Adrenal Incidentalomas: Diagnostic Evaluation and Long-Term Follow-Up

ObjectiveTo evaluate the cause and the clinical and laboratory features of adrenal incidentalomas (AI) in 52 patients and to assess the evolution of nonsurgically treated lesions during long-term follow-up.MethodsWe retrospectively analyzed the medical records of 52 patients with AI undergoing routine followup in 2 Brazilian endocrine centers.ResultsIn our study group, nonfunctioning adenomas were the most frequent cause of AI (42%), followed by cortisol-secreting adenomas (15%), metastatic disease (10%), pheochromocytomas (8%), myelolipomas (6%), cysts (6%), carcinomas (4%), lymphomas (4%), tuberculosis (4%), and aldosteronoma (2%). Only 13 lesions (25%) were functioning (8 cortisol-secreting adenomas, 4 pheochromocytomas, and 1 aldosteronoma). Carcinomas were the largest adrenal masses (mean diameter, 11.7 ± 1.3 cm). With the exception of 1 pheochromocytoma, 1 cyst, and 1 myelolipoma, all AI larger than 6 cm were carcinomas. During follow-up of 21 patients with nonsurgically treated AI for 6 to 36 months (mean, 24.8 ± 8.9), no patient had tumor reduction or disappearance. After 12 months of follow-up, however, a 45-year-old woman had adrenal mass enlargement from 3.2 cm to 4.4 cm; the excised lesion proved to be an adenoma. Moreover, evidence of cortisol hypersecretion developed after 24 months of follow-up in a 30-year-old man with a 3.5-cm adenoma in the left adrenal gland.ConclusionOur findings demonstrate that most AI are nonfunctioning benign lesions and emphasize the need for long-term follow-up of patients with conservatively managed lesions, in light of the potential for evolution to hormonal hypersecretion or tumor growth. (Endocr Pract. 2008;14:269-278)     

Thyroid Nodules Detected by Contrast-Enhanced Magnetic Resonance Angiography: Prevalence and Clinical Significance

Background and Purpose

Incidental thyroid lesions are frequently found on contrast-enhanced magnetic resonance (CE-MR) angiography. The purpose of this study is to determine the prevalence of thyroid incidentalomas detected by CE-MR angiography and to evaluate their clinical significance by correlation with ultrasound (US) and cytopathological results.

Materials and Methods

We retrospectively reviewed 3,299 consecutive CE-MR angiography examinations performed at our institution between January 2010 and March 2013. Two radiologists evaluated the CE-MR angiography imaging in consensus regarding the presence, location, and vascularity of thyroid incidentaloma. We correlated these findings with follow-up US and cytopathologic results.

Results

The prevalence of thyroid incidentalomas detected by CE-MR angiography was 4.6% (152/3,299 patients). CE-MR angiography showed hypervascularity in 86.8% (145/167), isovascularity in 8.4% (14/167), and hypovascularity in 4.8% (8/167) of thyroid nodules compared to vascularity of thyroid parenchyma. Among the patients with thyroid incidentaloma, 34 patients (22.4%) were followed by US examination, and all 36 nodules on CE-MR angiography were detected on follow-up US. Of these nodules, 9 (25%) nodules were classified as probably benign, 26 (72.2%) as indeterminate, and 1 (2.8%) as suspicious malignant nodule. Among the 16 nodules with available cytopathologic results, 12 nodules were benign, 2 nodules were follicular neoplasm, and 2 nodules showed non-diagnostic results.

Conclusion

Incidental thyroid nodules were found in 4.6% of CE-MR angiography examinations. Because the high incidence of indeterminate US feature among thyroid incidentaloma, when a thyroid incidentaloma is detected on CE-MR angiography, further evaluation with US should be performed.     

