S8 - Doenças da Suprarrenal (Hiperaldosteronismo, Feocromocitoma) Flashcards
Adrenal Incidentalomas?
Adrenal mass (>1 cm), which is discovered incidentally on an imaging examination performed for unrelated reasons
Assessment of the risk of malignancy?
Establish if an adrenal mass is benign or malignant at the time of initial detection.
Adrenal incidentalomas undergo an imaging procedure to determine if the mass is homogeneous and lipid-rich and therefore benign (noncontrast CT)
What non-contrast CT characteristics are consistent with a benign adrenal mass?
Homogeneous and smaller than 4 cm
Size and relation with risk?
Size remains an important predictor of the risk of adrenal cortical cancer and needs to be taken into account during evaluation.
If the adrenal mass is indeterminate on non-contrast CT and the results of the hormonal work-up do not indicate significant hormone excess?
Immediate additional imaging with another modality
Interval imaging in 6– 12 months (non-contrast CT or MRI)
Surgery without further delay
Biopsy?
Recommend against the use of an adrenal biopsy in the diagnostic work-up of patients with adrenal masses unless there is a history of extra-adrenal malignancy and additional criteria are fulfilled
Assessment for hormone excess?
All patients with adrenal incidentalomas undergo a 1 mg overnight DST to exclude cortisol excess
Serum cortisol levels post dexamethasone (≤1.8 μg/dL) as a diagnostic criterion for the exclusion of autonomous cortisol secretion
1 mg overnight DST results?
Serum cortisol levels post dexamethasone (≤1.8 μg/dL) as a diagnostic criterion for the exclusion of autonomous cortisol secretion.
Cortisol levels of 1.9–5.0 μg/dL should be considered as evidence of ‘possible autonomous cortisol secretion’
Cortisol levels post dexamethasone >5.0 μg/dL) should be taken as evidence of ‘autonomous cortisol secretion’.
Screening de comorbilidades?
Screening patients with ‘possible autonomous cortisol secretion’ or ‘autonomous cortisol secretion’ for hypertension and type 2 Diabetes Mellitus, and asymptomatic vertebral fractures
What should be considered in all patients considered for surgery?
ACTH-independency of cortisol excess should be confirmed
The recommended way to exclude pheochromocytoma?
Measurement of plasma-free metanephrines or
urinary fractionated metanephrines
Patients with concomitant hypertension or
unexplained hypokalemia?
Use of the aldosterone/renin ratio to exclude primary
aldosteronism
Patients with clinical or imaging features suggestive of adrenocortical carcinoma?
Measurement of sex hormones and steroid precursors
Metastases to the adrenal glands?
Primary tumors of the lung, breast, kidney, and gastrointestinal tract and melanoma or lymphoma
Typically bilateral and large (>3 cm)
History of malignant disease
Risk of pheochromocytoma in the autopsy?
Hypertensive crisis
