However, mild hormonal alterations as well as metabolic abnormalities may be present in patients with AIs. [ncbi.nlm.nih.gov]

• Pain

  Herein, we describe a case of a 69-year-old man with a pain at the base of right chest. On the basis of clinical evaluation, biochemical analysis, as well as imaging procedures, a diagnosis of right adrenocortical carcinoma was made. [ncbi.nlm.nih.gov]

  Herein we are reporting a case of right adrenal myelolipoma incidentally discovered in a 48 year old women presented with intermittent, dull aching, vague abdominal pain for the past one year. [ijbms.com]

  Three months after surgery, patient was pain free and no recurrent mass was seen on CT. [urologyannals.com]

• Weight Gain

  A 17-year-old male was admitted with the complaint of progressive weight gain. Abdominal ultrasonography was performed for elevation in transaminases which revealed a hypoechoic mass located in the left adrenal gland. [ncbi.nlm.nih.gov]

  “Most of the time the answer is no, but other times the gland starts making excess hormones, which can lead to high blood pressure, weight gain, diabetes or glucose intolerance — in which case, treatment is indicated.” [nydailynews.com]

  Symptoms of too much cortisol can include: Weight loss or weight gain (especially around the face and abdomen) Purplish skin stretch marks or skin that’s easily bruised Acne Muscle weakness Depression, anxiety, fatigue, and sleep disturbances In women [hormone.org]

• Fatigue

  Patients with adrenal incidentaloma reported reduced QoL and a higher level of physical fatigue compared to age- and sex-matched controls. [ncbi.nlm.nih.gov]

  Alpha-blockade with phenoxybenzamine 10mg daily, titrated to 10mg tds over 3weeks. - then lap adrenalectomy - side effects are orthostatic hypotension, fatigue and sinus congestion. - beta-blockade not recommended unless tachycardic. 2. [gog.net.nz]

  Symptoms of too much cortisol can include: Weight loss or weight gain (especially around the face and abdomen) Purplish skin stretch marks or skin that’s easily bruised Acne Muscle weakness Depression, anxiety, fatigue, and sleep disturbances In women [hormone.org]

  History of weight gain or development of centripetal obesity, easy bruisability, severe hypertension, diabetes, virilization, proximal muscle weakness, fatigue, osteoporosis etc., are suggestive of Cushing syndrome. [ijem.in]

  Non-specific, fatigue and generalized weakness are frequent complaints. Finally, neuropsychiatric symptoms have been reported, with depression and lethargy being the most common. [clinicaladvisor.com]

• Congestive Heart Failure

  J Am Coll Radiol. 2013 Dec;10(12):953-6 “In the absence of secondary causes of gallbladder wall thickening, such as hepatitis, congestive heart failure, acute or chronic liver disease, pancreatitis, or hypoproteinemia, a primary cause should be excluded [ctisus.com]

• Easy Bruising

  Patients with cortisol excess may also present with easy bruising, poor wound healing, weakness, new acne or excessive facial hair growth. Note, often cortisol-secreting adenomas are subclinical. [clinicaladvisor.com]

  bruising, poor wound-healing, emotional and cognitive changes Hypertension Hyperglycaemia Hyperlipidaemia Osteoporosis 1 mg overnight dexamethasone suppression test 8 mg dexamethasone suppression test Midnight salivary cortisol Conn’s syndrome Mostly [racgp.org.au]

• Abdominal Pain

  A 71-year-old man presented with left-sided abdominal pain. A computed tomography scan showed a large cystic mass with a solid component arising from the left adrenal gland (Figure 1). [ncbi.nlm.nih.gov]

  Herein we are reporting a case of right adrenal myelolipoma incidentally discovered in a 48 year old women presented with intermittent, dull aching, vague abdominal pain for the past one year. [ijbms.com]

  Occasionally, patients present with abdominal pain secondary to hemorrhage, tumor necrosis or mechanical compression; other rare presenting symptoms include hematuria and abdominal mass. [1], [4], [5], [7] Four distinct clinico-pathological patterns have [urologyannals.com]