Diagnostic and Therapeutic Approach to Pituitary Incidentalomas

ObjectiveTo review data on epidemiology, differential diagnosis, clinical, laboratory, and imaging findings, natural history, and management of incidentally discovered pituitary lesions (pituitary incidentalomas).MethodsA nonsystematic review was conducted, including articles indexed in Index Medicus that contained reference to incidentally discovered pituitary masses (pituitary incidentalomas).ResultsBoth autopsy and sensitive neuroimaging studies (including magnetic resonance imaging) suggest that pituitary incidentalomas are common, affecting approximately 10% of the general population. Although typically small (less than 10 mm in greatest diameter) and clinically silent, some pituitary incidentalomas may be hormonally active or cause mass effects by compressing neighboring structures. In addition, a minority of these lesions may grow over time; hence, long-term follow-up is necessary. Therapeutic interventions, including dopamine agonist therapy (in the case of prolactin-secreting adenomas) or transsphenoidal resection, are indicated in the case of pituitary lesions that are hormonally active, cause mass effects, or increase in size.ConclusionPituitary incidentalomas are common and constitute a heterogeneous group with regard to pathologic features, clinical, laboratory, and imaging characteristics, natural history, and growth potential. Currently available evidence suggests that many hormonally nonfunctioning pituitary incidentalomas causing no mass effects can be safely managed by follow-up surveillance. Nonetheless, more data are needed for further elucidation of the natural history of these lesions and for improvement in accurate and noninvasive diagnosis and in prediction of growth potential of pituitary incidentalomas. Improved understanding of the pathogenesis of this heterogeneous group of lesions may also lead to the development of novel, noninvasive therapeutic agents, rationally designed to interact with well-characterized molecular targets. (Endocr Pract. 2004;10:438-444)     

Intérêt de la TEP/TDM au 18F-FDG dans la neurofibromatose de type 1, expérience du centre national de référence Henri-Mondor sur 10 ans

ObjectiveMalignant peripherals nerve sheath tumours (MPNST) are one of the leading causes of death in neurofibromatosis type 1 (NF1). Given the temporal and spatial multiplicity of suspicious lesions, the histological diagnosis of certainty might require iterative and decaying surgical procedure. Our objective was to determine the threshold values of metabolic metrics determined on ¹⁸F-FDG PET/CT (SUV_max, total lesion glycolysis [TLG], total metabolic tumour volume [TMTV], tumour-to-liver [T/L] ratio and heterogeneity index [HI]) in order to distinguish at best MPNST from benign lesion (simple neurofibromas [NF] or dysplastic NF).Patients and methodsHundred and seven patients from the national reference centre of NF1 Henri-Mondor, clinically suspects of TMGN, underwent 160 ¹⁸F-FDG PET/CT over a period of 10 years, between 2005 and 2015. The hypermetabolics lesions identified on ¹⁸F-FDG PET/CT were confronted with pathological analysis or clinico-radiological and metabolic follow-up of more than 6 months.ResultsFour hundred and eight hypermetabolics lesions were identified, of which 112 were histologically confronted with 38 simple NF, 29 dysplastic NF, 39 TMGN and 6 incidentalomas. The remaining 296 hypermetabolics lesions experienced a median follow-up of 40.4 months [13.5–137 months]. The optimal cut-off values for malignant lesions, determined by ROC curves, were in order of decreasing performance: T/L ratio > 2.03 (sensitivity 96%, specificity 88%); SUVmax > 4.74 (sensitivity 93%, specificity 86%); TLG > 172 (sensitivity 84%, specificity 76%); TMTV > 53.5 (sensitivity 83%, specificity 68%); HI > 1.63 (sensitivity 84%, specificity 54%).Conclusions¹⁸F-FDG PET/CT is a powerful diagnostic and prognostic tool in the management of TMGN. Metabolic metrics allow with good sensitivity and specificity to identify lesions transformed into TMGN. The advent of PET/MRI will undoubtedly allow in the near future to reinforce the diagnostic and prognostic performances for the detection of transformations of neurofibromas in TMGN.     

¿Está de acuerdo nuestra conducta ante el nódulo tiroideo y cáncer diferenciado de tiroides con la guía norteamericana y el consenso europeo?

