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J Clin Endocrinol Metab. 2018 Oct 31. doi: 10.1210/jc.2018-01532. [Epub ahead of print]

CT characteristics of pheochromocytoma - Relevance for the evaluation of adrenal incidentaloma.

Author information

1
Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands.
2
Department of Experimental and Clinical Biomedical Sciences University of Florence, Florence, Italy.
3
Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
4
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
5
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.
6
Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia.
7
National Institute of Endocrinology "C. I. Parhon", Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Chair of Endocrinology, Bucharest, Romania.
8
Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
9
Service d'Endocrinologie Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France.
10
Department of Applied Health Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
11
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.
12
Division of Endocrinology, Center hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
13
Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron F, France.
14
Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany.
15
Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg, Germany.
16
Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland.
17
Addenbrooke's Hospital, Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Biomedical Research Center, Cambridge, United Kingdom.
18
Endocrinology in Charlottenburg, Berlin, Germany.
19
Department of Endocrinology, Center Hospitalier Universitaire de Liège, Liège, Belgium.
20
Medizinische Klinik und Poliklinik IV Ludwig-Maximilians-Universität München, Munich, Germany.
21
Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zurich, Switzerland.
22
Endocrinology Department, Hospital General Universitario de Albacete, Albacete, Spain.

Abstract

Background:

Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended to exclude PCC by measurement plasma free or 24h urinary fractionated metanephrines. However, recent studies suggest to abstain from biochemical exclusion of PCC in cases of lesions with computed tomography (CT) characteristics of an adrenocortical adenoma (ACA).

Aim:

To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT.

Methods:

For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield Units (HU), absolute percentage washout (APW) and relative percentage washout (RPW) were collected besides clinical parameters.

Results:

Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0,5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU >10 and available washout data, 22 (28,9%) had a high APW and/or RPW, suggestive of ACA.

Conclusion:

Based on the lack of PCCs with an unenhanced attenuation of <10 HU, and the low proportion (0,5%) of PCCs with an attenuation of =10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation ≤10 HU. The assessment of contrast washout, however, is unreliable to rule out PCC.

PMID:
30383267
DOI:
10.1210/jc.2018-01532

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