning tumors present with clinical manifestations related to tumor growth or constitutional symptoms.
Adrenocortical carcinoma
- Approximately 60 percent of adrenocortical carcinomas (ACCs) are sufficiently secretory to present clinical syndrome of hormone excess.[5]
- Adults with hormone-secreting ACCs usually present with Cushing's syndrome alone or a mixed Cushing's and virilization syndrome, with overproduction of both glucocorticoids and androgens.[6]
- Presence of virilization in a patient with an adrenal neoplasm suggests an ACC rather than an adenoma.
Less Common Symptoms
Subclinical Cushing's syndrome
- The less common symptoms of subclinical Cushing's syndrome include:[1][2]
- Insomnia
- Decreased libido
- Amenorrhoea
- Infertility
- Depression
Pheochromocytoma:
- The less common symptoms of pheochromocytoma syndrome include:[3][7][8]
- Cardiomyopathy
- Episodic hypotension
Primary hyperaldosteronism:
References
- ↑ 1.0 1.1 McLeod MK, Thompson NW, Gross MD, Bondeson AG, Bondeson L (1990). "Sub-clinical Cushing's syndrome in patients with adrenal gland incidentalomas. Pitfalls in diagnosis and management". Am Surg. 56 (7): 398–403. PMID 2164335.
- ↑ 2.0 2.1 Ntali G, Grossman A, Karavitaki N (2015). "Clinical and biochemical manifestations of Cushing's". Pituitary. 18 (2): 181–7. doi:10.1007/s11102-014-0631-4. PMID 25571880.
- ↑ 3.0 3.1 Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A (2011). "Cardiovascular manifestations of phaeochromocytoma". J Hypertens. 29 (11): 2049–60. doi:10.1097/HJH.0b013e32834a4ce9. PMID 21826022.
- ↑ 4.0 4.1 Kim SH, Ahn JH, Hong HC, Choi HY, Kim YJ, Kim NH; et al. (2014). "Changes in the clinical manifestations of primary aldosteronism". Korean J Intern Med. 29 (2): 217–25. doi:10.3904/kjim.2014.29.2.217. PMC 3956992. PMID 24648805.
- ↑ Vassilopoulou-Sellin R, Schultz PN (2001). "Adrenocortical carcinoma. Clinical outcome at the end of the 20th century". Cancer. 92 (5): 1113–21. PMID 11571723.
- ↑ Wajchenberg BL, Albergaria Pereira MA, Medonca BB, Latronico AC, Campos Carneiro P, Alves VA; et al. (2000). "Adrenocortical carcinoma: clinical and laboratory observations". Cancer. 88 (4): 711–36. PMID 10679640.
- ↑ Bravo EL (1994). "Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma". Endocr Rev. 15 (3): 356–68. doi:10.1210/edrv-15-3-356. PMID 8076587.
- ↑ Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM (2008). "Catecholamine-induced cardiomyopathy". Endocr Pract. 14 (9): 1137–49. doi:10.4158/EP.14.9.1137. PMID 19158054.
- ↑ Moeller J, Muniz B (1967). "[Hypokalemic ileus and aldosteronism]". Med Klin (in German). 62 (52): 2019–24. PMID 5596496.
- ↑ Failor RA, Capell PT (2003). "Hyperaldosteronism and pheochromocytoma: new tricks and tests". Prim. Care. 30 (4): 801–20, viii. PMID 15024897.