  Results: We evaluated 24 patients undergoing surgery, 66.7% female, 58.3% between 41 and 70 years. 58.3% were found in the study of abdominal pain. [repositorio.uchile.cl]

  Some studies suggest surgical intervention for symptomatic tumors, growing tumors, or tumors larger than 10 cm to reduce the risk of developing abdominal pain or life-threatening hemorrhage [ 35 ]. [omicsonline.org]

• Nausea

  About 2 h after taking the second dose of 2 mg dexamethasone, she suddenly developed nausea and vomiting, palpitations, and anxiety with severe hypertension. On the same day, we measured serum catecholamines, which were markedly elevated. [ncbi.nlm.nih.gov]

  Nausea and vomiting were associated. Physical examination was unremarkable. No other abnormalities e. g hypertension, diabetes mellitus, headache could be detected after examination of the patient & subsequent investigations. [ispub.com]

  Clinical clues include nausea, abdominal pain, fever, and diarrhea. Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A. Management of adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab. 2009 Apr. 23(2):233-43. [Medline]. [emedicine.medscape.com]

  Medical therapy consists of spironolactone, but side effects such as painful gynecomastia, nausea and headache can lead to poor compliance. Eplerenone may be more tolerable for many patients but may be somewhat less effective. E. [clinicaladvisor.com]

• Vomiting

  About 2 h after taking the second dose of 2 mg dexamethasone, she suddenly developed nausea and vomiting, palpitations, and anxiety with severe hypertension. On the same day, we measured serum catecholamines, which were markedly elevated. [ncbi.nlm.nih.gov]

  CASE REPORT: A 48 yrs old female presented with complaints of intermittent, dull aching, vague abdominal pain for the past one year.Nohistory of abdomen distention, burning micturition, fever, vomiting,gastrointestinal bleeding, headache, sweating, palpitation [ijbms.com]

  Nausea and vomiting were associated. Physical examination was unremarkable. No other abnormalities e. g hypertension, diabetes mellitus, headache could be detected after examination of the patient & subsequent investigations. [ispub.com]

• Hypertension

  Two patients had hypertension and one both hypertension and non-insulin-dependent diabetes mellitus, but none showed classical stigmata of Cushing's syndrome. [ncbi.nlm.nih.gov]

  […] variation), 24h urine cortisol Conn's syndrome: Signs: hypertension, hypokalemia Diagnosis: Aldosterone to renin ratio, with value greater than 20 suggesting diagnosis Should be done in early morning, and when patient is ambulatory Cannot be done if [errolozdalga.com]

• Hypotension

  […] antagonist If patient is on ACEi/ARB, renin typically elevated, so low ratio may be inaccurate, but high ratio (i.e. low renin) strongly suggests diagnosis Pheochromocytoma: Symptoms: palpitations, headache, diaphoresis Signs: hypertension, paradoxical hypotension [errolozdalga.com]

  - then lap adrenalectomy - side effects are orthostatic hypotension, fatigue and sinus congestion. - beta-blockade not recommended unless tachycardic. 2. Adequately hydrate to make up for volume depletion 3. [gog.net.nz]

  Evidence of hypertension by displaced point of maximal impulse, pallor, orthostatic hypotension. Third question: Is there evidence of widespread malignancy? Enlarged lymph nodes, palpable masses. 3. [clinicaladvisor.com]

  Hemorrhage Extensive adrenal hemorrhage may occur at any age and under various circumstances such as severe stress as in surgery, sepsis, burns, hypotension, trauma, hemorrhagic diathesis and underlying conditions such as adenoma, cyst and tumour. [radiologyassistant.nl]

• Osteoporosis

  Initial diagnostical work up showed subclinical Cushing syndrome with osteoporosis and arterial hypertension as part of clinical presentation. [endocrine-abstracts.org]

  The challenge facing the clinician is that in the sixth and seventh decade of life hypertension, diabetes, osteoporosis and obesity are common and establishing whether these are directly related to the low-grade excess cortisol secretion in a given individual [ncbi.nlm.nih.gov]