IntroductionThe aim of this study was to assess the approaches of specialists in Spain to patients with thyroid nodules and differentiated thyroid carcinoma and to compare them with the American guideline and European consensus.Material and methodsWe performed a cross-sectional study based on a questionnaire addressed to clinical endocrinologists specialized in thyroid cancer and specialists in nuclear medicine throughout Spain.ResultsA total of 177 questionnaires were completed, representing an overall response rate of 85%; 74% of responses were from endocrinologists and 24% from physicians active in nuclear medicine; 82% of respondents worked in third-level hospitals, 10% in second level hospitals and the remainder in private practice. Most used ultrasonography and cytology to assess thyroid nodules and collaborated with a group of surgeons expert in thyroid surgery. The majority preferred total or subtotal thyroidectomy in tumors with a diameter of 1 cm or more, and systematic lymph node dissection. Only 43 (24%) preferred prophylactic central lymph node dissection. Eighty-one respondents (45%) would still use whole body scan with ¹³¹I or ¹²³I before ¹³¹I ablation. Follow-up was based on cervical echography and thyroglobulin determination; however, 101 (57%) respondents continued to use diagnostic whole body scan in the follow-up.ConclusionThe approaches of the respondents were mainly in accordance with the guideline and consensus, although some variations were found, especially in the use of whole body scan with ¹³¹I before ablation and in follow-up.     

The value of 99mTc-MIBI scan in the detection of malignancy potential of hypermetabolic thyroid incidentalomas of 18F-FDG PET/CT

Aim of the studyIncreasingly use of PET/CT leads to discovery of incidental findings. Hypermetabolic thyroid nodules are one of the unexpected lesions in PET/CT imaging with an increased risk of thyroid cancers. Our study aims to determine the malignant potential of incidentally detected 18F-FDG avid thyroid nodules by using Tc-99m MIBI imaging.Materials and methodsPET/CT scans were performed for nonthyroidal purposes and were evaluated for the presence of hypermetabolic thyroid nodules. Tc-99m MIBI scans and ultrasonography-guided fine needle aspiration biopsies were subsequently performed for all patients.ResultsPrimary thyroid malignancies were identified in 25% of patients with increased focal FDG uptake at definitive diagnosis. Among the patients with FDG avid thyroid nodules, Tc-99m MIBI scan showed true-positive results in all thyroid carcinomas (n:7) with a 36.3% (4/11) false-positivity rate. In three patients with indeterminate cytology results, Tc-99m MIBI scan findings were also negative. The sensitivity, specificity, positive predictive value of Tc-99m MIBI scan in predicting the malignancy of FDG-positive thyroid nodules were 100%, 77%, 63.6%, respectively.ConclusionThe implementation of ^99mTc-MIBI scan performed by dual phase and SPECT/CT modality might be a helpful cost-effective approach in addition to FNAB in patients with ¹⁸F-FDG-positive thyroid nodules and indeterminate cytology to improve the patients’ prognosis and reduce unnecessary thyroid operations with associated use of FNAB.     

Adrenal imaging

The differentiation of adrenal nodules is wide and varies from primary benign neoplasia, through hormone secreting lesions, to primary and secondary malignant masses. With the rapid development of cross-sectional imaging, incidental detection of adrenal nodules has become an everyday practice, leaving clinicians with the necessity of further investigation. In this article, we present the current possibilities of adrenal gland imaging and we propose a diagnostic schema for differential diagnosis of incidentaloma. Non-contrast enhanced computer tomography (CT) is a modality of choice used for the differential diagnosis of adrenal lesions. It allows the detection of 95% of adrenal masses, and the characterisation of most of them. Magnetic resonance imaging (MRI) is a good modality for cases in which CT examination cannot determine the character of an adrenal tumour. Nuclear medicine study with the use of Iodine-131 meta iodobenzylguanidine(MIBG) is helpful in the diagnosis of pheochromocytoma. Positron Emission Tomography-Computed Tomography (PET-CT) is considered a useful method in patients with a known malignancy history. Ultrasound has a low sensitivity for the detection of small lesions and is not capable of reliable characterisation of visualised masses. However, this technique plays an important role in the follow-up of non-hypersecreting adrenal lesions.     

