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

• 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]

• 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]

  Weight gain? Diabetes? Infertility? 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]

• 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]

  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]

• Cushingoid

  Even without Cushingoid features in pituitary incidentaloma, we concluded that the elevated ACTH and cortisol levels should be followed up by CRH, desmopressin and dexamethasone suppression tests. [ncbi.nlm.nih.gov]

  severe or paroxysmal hypertension, frank hypokalemia, Cushingoid features, or referral from another hospital for adrenal examination, n 93); 2) adrenal tumor smaller than 1.0 cm (n 13); 3) adrenal thickening or hyperplasia (n 32); or 4) missing baseline [kjim.org]

• Familial Adenomatous Polyposis

  CONCLUSIONS: Familial adenomatous polyposis-associated adrenal incidentaloma may warrant long-term follow-up. [ncbi.nlm.nih.gov]

  Marchesa P, Fazio VW, Church JM, McGannon E. adrenal masses in patients with familial adenomatous polyposis. Dis Colon Rectum 1997;40:1023–1028. 7. Gross MD, Shapiro B. Clinical review 50: clinically silent adrenal masses. [synapse.koreamed.org]

• Pseudotumor

  Berliner L, Bosniak MA, Megibow A: Adrenal pseudotumors on computed tomography. J Comput Assist Tomogr 1982;6:281–285. PubMed CrossRef Google Scholar (8). [link.springer.com]

• 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]

  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]

  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]

  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]

• 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]

  presented in 1995y. (23y.) as severe hirsutism and infertility managed by team of gynecologists. She refused any additional investigations and was severily depressed. Ex iuvantibus 0.5mg dexamethason therapy was followed with pregnancy. [endocrine-abstracts.org]

• 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]

  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]

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]

• Lymph Node Hyperplasia

  node hyperplasia (Castleman’s disease) of the hyaline-vascular type. [karger.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]

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). [journals.viamedica.pl]

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]

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]

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

Jockenhovel F, Kuck W, Benker G, Lederbogen S, Olbricht T, Reinwein D: Prognosis of untreated incidentally discovered adrenal tumors (incidentalomas). Clin Res 1991;39:26A. Google Scholar (35). [link.springer.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]

[…] 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]

Etiology Some studies report an association with chromosomal and genetic abnormalities (genes coding for p53 and p57). Tumor markers are also present in other syndromes. [emedicine.medscape.com]

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 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]

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]