  Updated clinical guidelines for diabetes, lipid disorders, obesity management, osteoporosis, and more, as well as essential treatment updates for the medical management of acromegaly, Cushing's Disease, hypercalcemia, and diabetes mellitus. [books.google.ro]

  Too much cortical hormone can put you at risk of osteoporosis, so you may be a candidate for having your bone density checked. Sign up for BREAKING NEWS Emails Send a Letter to the Editor [nydailynews.com]

  History of weight gain or development of centripetal obesity, easy bruisability, severe hypertension, diabetes, virilization, proximal muscle weakness, fatigue, osteoporosis etc., are suggestive of Cushing syndrome. [ijem.in]

• Hirsutism

  Adrenal incidentaloma is not infrequent and can be found in hirsute women. [ncbi.nlm.nih.gov]

  hirsutism temporal balding voice changes clitoral enlargement acne increased muscle mass decreased breast size amenorrhea 23 Before we proceed……. chromaffin 1.The medulla is composed of ____________ cells derived from the_____________. neural crest. 2 [slideplayer.com]

  Case descriptions: Case 1 : female, 1972y., presented in 1995y. (23y.) as severe hirsutism and infertility managed by team of gynecologists. She refused any additional investigations and was severily depressed. [endocrine-abstracts.org]

  Physical examination should include blood pressure and pulse and to look for physical signs of cortisol excess like central obesity, striae, muscle wasting, hirsutism or other signs of virilization. [ijem.in]

• Headache

  […] ambulatory Cannot be done if patient is on aldosterone antagonist If patient is on ACEi/ARB, renin typically elevated, so low ratio may be inaccurate, but high ratio (i.e. low renin) strongly suggests diagnosis Pheochromocytoma: Symptoms: palpitations, headache [errolozdalga.com]

  Signs of pheochromocytoma: Patients should be asked about headache, palpitations, panic attacks, orthostasis, tremulousness, flushing or pallor, and constipation. [clinicaladvisor.com]

  Symptoms of too much norepinephrine or epinephrine can include: Fast or irregular heartbeat Sweating Severe headaches Shakiness Pale face High blood pressure. [hormone.org]

  tremor, anxiety Severe hypertension Weight loss 24-hour urinary catecholamines and metanephrines Fractionated plasma metanephrines Adrenocortical carcinoma Mass effect Palpitations, flushing, sweating, headache, tremor, anxiety, hirsuitism, gynaecomastia [racgp.org.au]

• Seizure

  Medulla MEN - multiple endocrine neoplasia Type II A - medullary CA, parathyroid Type II B - medullary CA, neuromas, marfanoid Rule of 10 Familial malignant extra-adrenal. malignant sporadic bilateral 25 Complications of pheochromocytoma crisis shock DIC seizures [slideplayer.com]

• Lethargy

  Finally, neuropsychiatric symptoms have been reported, with depression and lethargy being the most common. Insomnia is also a common finding, while paranoia and psychosis are rare manifestations. [clinicaladvisor.com]

• Tremor

  Refractory hypertension Hypokaleamia ( If hypertensive, plasma aldosterone to plasma renin activity ratio Plasma aldosterone 24-hour urinary aldosterone, sodium, creatinine Phaeochromocytoma May be asymptomatic Palpitations, flushing, sweating, headache, tremor [racgp.org.au]

RESULTS: A total of 125 patients with incidental adrenal lesions were identified, of which 74 patients were considered appropriate for further endocrine/radiological workup. [ncbi.nlm.nih.gov]

• Nephrolithiasis

  Of note, a bilateral non-obstructive nephrolithiasis was observed ( Figure 1 ). [f1000research.com]

TREATMENT: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). [ncbi.nlm.nih.gov]

The prognosis of patients with adrenal metastasis was extremely poor, but otherwise, the mortality rate was similar to that for the general population. Follow-up of AIs [ncbi.nlm.nih.gov]

Abstract Adrenocortical carcinomas are extremely, rare, heterogeneous malignancies that arise from adrenal cortical cells and carries poor prognosis. [ispub.com]

Treatment and prognosis Small adrenal masses with manifestations of hormonal excess require resection, as do large (>3-5 cm) non-functioning adrenal mass lesions, as they are considered potentially malignant (see adrenal carcinoma ). [radiopaedia.org]