Large Adrenal Incidentalomas Require a Dedicated Diagnostic Procedure

Objective: The management of large nonsecreting adrenal tumors (at least 4 cm) is still a matter of debate as it is unclear whether imaging, especially ¹⁸F-fluorodeoxyglucose (FDG), can be used to characterize their potential malignancy. Moreover, the risk of new hypersecretion in nonoperated tumors is uncertain. Our aim was to better characterize these large adrenal incidentalomas.Methods: Patients followed in our center for a nonsecreting large (at least 4 cm) adrenal incidentaloma, with an initial computed tomography (CT) and ¹⁸F-FDG positron emission tomography (PET) CT, were retrospectively included. Patients who were not operated after initial diagnosis had to be followed with clinical, biological, and imaging evaluations for at least 3 years or until delayed surgery.Results: Eighty-one patients were included in the study: 44 patients (54.3%) had initial surgery while 37 were followed, including 21 (25.9%) who were operated after a mean of 19 months. Among the 65 operated patients, 13 (20%) had a malignant lesion (3 with metastasis, and 10 with adrenocortical carcinoma). Unenhanced CT <10 showed 85.6% sensitivity and 78.8% specificity; all had a ¹⁸F-FDG uptake ratio >1.5. Among the 24 patients who were followed for at least 3 years, 5 (20.8%) finally presented hypercortisolism (4 subclinical).Conclusion: As expected, large adrenal tumors are at a higher risk of malignancy. The combination of unenhanced CT <10 and ¹⁸F-FDG PET ratio <1.5 prove to be reassuring and might lead to a close follow-up rather than immediate surgery. Hormonal follow-up should be focused on the risk of hypercortisolism.Abbreviations: CI = confidence interval; CT = Computed Tomography; ENSAT = European Network for the Study of Adrenal Tumors; ESE = European Society of Endocrinology; FDG = fluorodeoxyglucose; HU = Hounsfield units; PET = positron emission tomography; ROI = regions of interest; SUV = standard uptake value     

Large Adrenal Oncocytoma with Uncertain Malignant Potential: Case Report and Review of Literature

ObjectiveTo report a case of oncocytoma, a relatively rare adrenal tumor, which most commonly is detected as an adrenal incidentaloma.MethodsWe present a case report, including laboratory, imaging, and pathologic findings, of a 47-year-old obese woman who had hypertension and an incidentally found large, left adrenal mass.ResultsOn the basis of the hormonal evaluation, this mass was a nonsecreting adrenal tumor, which histologically proved to be an oncocytoma with borderline malignant characteristics. A collective analysis of the few cases of adrenal oncocytoma published in the medical literature showed that our case corresponded to the previously published cases in preponderant location (left side) as well as the general size (11.4 cm in the largest dimension) and weight (372 g).ConclusionAdrenal oncocytoma should be included in the differential diagnosis of adrenal incidentalomas, especially if large tumors are detected. In addition, a longterm follow-up is suggested because there are no certain clues about the true potential of this tumor. (Endocr Pract. 2010;16:641-645)     

Incidentally discovered adrenal tumors: a lesson from observation of 1,444 patients

This study was aimed at summarizing our experience in the management of 1,444 patients with incidentally found adrenal tumors observed at a single endocrinological centre. Hormonal determinations were performed in all patients at the beginning of the observation period to detect subclinical adrenal hyperfunction. The imaging phenotype on CT and MRI was analyzed for defining the malignant potential of the tumors. Based on the results of these examinations we diagnosed among our cohort probably benign masses in 87%, malignant tumors in 10% (adrenal carcinoma - 9%), and metastases in 3%. Subclinical hyperfunction was diagnosed in 8%; the most frequent was the pre-Cushing's syndrome. A subgroup of 480 patients (33%) was submitted to surgery because of oncological or endocrinological indications. The patients not qualified for surgery were carefully controlled by imaging and hormonal examinations. Malignancy is the most serious risk in the group of patients with incidentally discovered adrenal tumors.     

