Incidentaloma history and symptoms
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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
History and Symptoms
History
- Family history may include:
- Li-Fraumeni syndrome (breast cancer, soft tissue and bone sarcoma, brain tumors)
- Beckwith-Wiedemann syndrome (Wilms' tumor, neuroblastoma, 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 adrenal 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:
- Most patients with nonfunctioning tumors present with clinical manifestations related to tumor growth or constitutional symptoms (weight loss, anorexia).
- The most common clinical presentation is called 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. These patients lack many of the usual stigmata of Cushing's syndrome.
- Pheochromocytoma: Paroxysmal attacks of hypertension, palpitation, diaphoresis, headache, pallor, and tremor.
- Cushing's syndrome: central obesity, proximal muscle weakness, supraclavicular fat pad, and plethora in face.
- Primary hyperaldosteronism: hypertension and hypokalemia. So, hypertensive patients should be evaluated for an aldosteronoma even if the serum potassium concentration is normal.
- Approximately 60 percent of adrenocortical carcinomas (ACCs) are sufficiently secretory to present clinical syndrome of hormone excess.[1]
- 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.[2]
- Presence of virilization in a patient with an adrenal neoplasm suggests an ACC rather than an adenoma.
References
- ↑ 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.