摘要:

OBJECTIVE Most incidentally discovered adrenal tumours (‘incidentaloma’) are benign adrenocortical adenomas. It has been suggested that131I‐6β‐iodomethylnorcholesterol (IMC) scan could specify the degree of functional autonomy of such adenomas depending on whether they prevent contralateral adrenal tracer uptake. Our purpose was to examine this hypothesis in a correlated scintigraphic and endocrine study.DESIGN Prospective study evaluating the prevalence of unilateral IMC uptake (tumour uptake with no visualization of the contralateral adrenal gland) and bilateral uptake (uptake in both the tumoral and the contralateral adrenal glands) in patients with unilateral incidentaloma. Comparison of adrenocortical function and of IMC scan after dexamethasone (DXM) in the two scintigraphic groups thus defined.PATIENTS Thirty‐five patients with a unilateral mass highly suggestive of benign adrenocortical adenoma on CT scan.MEASUREMENTS The IMC scan was performed in basal conditions (baseline scan) and after DXM (suppression scan). Adrenocortical function assessment included basal measurements of 11‐deoxycortisol, 17α‐hydroxyprogesterone (17‐OHP), dehydroepiandrosterone sulphate (DHEAS), plasma cortisol and ACTH, urinary free cortisol (UFC), overnight and low‐dose DXM suppression test, and CRH test.RESULTS The baseline scan showed 16 patients (46%) with unilateral uptake (group A) and 19 (54%) with bilateral uptake (group B). Patients in group A exhibited lower ACTH values at 0800 h (P = 0.05) and higher cortisol values after an overnight DXM suppression test (P = 0.02), than did patients in group B. In addition, 3 patients in group A failed the overnight and the low‐dose DXM suppression tests. Adrenal masses were larger in group A than group B (P = 0.04) and an inverse correlation was found in the whole population between tumour size and ACTH value at 0800 h (P = 0.05). On the suppression scan performed in 14 patients (7 in each group), patients in group A continued to exhibit unilateral tumour uptake and bilateral uptake was suppressed in 72% of patients in group B. An adrenal mass was removed in 3 patients of group A with confirmed benign adrenocortical adenomas. In the post‐surgical period, the contralateral gland was again visualized in a baseline scan and the hormonal evaluation returned to the normal range.CONCLUSION Unilateral131I‐6β‐iodomethylnorcholesterol tumour uptake is a frequent feature in benign adrenocortical adenomas. Hormonal data and scintigraphic profiles obtained after dexamethasone, as well as hormono‐scintigraphic changes observed after surgery, provide evidence that unilateral uptake is related to functioning adenomas with various degrees of autononomy and suggest that the131I‐6β‐iodomethylnorcholesterol scan coul

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.720541.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Pituitary carcinoma with metastatic endocrine secreting tissue is rare. Eight cases of malignant, growth hormone‐secreting tumours, all metastatic within the central nervous system have been previously described. Complete surgical resection was not possible and the patients died within 4 years of presentation with distant spread. Here we describe the first case of an apparent surgical cure of a somatotroph carcinoma metastatic to the cervical spine, documented by biochemical assessment and magnetic resonance and radioligand imaging. The possibility that intrathecal metastasis of somatotroph tumours may be responsible for some cases of treatment resistant acromegaly is discusse

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.685507.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The coexistence of phaeochromocytoma and primary aldosteronism is rare. In the four cases reported in the English literature, adrenal gland involvement was unilateral. The case we report is unusual in that both adrenal glands were affected. Our patient was a 63‐year‐old man who presented with long‐standing hypertension and hypokalaemia. Evaluation for secondary hypertension showed biochemical evidence of both phaeochromocytoma and primary aldosteronism. Bilateral adrenal masses were found on imaging studies. Right total and left partial adrenalectomy were performed. Pathological examination revealed bilateral phaeochromocytomas, with cortical findings consistent with mild cortical hyperplasia. Annual biochemical evaluation over a 2‐year period has shown no evidence of recurrent disease. To our knowledge, this is the first reported case in the English‐language literature of phaeochromocytomas involving both adrenal glands coexisting with hyperaldo

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.709530.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.733554.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY