TY - JOUR
T1 - CT Characteristics of Pheochromocytoma
T2 - Relevance for the Evaluation of Adrenal Incidentaloma
AU - Canu, Letizia
AU - Van Hemert, Janna A.W.
AU - Kerstens, Michiel N.
AU - Hartman, Robert P.
AU - Khanna, Aakanksha
AU - Kraljevic, Ivana
AU - Kastelan, Darko
AU - Badiu, Corin
AU - Ambroziak, Urszula
AU - Tabarin, Antoine
AU - Haissaguerre, Magalie
AU - Buitenwerf, Edward
AU - Visser, Anneke
AU - Mannelli, Massimo
AU - Arlt, Wiebke
AU - Chortis, Vasileios
AU - Bourdeau, Isabelle
AU - Gagnon, Nadia
AU - Buchy, Marie
AU - Borson-Chazot, Francoise
AU - Deutschbein, Timo
AU - Fassnacht, Martin
AU - Hubalewska-Dydejczyk, Alicja
AU - Motyka, Marcin
AU - Rzepka, Ewelina
AU - Casey, Ruth T.
AU - Challis, Benjamin G.
AU - Quinkler, Marcus
AU - Vroonen, Laurent
AU - Spyroglou, Ariadni
AU - Beuschlein, Felix
AU - Lamas, Cristina
AU - Young, William F.
AU - Bancos, Irina
AU - Timmers, Henri J.L.M.
N1 - Publisher Copyright:
© Copyright 2019 Endocrine Society.
PY - 2018/11/9
Y1 - 2018/11/9
N2 - Background Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with 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 in addition to 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 of ≤10 HU. The assessment of contrast washout, however, is unreliable for ruling out PCC.
AB - Background Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with 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 in addition to 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 of ≤10 HU. The assessment of contrast washout, however, is unreliable for ruling out PCC.
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U2 - 10.1210/jc.2018-01532
DO - 10.1210/jc.2018-01532
M3 - Article
C2 - 30383267
AN - SCOPUS:85058895405
SN - 0021-972X
VL - 104
SP - 312
EP - 318
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 2
ER -