Impact clinique et thérapeutique de l’acquisition corps entier en TEP/TDM au 18F-FDG chez les patients suivis pour mélanome malin

ObjectiveTo assess the added benefit of scanning lower limbs in addition to usual whole-body PET/CT scan in patients with no known or suspected primary or metastatic melanoma involving the lower limbs.Materials and methodsThis is a retrospective study of 133 consecutive patients (189 FDG PET/CT) who underwent FDG PET/CT for staging of melanoma at different time points in the course of disease from October 2005 to July 2009 at Brest University Hospital. Reports of whole-body PET/CT scans including lower limbs were reviewed. PET/CT abnormalities on the lower extremities were tabulated by location and correlated with pathology, other imaging studies and at least a 6-month clinical follow-up.ResultsAmong the 189 consecutive PET/CT scans performed in 133 patients, 34 scans in 29 patients highlighted abnormal FDG uptakes considered as equivocal or suggestive of malignancy on lower limbs. In 29 cases, uptakes were located both on lower limbs and on the rest of the body (lung, liver, mediastinal and sub-diaphragmatic lymph nodes, adrenal glands, bone) corresponding to disseminated disease. In five cases, PET/CT uptakes were located only on lower limbs; each pathological uptake corresponded to benign lesions. Lower limbs findings never impacted clinical and therapeutic decision.ConclusionLower limbs additional PET/CT acquisition appears to offer poor additional benefit with no unexpected solitary lesion detected and routine skull base to upper thigh images may be sufficient for this subset of patients.     

分侧肾上腺静脉取血与肾上腺CT对原发性醛固酮增多症诊断的价值比较研究

摘要 目的：研究原发性醛固酮增多症（PA）患者行分侧肾上腺静脉取血（AVS）、肾上腺CT诊断的效果。方法：数据遴选本院2018年1月-2021年11月收治的70例原发性醛固酮增多症患者,所有患者均行肾上腺CT、AVS诊断,对最终诊断结果比较分析。结果：收缩压、舒张压、空腹血糖、总胆固醇在单双侧间无差异（P＞0.05）,双侧肾素活性、血清醛固酮肾素比值较单侧存在差异（P＜0.05）;肾上腺CT与AVS诊断的符合率情况：肾上腺CT显示为单侧异常、双侧异常及双侧正常患者,AVS符合率分别为65.00 %、31.25 %、50.00 %;单独肾上腺CT诊断：灵敏度为57.1 %,特异度为25.7 %,肾上腺静脉采血诊断：灵敏度为74.3 %,特异度为42.9 %;并联联合诊断灵敏度为100.0 %,特异度为26.3 %,串联诊断灵敏度为19.5 %,特异度为100.0 %。结论：PA是临床常见疾病,具有患病率高、预后差等特点,临床依靠临床表现、血液生化检查诊断PA疾病,但仅借助血液生化检验进行诊断治疗较困难,功能定位是治疗关键。实际工作中,可以临床通过CT检查及AVS检查功能定位诊断,但对于PA患者来说,仅借助肾上腺CT诊断结果制定治疗方案,可能导致手术侧选择错误,建议愿意接受肾上腺手术治疗者,推荐先行AVS,正确选择治疗方案,达到改善预后作用,效果较理想、值得临床借鉴推广。     

Incorporación de la ecografía y la punción de tiroides a la actividad de endocrinología en una consulta de alta resolución

IntroductionFine-needle aspiration biopsy (FNAB) is considered the reference diagnostic procedure for thyroid nodules.Materials and methodsRoutine performance of thyroid ultrasound and ultrasound-guided FNAB by endocrinologists allows a more efficient approach in the setting of a high-resolution practice, thus reducing costs and the time elapsed until diagnosis.ResultsWe present our initial results of this procedure 2 years after its introduction, with a total of 286 biopsies performed. After a progressive learning curve over time and according to the endocrinologists’ previous experience, 72.72% samples were considered satisfactory for diagnosis. Greater difficulty was observed in obtaining optimal cytological specimens in smaller nodules. In conclusion, we have successfully incorporated thyroid ultrasound and ultrasound-guided FNAB into routine endocrine practice.ConclusionRoutine performance of thyroid ultrasound in endocrine practice will considerably aid the management of nodular thyroid disease.     