AI prevalence is higher in white than in black people and in obese, diabetic, and hypertensive patients. [10] Prognosis Generally, the prognosis is excellent, but it depends on the type of underlying adrenal disease. [emedicine.medscape.com]

The following paper is to summarize the etiology of the most common diagnostic mishaps which frequently lead to misdiagnoses, an increase in patient's anxiety and, as a consequence, in the introduction of improper therapy or its discontinuation. [ncbi.nlm.nih.gov]

The etiology for adrenal myelolipoma is not clear with numerous theories being proposed. [f1000research.com]

[…] consistent with subclinical Cushing syndrome, now presenting with osteoporosis, hypertension and glucose impairment with no signs of other excessive hormone secretion but now her chest x-Ray revealed a lesion in her left lung 27 mm in diameter of unknown etiology [endocrine-abstracts.org]

Most likely etiology of AI is pathology of AI is benign non-functional adenoma. [ijem.in]

They are organised into groups, and further divided into clinical, etiological or histopathological sub-types. [orpha.net]

We described the epidemiological characteristics of Adrenal Incidentalomas. We cited and commented the characteristics and pitfalls of various radiological modalities. [ncbi.nlm.nih.gov]

D E A B M I M EPIDEMIOLOGY Large increase at present due to increasing CT usage. - between 1-5% of CTs may have an incidental adrenal abnormality Increases with age. - 70 --> Greater concern for malignant potential with larger lesions in younger patients [gog.net.nz]

Clin Endocrinol (Oxf). 40 : 561 – 576. 18, et al. 1998 Epidemiology of osteoporosis in women in southern Italy. Aging Clin Exp Res. 10 : 53 – 58. 19. 1993 Bone density reference data. In: Favus MJ, ed. [academic.oup.com]

Epidemiology and treatment with mitotane and a review of the literature .Cancer 72(11):3145-55, 1993. 21. Hesketh PJ,McCaffrey RP. Finkel HE, et al.: Cisplatin based treatment of adrenocortical carcinoma.Cancer Treat Rep 71(2): 222-4, 1987. 22. [ispub.com]

Epidemiology Adrenal incidentalomas (AIs) are a common finding on cross-sectional abdominal images. [emedicine.medscape.com]

This issue will be broken down into 3 sections: Overview of Adrenal Cortical Development, Steroidogenesis, Comparative Anatomy and Molecular Pathophysiology; Benign Adrenal Tumors; and Adrenal Cortical Carcinoma. [books.google.de]

Evolving concepts in the pathophysiology, diagnosis and treatment of pheochromocytoma. Endocr Rev 15: 356, 1994. [link.springer.com]

Pathophysiology The biochemical mechanisms depend on the underlying cell type. The cellular mechanisms for primary adrenocortical tumorigenesis are just beginning to be understood. [emedicine.medscape.com]

[…] biochemical and radiological data necessary for assessing and managing AI patients. eAIMS will create a clear management pathway for AI patients, enabling multidisciplinary teams to provide a management plan in a timely and cost effective manner, thereby preventing [health.org.uk]

Therefore, elective surgery can prevent more severe symptom presentation and life-threatening progression and can allow accurate diagnosis in patients with tumors larger than 6 cm [ 33 ]. [omicsonline.org]

Results of the national program for prevention of beta-thalassemia major in the Iranian Province of Mazandaran. Hemoglobin. 2008; 32 (3): 263-71[ DOI ][ PubMed ] [numonthly.com]

[…] hormonal abnormalities, which have been associated with an increased risk of metabolic, cardiovascular and bone diseases. 3 Thus, identification of the incidental adrenal lesion provides the primary care physician with an opportunity to undertake early prevention [racgp.org.au]

Appropriate Prophylaxis and Other Measures to Prevent Readmission NA Arnaldi, G, Angeli, A, Atkinson, AB. "Diagnosis and complications of Cushing's syndrome: A consensus statement". J Clin Endocrinol Metab. vol. 88. 2003. pp. 5593-5602. Boscaro, M. [clinicaladvisor.com]