CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma

Letizia Canu, Janna A.W. Van Hemert, Michiel N. Kerstens, Robert P. Hartman, Aakanksha Khanna, Ivana Kraljevic, Darko Kastelan, Corin Badiu, Urszula Ambroziak, Antoine Tabarin, Magalie Haissaguerre, Edward Buitenwerf, Anneke Visser, Massimo Mannelli, Wiebke Arlt, Vasileios Chortis, Isabelle Bourdeau, Nadia Gagnon, Marie Buchy, Francoise Borson-ChazotTimo Deutschbein, Martin Fassnacht, Alicja Hubalewska-Dydejczyk, Marcin Motyka, Ewelina Rzepka, Ruth T. Casey, Benjamin G. Challis, Marcus Quinkler, Laurent Vroonen, Ariadni Spyroglou, Felix Beuschlein, Cristina Lamas, William F. Young, Irina Bancos, Henri J.L.M. Timmers

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)312-318
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number2
DOIs
StatePublished - Nov 9 2018

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Canu, L., Van Hemert, J. A. W., Kerstens, M. N., Hartman, R. P., Khanna, A., Kraljevic, I., Kastelan, D., Badiu, C., Ambroziak, U., Tabarin, A., Haissaguerre, M., Buitenwerf, E., Visser, A., Mannelli, M., Arlt, W., Chortis, V., Bourdeau, I., Gagnon, N., Buchy, M., ... Timmers, H. J. L. M. (2018). CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma. Journal of Clinical Endocrinology and Metabolism, 104(2), 312-318. https://doi.org/10.1210/jc.2018-01532