Mifepristone Treatment for Mild Autonomous Cortisol Secretion Due to Adrenal Adenomas: A Pilot Study

Objective: Adrenal incidentalomas are increasingly detected with the widespread use of thoracic and abdominal imaging. The most common secretory syndrome in adrenal nodules is autonomous cortisol secretion (ACS). Recent data show that even mild cortisol excess is associated with adverse outcomes. The glucocorticoid receptor antagonist mifepristone has been used in patients with overt Cushing syndrome and hyperglycemia. The purpose of our study was to determine the effect of mifepristone on metabolic parameters in patients with ACS and concomitant prediabetes or diabetes.Methods: Eight patients with either unilateral or bilateral adrenal nodules with ACS were included in the study. Fasting laboratory tests including glucose and insulin levels to calculate homeostatic model assessment for insulin resistance (HOMA-IR) were performed at baseline and again after either 3 months (3 patients) or 6 months (5 patients) on mifepristone 300 mg daily treatment. Patients also completed several validated surveys on mood and quality of life at baseline and follow-up.Results: There were significant reductions in fasting glucose measurements and insulin resistance as measured by HOMA-IR in the 6 of 8 study patients in whom these measurements were available (P = .03).Conclusion: This pilot study demonstrates that mifepristone treatment of ACS is associated with a significant decrease in fasting glucose and insulin resistance as measured by HOMA-IR scores. Mifepristone treatment of ACS may be considered as a medical option for patients with ACS due to adrenal adenomas with concomitant abnormal glucose parameters in whom surgical removal is not being considered.Abbreviations: ACS = autonomous cortisol secretion; ACTH = adrenocorticotropic hormone; AI = adrenal incidentaloma; DHEAS = dehydroepiandrosterone sulfate; GR = glucocorticoid receptor; HbA1c = hemoglobin A1c; HOMA-IR = homeostatic model assessment for insulin resistance; ODT = overnight dexamethasone suppression test; QoL = quality of life; STAI = state trait anxiety inventory; TSH = thyroid stimulating hormone; UFC = urinary free cortisol     

胸部CT结合AI诊断系统对疑似肺结节患者的诊断及对结节类型的评估价值

摘要 目的：探讨胸部CT结合AI诊断系统对疑似肺结节患者的诊断及对结节类型的评估价值。方法：选取2019年12月-2020年12月在我院进行CT检查的358例疑似肺结节患者,将其按照随机数字表法分为两组：对照组（放射科医生根据CT扫描结果,通过人工阅片分析记录检出结节数量和影像特征）,观察组（将CT扫描结果导入AI辅助诊断系统,经AI运算得到结节检出数量和影像特征）。AI辅助系统IMsight用于肺结节的图像分析和自动检测。通过组织病理学确定结节的良恶性。绘制受试者工作特征曲线（ROC）曲线以评估AI和CT结合图像的诊断价值。结果：病理结果最后确诊结节数量736个,恶性结节139个（18.89 %）,良性结节597个（81.11 %）。观察组诊断结节数量717个,检出率97.42%,对照组诊断出结节数量603个,检出率81.93 %。观察组较对照组的结节检出率、阳性检出率升高（P<0.05）,漏检率和假阴性率均显著降低（P<0.05）。当结节小于10 mm时,观察组较对照组的检出率升高（P<0.05）,观察组较对照组对磨玻璃密度结节和实性结节检出率升高（P<0.05）,观察组较对照组位于胸膜结节检出率升高（P<0.05）。观察组较对照组AUC（P<0.05）,表明AI系统下的结节检出准确率高。ROC曲线显示观察组的敏感性和特异性分别为88.39%和89.68 %,对照组的敏感性和特异性分别为75.24 %和82.34 %,观察组较对照组的ROC曲线敏感性和特异性升高（P<0.05）。结论：AI辅助诊断系统可有效提高肺结节的检出率,减少误检率及漏检率,值得在肺结节CT检测中应用推广。     

