Incidentaloma differential diagnosis: Difference between revisions
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**Symptoms related to excess [[mineralocorticoid]] | **Symptoms related to excess [[mineralocorticoid]] | ||
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* Round and homogeneous density, smooth contour and sharp margination | |||
* Round and homogeneous density, smooth contour and sharp margination | |||
* Diameter less than 4 cm, unilateral location | * Diameter less than 4 cm, unilateral location | ||
* Low unenhanced CT attenuation values (<10 HU | * Low unenhanced [[Computed tomography|CT]] attenuation values (<10 HU) | ||
* Rapid contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of more than 50 percent) | * Rapid [[contrast medium]] washout (10 minutes after administration of contrast, an absolute [[contrast medium]] washout of more than 50 percent) | ||
* Isointensity with liver on both T1 and T2 weighted MRI sequences | * Isointensity with [[liver]] on both T1 and T2 weighted [[Magnetic resonance imaging|MRI]] sequences | ||
* Chemical shift evidence of lipid on MRI | * [[Chemical shift]]: evidence of [[lipid]] on [[Magnetic resonance imaging|MRI]] | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Adrenocortical carcinoma|'''Adrenocortica'''l carcinoma]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Adrenocortical carcinoma|'''Adrenocortica'''l carcinoma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |[null Insert paragraph] | ||
* Mass effect symptoms | * Mass effect symptoms | ||
* Symptoms related to excess [[glucocorticoid]] | |||
* Symptoms related to excess [[mineralocorticoid]] | |||
* Symptoms related to excess [[androgen]] or [[estrogen]] secretion | |||
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* Irregular shape | *Irregular shape | ||
* Inhomogeneous density because of central areas of low attenuation due to tumor necrosis | *Inhomogeneous density because of central areas of low attenuation due to [[tumor]] [[necrosis]] | ||
* Tumor calcification | *[[Tumor]] [[calcification]] | ||
* Diameter usually >4 cm | *Diameter usually >4 cm | ||
* Unilateral location | *Unilateral location | ||
* High unenhanced CT attenuation values (>20 HU) | *High unenhanced [[Computed tomography|CT]] attenuation values (>20 HU) | ||
* Inhomogeneous enhancement on CT with intravenous contrast | *Inhomogeneous enhancement on [[Computed tomography|CT]] with intravenous [[Contrast medium|contrast]] | ||
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent) | *Delay in [[contrast medium]] washout (10 minutes after administration of contrast, an absolute [[contrast medium]] washout of less than 50 percent) | ||
* Hypointensity compared with liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI | *Hypointensity compared with [[liver]] on T1 weighted [[Magnetic resonance imaging|MRI]] and high to intermediate signal intensity on T2 weighted [[Magnetic resonance imaging|MRI]] | ||
* High standardized uptake value (SUV) on FDG-PET-CT study | *High standardized uptake value (SUV) on FDG-[[PET scan|PET-CT]] study | ||
* Evidence of local invasion or metastases | *Evidence of local invasion or [[Metastasis|metastases]] | ||
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* [[Androgen|Adrenal androgens]] [[[DHEAS]]] | * [[Androgen|Adrenal androgens]] [[[DHEAS]]] | ||
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* [[Headache]] | * [[Headache]] | ||
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* Imaging may show | * Imaging may show [[mass]] if presents | ||
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* 24-hour urine [[cortisol]] | * 24-hour urine [[cortisol]] | ||
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* Paroxysmal attacks of [[hypertension]] but some patients have normal [[blood pressure]]. | * Paroxysmal attacks of [[hypertension]] but some patients have normal [[blood pressure]]. | ||
* It may be [[asymptomatic]] and discovered incidentally after [[Screening (medicine)|screening]] for [[MEN, type 2|MEN]] patients. | * It may be [[asymptomatic]] and discovered incidentally after [[Screening (medicine)|screening]] for [[MEN, type 2|MEN]] patients. | ||
| | |[null Insert paragraph] | ||
* Increased attenuation on nonenhanced CT (>20 HU) | * Increased attenuation on nonenhanced [[Computed tomography|CT]] (>20 HU) | ||
* Increased mass vascularity | * Increased [[mass]] vascularity | ||
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent) | * Delay in [[contrast medium]] washout (10 minutes after administration of contrast, an absolute [[contrast medium]] washout of less than 50 percent) | ||
* High signal intensity on T2 weighted MRI | * High signal intensity on T2 weighted [[Magnetic resonance imaging|MRI]] | ||
* Cystic and hemorrhagic changes | * Cystic and [[hemorrhagic]] changes | ||
* Variable size and may be bilateral | * Variable size and may be bilateral | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Adrenal metastases|Adrenal metastasis]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Adrenal metastases|Adrenal metastasis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Symptoms and signs of primary [[malignancy]] especially [[lung cancer]] | |||
* General constitutional symptoms: | |||
** Fever | ** [[Fever]] | ||
** Fatigue | ** [[Fatigue]] | ||
** Weight loss | ** [[Weight loss]] | ||
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* Irregular shape and inhomogeneous nature | **Irregular shape and inhomogeneous nature | ||
* Tendency to be bilateral | **Tendency to be bilateral | ||
* High unenhanced CT attenuation values (>20 HU) and enhancement with intravenous contrast on CT | **High unenhanced [[Computed tomography|CT]] attenuation values (>20 HU) and enhancement with [[Contrast medium|intravenous contrast]] on [[Computed tomography|CT]] | ||
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent) | **Delay in [[contrast medium]] washout (10 minutes after administration of contrast, an absolute [[contrast medium]] washout of less than 50 percent) | ||
* Isointensity or slightly less intense than the liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI (representing an increased water content) | **Isointensity or slightly less intense than the liver on T1 weighted [[Magnetic resonance imaging|MRI]] and high to intermediate signal intensity on T2 weighted [[Magnetic resonance imaging|MRI]] (representing an increased water content) | ||
* Elevated standardized uptake value on FDG-PET scan | **Elevated standardized uptake value on FDG-[[PET scan]] | ||
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Revision as of 20:39, 25 September 2017
Incidentaloma Microchapters |
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Incidentaloma differential diagnosis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Adrenal incidentaloma must be differentiated from other diseases that cause adrenal masses such as adrenal adenoma, adrenocortical carcinoma, Cushing's syndrome, pheochromocytoma, and metastasis.
Differentiating Incidentaloma from other Diseases
- Adrenal incidentaloma must be differentiated from other diseases that cause adrenal masses such as adrenal adenoma, adrenocortical carcinoma, Cushing's syndrome, pheochromocytoma, and metastasis.
Differential Diagnosis | Clinical picture | Imagings | Laboratory tests |
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Adrenal adenoma |
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Adrenocortical carcinoma | [null Insert paragraph]
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Cushing's syndrome |
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Pheochromocytoma |
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[null Insert paragraph]
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Adrenal metastasis |
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Differential diagnosis of Cushing's disease from other diseases
The table below summarizes the findings that differentiate Cushing's disease from other conditions that may cause hypertension, hyperandrogenism, and obesity. Facial plethora, skin changes, osteoporosis, nephrolithiasis and neuropsychiatric conditions should raise the concern for Cushing's syndrome.[1][2][3][4]
Differentiating pheochromocytoma from other diseasesPheochromocytoma must be differentiated from other causes of paroxysmal hypertension. The differentials include:
References
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