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 Francis Young, Irina Bancos, Henri J.L.M. Timmers

Research output: Contribution to journalArticle

12 Citations (Scopus)

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
JournalThe Journal of clinical endocrinology and metabolism
Volume104
Issue number2
DOIs
StatePublished - Feb 1 2019

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Metanephrine
Pheochromocytoma
Tumors
Plasmas
Testing
Adrenocortical Adenoma
Adrenal incidentaloma
Multicenter Studies

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., ... Timmers, H. J. L. M. (2019). CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma. The Journal of clinical endocrinology and metabolism, 104(2), 312-318. https://doi.org/10.1210/jc.2018-01532

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

In: The Journal of clinical endocrinology and metabolism, Vol. 104, No. 2, 01.02.2019, p. 312-318.

Research output: Contribution to journalArticle

Canu, L, Van Hemert, JAW, Kerstens, MN, Hartman, RP, 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, Borson-Chazot, F, Deutschbein, T, Fassnacht, M, Hubalewska-Dydejczyk, A, Motyka, M, Rzepka, E, Casey, RT, Challis, BG, Quinkler, M, Vroonen, L, Spyroglou, A, Beuschlein, F, Lamas, C, Young, WF, Bancos, I & Timmers, HJLM 2019, 'CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma', The Journal of clinical endocrinology and metabolism, vol. 104, no. 2, pp. 312-318. https://doi.org/10.1210/jc.2018-01532
Canu, Letizia ; Van Hemert, Janna A.W. ; Kerstens, Michiel N. ; Hartman, Robert P. ; Khanna, Aakanksha ; Kraljevic, Ivana ; Kastelan, Darko ; Badiu, Corin ; Ambroziak, Urszula ; Tabarin, Antoine ; Haissaguerre, Magalie ; Buitenwerf, Edward ; Visser, Anneke ; Mannelli, Massimo ; Arlt, Wiebke ; Chortis, Vasileios ; Bourdeau, Isabelle ; Gagnon, Nadia ; Buchy, Marie ; Borson-Chazot, Francoise ; Deutschbein, Timo ; Fassnacht, Martin ; Hubalewska-Dydejczyk, Alicja ; Motyka, Marcin ; Rzepka, Ewelina ; Casey, Ruth T. ; Challis, Benjamin G. ; Quinkler, Marcus ; Vroonen, Laurent ; Spyroglou, Ariadni ; Beuschlein, Felix ; Lamas, Cristina ; Young, William Francis ; Bancos, Irina ; Timmers, Henri J.L.M. / CT Characteristics of Pheochromocytoma : Relevance for the Evaluation of Adrenal Incidentaloma. In: The Journal of clinical endocrinology and metabolism. 2019 ; Vol. 104, No. 2. pp. 312-318.
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title = "CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma",
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.",
author = "Letizia Canu and {Van Hemert}, {Janna A.W.} and Kerstens, {Michiel N.} and Hartman, {Robert P.} and Aakanksha Khanna and Ivana Kraljevic and Darko Kastelan and Corin Badiu and Urszula Ambroziak and Antoine Tabarin and Magalie Haissaguerre and Edward Buitenwerf and Anneke Visser and Massimo Mannelli and Wiebke Arlt and Vasileios Chortis and Isabelle Bourdeau and Nadia Gagnon and Marie Buchy and Francoise Borson-Chazot and Timo Deutschbein and Martin Fassnacht and Alicja Hubalewska-Dydejczyk and Marcin Motyka and Ewelina Rzepka and Casey, {Ruth T.} and Challis, {Benjamin G.} and Marcus Quinkler and Laurent Vroonen and Ariadni Spyroglou and Felix Beuschlein and Cristina Lamas and Young, {William Francis} and Irina Bancos and Timmers, {Henri J.L.M.}",
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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 Francis

AU - Bancos, Irina

AU - Timmers, Henri J.L.M.

PY - 2019/2/1

Y1 - 2019/2/1

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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DO - 10.1210/jc.2018-01532

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