Incidentaloma secondary prevention: Difference between revisions
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==Secondary Prevention== | ==Secondary Prevention== | ||
Effective measures for the [[secondary prevention]] of [[adrenal incidentaloma]] include:<ref name="pmid10022410">{{cite journal| author=Barzon L, Scaroni C, Sonino N, Fallo F, Paoletta A, Boscaro M| title=Risk factors and long-term follow-up of adrenal incidentalomas. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 2 | pages= 520-6 | pmid=10022410 | doi=10.1210/jcem.84.2.5444 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10022410 }}</ref><ref name="pmid12614096">{{cite journal| author=Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA et al.| title=Management of the clinically inapparent adrenal mass ("incidentaloma"). | journal=Ann Intern Med | year= 2003 | volume= 138 | issue= 5 | pages= 424-9 | pmid=12614096 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12614096 }}</ref><ref name="pmid20150023">{{cite journal| author=Pantalone KM, Gopan T, Remer EM, Faiman C, Ioachimescu AG, Levin HS et al.| title=Change in adrenal mass size as a predictor of a malignant tumor. | journal=Endocr Pract | year= 2010 | volume= 16 | issue= 4 | pages= 577-87 | pmid=20150023 | doi=10.4158/EP09351.OR | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20150023 }}</ref><ref name="pmid19632968">{{cite journal| author=Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D et al.| title=American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. | journal=Endocr Pract | year= 2009 | volume= 15 | issue= 5 | pages= 450-3 | pmid=19632968 | doi=10.4158/EP.15.5.450 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19632968 }}</ref><ref name="pmid19439510">{{cite journal| author=Cawood TJ, Hunt PJ, O'Shea D, Cole D, Soule S| title=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? | journal=Eur J Endocrinol | year= 2009 | volume= 161 | issue= 4 | pages= 513-27 | pmid=19439510 | doi=10.1530/EJE-09-0234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19439510 }}</ref> | |||
*Excess [[hormone]] secretion may develop in up to 20% of patients with previously non-functional [[Adrenal gland|adrenal]] [[tumors]] during follow-up. | |||
*The transformation rate of non-functional [[Adrenal gland|adrenal]] [[Mass|masses]] to functional [[tumors]] seems to be higher in [[Adrenal gland|adrenal]] [[Mass|masses]] greater than 3 cm in size. | |||
*Annual [[biochemical]] follow-up for up to 5 years may be reasonable for patients with [[Adrenal incidentaloma|adrenal incidentalomas]], especially if the [[tumor]] is more than 3 cm in size. | |||
*No routine follow-up of [[Adrenal gland|adrenal]] incidentalomas with a non-contrast attenuation value no greater than 10 [[Hounsfield units|HU]]. | |||
*[[Malignancy]] can be detected by an absolute increase in size of 0.8 cm, 0.64 cm growth per year or a 25% increase in size per year. | |||
*A one-time follow-up scan in 6–12 months may be reassuring to the physician and the patient. | |||
*Patients with [[Adrenal mass causes|adrenal masses]] less than 4 cm in size and a non-contrast attenuation value more than 10 [[Hounsfield units|HU]] should have a repeat [[Computed tomography|CT]] study in 3–6 months and then yearly for 2 yr. | |||
*Surgical excision may be considered for [[Tumor|tumors]] with indeterminate radiological features that grow at least 0.8 cm over 3- to 12-month follow-up. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 16:20, 9 November 2017
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Risk calculators and risk factors for Incidentaloma secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Effective measures for the secondary prevention of adrenal incidentaloma include annual biochemical follow-up for up to 5 yr, no routine follow-up of adrenal incidentalomas with a non-contrast attenuation value no greater than 10 HU. Patients with adrenal masses less than 4 cm in size and a non-contrast attenuation value more than 10 HU should have a repeat CT study in 3–6 months and then yearly for 2 yr.
Secondary Prevention
Effective measures for the secondary prevention of adrenal incidentaloma include:[1][2][3][4][5]
- Excess hormone secretion may develop in up to 20% of patients with previously non-functional adrenal tumors during follow-up.
- The transformation rate of non-functional adrenal masses to functional tumors seems to be higher in adrenal masses greater than 3 cm in size.
- Annual biochemical follow-up for up to 5 years may be reasonable for patients with adrenal incidentalomas, especially if the tumor is more than 3 cm in size.
- No routine follow-up of adrenal incidentalomas with a non-contrast attenuation value no greater than 10 HU.
- Malignancy can be detected by an absolute increase in size of 0.8 cm, 0.64 cm growth per year or a 25% increase in size per year.
- A one-time follow-up scan in 6–12 months may be reassuring to the physician and the patient.
- Patients with adrenal masses less than 4 cm in size and a non-contrast attenuation value more than 10 HU should have a repeat CT study in 3–6 months and then yearly for 2 yr.
- Surgical excision may be considered for tumors with indeterminate radiological features that grow at least 0.8 cm over 3- to 12-month follow-up.
References
- ↑ Barzon L, Scaroni C, Sonino N, Fallo F, Paoletta A, Boscaro M (1999). "Risk factors and long-term follow-up of adrenal incidentalomas". J Clin Endocrinol Metab. 84 (2): 520–6. doi:10.1210/jcem.84.2.5444. PMID 10022410.
- ↑ Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA; et al. (2003). "Management of the clinically inapparent adrenal mass ("incidentaloma")". Ann Intern Med. 138 (5): 424–9. PMID 12614096.
- ↑ Pantalone KM, Gopan T, Remer EM, Faiman C, Ioachimescu AG, Levin HS; et al. (2010). "Change in adrenal mass size as a predictor of a malignant tumor". Endocr Pract. 16 (4): 577–87. doi:10.4158/EP09351.OR. PMID 20150023.
- ↑ Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D; et al. (2009). "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. 15 (5): 450–3. doi:10.4158/EP.15.5.450. PMID 19632968.
- ↑ Cawood TJ, Hunt PJ, O'Shea D, Cole D, Soule S (2009). "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. 161 (4): 513–27. doi:10.1530/EJE-09-0234. PMID 19439510.