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Background
The management of adrenal incidentaloma is still a challenge with respect to determining its functionality (hormone secretion) and malignancy. In this light, we performed 18F-FDG PET/CT scan to assess the SUVmax values in different adrenal masses including Cushing syndrome, pheochromocytoma, primary hyperaldosteronism and non-functional adrenal adenomas.
Methods
Total 109 (73 F, 36 M) patients with adrenal mass (incidentaloma), mean age of 53.3 ± 10.2 years (range, 24–70) were screened by 18F-FDG PET/CT. Data of 18F-FDG PET/CT imaging of the patients were assessed by the same specialist. Adrenal masses were identified according to the calculated standardized uptake values (SUVs). Clinical examination, 24-h urine cortisol, catecholamine metabolites, 1-mg dexamethasone suppression test, aldosterone/renin ratio and serum electrolytes were analyzed.
Results
Based on the clinical and hormonal evaluations, there were 100 patients with non-functional adrenal mass, four with cortisol-secreting, four with pheochromocytomas and one with aldosterone-secreting adenoma. Mean adrenal mass diameter of 109 patients was 2.1 ± 4.3 (range, 1–6.5 cm). The 18F-FDG PET/CT imaging of the patients revealed that lower SUVmax values were found in non-functional adrenal masses (SUVmax 3.2) when compared to the functional adrenal masses including four with cortisol-secreting adenoma (SUVmax 10.1); four with pheochromcytoma (SUVmax 8.7) and one with aldosterone-secreting adenomas (SUVmax 3.30). Cortisol-secreting (Cushing syndrome) adrenal masses showed the highest SUVmax value (10.1), and a cut-off SUVmax of 4.135 was found with an 84.6% sensitivity and 75.6% specificity cortisol-secreting adrenal adenoma.
Conclusions
Consistent with the similar studies, non-functional adrenal adenomas typically do not show increased FDG uptake and a certain form of functional adenoma could present various FDG uptake in FDG PET/CT. Especially functional adrenal adenomas (cortisol secreting was the highest) showed increased FDG uptake in comparison to the non-functional adrenal masses. Therefore, setting a specific SUVmax value in the differentiation of malignant adrenal lesion from the benign one is risky and further studies, including a high number of functional adrenal mass are needed.
National Hospital for Neurology and Neurosurgery, London, UK
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National Hospital for Neurology and Neurosurgery, London, UK
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arteriovenous malformation Bacterial/viral meningitis Brainstem infarction Cavernous sinus thrombosis Management Ensure haemodynamic stability through supportive measures Urgent bloods: urea and electrolytes, full blood count, renal and liver
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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inhalers. In primary adrenal insufficiency cortisol deficiency is aggravated by a lack of adrenal aldosterone production, a hormone important for blood pressure and electrolyte regulation. This puts primary adrenal insufficiency patients at a somewhat
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-specialist clinicians and delay the appropriate treatment of this common and potentially life-threatening condition. Acute hypocalcaemia ( 5 ) and hypercalcaemia ( 6 ): disorders of calcium regulation are the second most common electrolyte disorder requiring endocrine
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magnesaemia) Cytotoxic drug-induced hypocalcaemia Pancreatitis, rhabdomyolysis and large volume blood transfusions Investigations Serum calcium (adjusted for albumin) Phosphate Parathyroid hormone (PTH) Urea and electrolytes Vitamin D Magnesium
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Look for shortened QT interval or other conduction abnormalities Bloods Calcium adjusted for albumin Phosphate PTH Urea and electrolytes High calcium and high PTH = primary or tertiary hyperparathyroidism* High calcium and low
Department of Clinical Research, University of Basel, Basel, Switzerland
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Central Laboratory, University Hospital Wuerzburg, Wuerzburg, Germany
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Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
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Department of Clinical Research, University of Basel, Basel, Switzerland
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, elevated intracranial pressure, correction of hyponatremia, and for fluid substitution during major operations, it has already been used since decades, with different concentrations and different infusion protocols ( 2 , 3 ). In these contexts, electrolyte
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Department of Molecular Surgery and Medicine, Karolinska Institute, Stockholm, Sweden
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Introduction Hyponatremia (HN) is the most common electrolyte disturbance in hospitalized patients constituting at least about 30% of patients in medical, surgical and psychiatric wards ( 1 , 2 ). The syndrome of inappropriate antidiuresis
Department of Clinical Science, Department of Medicine, Department of Medicine, Pediatric Department, University of Bergen, Bergen, Norway
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Department of Clinical Science, Department of Medicine, Department of Medicine, Pediatric Department, University of Bergen, Bergen, Norway
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Department of Clinical Science, Department of Medicine, Department of Medicine, Pediatric Department, University of Bergen, Bergen, Norway
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is hereditary (2, 3) , either isolated or combined with other electrolytes disturbances like Bartter's and Gitelman's syndromes. Over the last decades several genetic forms of hypomagnesemia have been identified, including mutations in transient
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admission. Renal function Blood urea nitrogen 4.99 mmol/L (2.86–7.90) Creatinine 105 µmol/L (44–133) Uric acid 380 µmol/L (148.8–416.5) Serum electrolytes Sodium 142 mmol/L (137–147) Potassium