Thyroid Carcinoma Detected by 18f-Fluorodeoxyglucose Positron Emission Tomography Among Individuals without Prior Evidence of Thyroid Disease: Relevance and Clinicopathologic Features

ObjectiveThe expanding use of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) has contributed to an increasing number of thyroid incidentalomas. The present study aimed to estimate the prevalence of ¹⁸F-FDG-PET thyroid incidentalomas and evaluate the clinicopathologic features of thyroid malignancies detected by ¹⁸F-FDG-PET.MethodsWe reviewed all ¹⁸F-FDG-PET exams performed at the Portuguese Institute of Oncology, Lisbon, between 2007 and 2012 (n = 9,374). The inclusion criteria were focal thyroid uptake and absence of known thyroid disease.ResultsFocal thyroid uptake was observed in 60 out of 9,374 ¹⁸F-FDG-PET exams (prevalence of 0.64%). Fineneedle aspiration cytology (FNAC) was performed in 23 patients and reported as malignant in 14 cases (56.5% primary thyroid carcinoma; 4.3% secondary malignancy), as benign in 7 cases (30.5%) and as follicular lesion of undetermined significance in 2 cases (8.7%). Fourteen patients had surgery. A final histologic diagnosis of papillary thyroid carcinoma was established in 12 cases (52.2%). Three were multifocal (25.0%); 8 had extrathyroidal extension (66.7%); 5 had angioinvasion (41.7%); 3 had lymph nodes metastases (25.0%) and 2 showed lung metastases (16.7%). Overall, 91.7% were classified as intermediate or high risk. All patients had radioiodine therapy. At the last observation (mean follow-up was 29.9 months), persistent or recurrent disease was identified in 4 patients (33.3%) and none died from thyroid malignancy.ConclusionsThyroid carcinomas disclosed by ¹⁸F-FDG-PET are associated with aggressive histological criteria likely to carry a worse prognosis. (Endocr Pract. 2014;20:1129-1136)     

Multiple Unilateral adrenal Adenomas in a Patient with Primary Hyperaldosteronism

ObjectiveTo report a rare case of multiple unilateral adrenal adenomas in which immunohistochemistry results confirmed primary hyperaldosteronism in each of 3 adenomas.MethodsWe present the clinical, laboratory, radiographic, and pathologic findings of a case of multiple unilateral adrenal adenomas.ResultsAlthough multiple nodules in both adrenal glands are fairly common in patients with bilateral hyperplasia, multiple unilateral nodules are extremely rare. A 45-year-old woman with a long-standing history of severe hypertension was found to have biochemical parameters consistent with primary hyperaldosteronism, multiple unilateral adrenal adenomas, and immunohistochemical test results confirming primary hyperaldosteronism arising from each of 3 adrenal nodules (measuring 2.2 × 2.2 cm, 1.7 × 0.7 cm, and 0.5 × 0.5 cm).ConclusionThis case illustrates the rare presentation of primary hyperaldosteronism as multiple unilateral adrenal adenomas in which immunohistochemistry results can confirm the suspected preoperative diagnosis as suggested by biochemical and radiographic evidence. (Endocr Pract. 2008;14:76-79)     

