Incidentaloma differential diagnosis: Difference between revisions
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**Symptoms related to excess [[glucocorticoid]] | **Symptoms related to excess [[glucocorticoid]] | ||
**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 | ||
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* Isointensity with [[liver]] on both T1 and T2 weighted [[Magnetic resonance imaging|MRI]] sequences | * Isointensity with [[liver]] on both T1 and T2 weighted [[Magnetic resonance imaging|MRI]] sequences | ||
* [[Chemical shift]]: evidence of [[lipid]] on [[Magnetic resonance imaging|MRI]] | * [[Chemical shift]]: evidence of [[lipid]] on [[Magnetic resonance imaging|MRI]] | ||
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* [[Cortisol level]] | * [[Cortisol level]] | ||
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* Symptoms related to excess [[mineralocorticoid]] | * Symptoms related to excess [[mineralocorticoid]] | ||
* Symptoms related to excess [[androgen]] or [[estrogen]] secretion | * 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]] | ||
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*High standardized uptake value (SUV) on FDG-[[PET scan|PET-CT]] study | *High standardized uptake value (SUV) on FDG-[[PET scan|PET-CT]] study | ||
*Evidence of local invasion or [[Metastasis|metastases]] | *Evidence of local invasion or [[Metastasis|metastases]] | ||
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* [[Androgen|Adrenal androgens]] [[[DHEAS]]] | * [[Androgen|Adrenal androgens]] [[[DHEAS]]] | ||
* [[Androstenedione]] | * [[Androstenedione]] | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Cushing's syndrome]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Cushing's syndrome]]''' | ||
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* Rapid [[Obesity|weight gain]], particularly of the [[trunk]] and [[face]] with [[limbs]] sparing ([[central obesity]]) | * Rapid [[Obesity|weight gain]], particularly of the [[trunk]] and [[face]] with [[limbs]] sparing ([[central obesity]]) | ||
* Proximal [[muscle weakness]] | * Proximal [[muscle weakness]] | ||
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* Excess [[sweating]] | * Excess [[sweating]] | ||
* [[Headache]] | * [[Headache]] | ||
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* Imaging may show [[mass]] if presents | * Imaging may show [[mass]] if presents | ||
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* 24-hour urine [[cortisol]] | * 24-hour urine [[cortisol]] | ||
* Midnight salivary [[cortisol]] | * Midnight salivary [[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. | ||
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* Increased attenuation on nonenhanced [[Computed tomography|CT]] (>20 HU) | * Increased attenuation on nonenhanced [[Computed tomography|CT]] (>20 HU) | ||
* Increased [[mass]] vascularity | * Increased [[mass]] vascularity | ||
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** [[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 | ||
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**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) | **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 19:26, 16 October 2017
Incidentaloma Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Incidentaloma differential diagnosis On the Web |
American Roentgen Ray Society Images of Incidentaloma differential diagnosis |
Risk calculators and risk factors for Incidentaloma differential diagnosis |
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 different causese of Incidentaloma
- The cause of adrenal incidentaloma commonly include adrenal adenoma, sub-clinical Cushing's syndrome, pheochromocytoma, and adrenocortical carcinoma. These causes can be differentiated from each other as follows:
Differential Diagnosis | Clinical picture | Imagings | Laboratory tests | |
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Adrenal adenoma |
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Adrenocortical carcinoma |
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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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