Diagnostic Use of Ultrasonography in Patients with Nodular Thyroid Disease

ObjectiveTo review the published reports pertaining to the diagnostic utility of ultrasonography for evaluation of thyroid nodules.MethodsVarious roles for diagnostic thyroid ultrasonography and screening ultrasound studies of the thyroid are discussed, and ultrasound characteristics of thyroid nodules and their association with malignant potential are described.ResultsIn two studies that correlated ultrasound findings with physical examination findings in patients with a solitary thyroid nodule detected by palpation, 16% of such patients had no corresponding nodule evident on ultrasonography, and 45% of such patients had an additional nodule detected by ultrasonography. Similarly, approximately 18% of patients with a palpable multinodular thyroid had no nodules larger than 1 cm in diameter on ultrasound studies. Thyroid nodules larger than 1 cm have been found by ultrasonography to be present in from 2 to almost 5% of the population with normal findings on examination of the thyroid. Use of screening ultrasound study of the thyroid has been suggested for patients with a history of childhood irradiation to the head and neck or a family history of thyroid cancer. Numerous investigations that have evaluated ultrasound features of thyroid nodules have suggested five characteristics as suggestive of malignant potential—hypoechogenicity, microcalcifications. irregular or microlobulated border, absent or irregular thick halo, and increased intranodular vascularity.ConclusionCorrelation of ultrasound and palpation findings will provide a comprehensive evaluation of nodular thyroid disease. Moreover, real-time ultrasonography facilitates characterization of features associated with an increased risk of a malignant lesion. High-resolution thyroid ultrasonography is a dynamic tool for endocrinologists. (Endocr Pract. 2004;10:246-252)     

Diagnostic Challenges in Adrenocortical Carcinoma: Recommendations for Surveillance after Surgical Resection of Selected Adrenal Nodules

ObjectiveTo discuss challenges in the diagnosis of adrenocortical carcinoma and to suggest surveillance measures after removal of selected adrenal nodules.MethodsWe present the case of a 65-year-old man with worsening hypertension and new-onset hypokalemia attributed to primary hyperaldosteronism due to a 3-cm right adrenal nodule.ResultsA laparoscopic right adrenalectomy was performed, and the histologic diagnosis was a benign adenoma. The patient’s hypertension and hypokalemia improved postoperatively but recurred 8 months later, and florid Cushing’s syndrome developed. Magnetic resonance imaging showed an 8-cm mass in the right adrenal bed and multiple hepatic metastatic lesions. Fine-needle biopsy confirmed the presence of adrenocortical carcinoma.ConclusionDespite a comprehensive biochemical, radiologic, and histologic assessment, the diagnosis of adrenocortical carcinoma can be missed. Particularly, we caution against undue reliance on the initial tumor size. We recommend that abdominal imaging be performed every 3 months for the first year and every 6 months for the second year after surgical removal of selected adrenal nodules. (Endocr Pract. 2007;13:636-641)     

高分辨率CT与常规CT检查对肺小结节及早期肺癌诊断价值的对比研究

目的:对比高分辨率电子计算机断层扫描(CT)与常规CT检查对肺小结节及早期肺癌的诊断价值。方法:将2018年6月2020年1月我院收治的肺小结节及早期肺癌患者94例纳入研究。以随机数字表法将其分为观察组及对照组,每组各47例,对照组实施常规CT检查,观察组则实施高分辨率CT检查。比较两组CT肿瘤征象情况(主要包括毛刺征、分叶征、棘突征、钙化征、空泡征、支气管征、胸膜凹陷征、血管集束征),CT扫描图像质量,诊断肺小结节及早期肺癌的效能。结果:观察组各项CT肿瘤征象人数占比均高于对照组(P<0.05)。观察组CT扫描图像质量优良率为97.87%(46/47),高于对照组的72.34%(34/47)(P<0.05)。高分辨率CT诊断早期肺癌的灵敏度及准确度、特异度分别为96.67%(29/30)、95.74%(45/47)、94.12%(16/17),高于常规CT检查的74.19%(23/31)、74.47%(35/47)、75.00%(12/16)。结论:高分辨率CT检查对肺小结节及早期肺癌诊断价值显著高于常规CT检查,可作为临床肺小结节及早期肺癌诊断的有效影像学手段,值得临床应用。