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Endocrinol Diabetes Metab Case Rep 2021 Jun 1;2021. Epub 2021 Jun 1.

Department of Endocrinology, Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.

Summary: A male patient with a germline mutation in MEN1 presented at the age of 18 with classical features of gigantism. Previously, he had undergone resection of an insulin-secreting pancreatic neuroendocrine tumour (pNET) at the age of 10 years and had subtotal parathyroidectomy due to primary hyperparathyroidism at the age of 15 years. He was found to have significantly elevated serum IGF-1, GH, GHRH and calcitonin levels. Read More

Abdom Radiol (NY) 2021 Jun 12. Epub 2021 Jun 12.

Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

Objective: To compare MR-imaging features in benign lipid-rich and lipid-poor adrenal adenomas.

Materials And Methods: With institutional review board approval, we compared 23 consecutive lipid-poor adenomas (chemical shift [CS] signal intensity [SI] index < 16.5%) imaged with MRI to 29 consecutive lipid-rich adenomas (CS-SI index ≥ 16. Read More

Ann Lab Med 2021 Nov;41(6):521-531

Endocrinology Unit, Department of Medicine (DIMED), University-Hospital of Padova, Padova, Italy.

Cushing's syndrome (CS) is a rare disease caused by chronic and excessive cortisol secretion. When adrenocorticotropin hormone (ACTH) is measurable, autonomous adrenal cortisol secretion could be reasonably ruled out in a differential diagnosis of CS. ACTH-dependent CS accounts for 80%-85% of cases and involves cortisol production stimulated by uncontrolled pituitary or ectopic ACTH secretion. Read More

AACE Clin Case Rep 2021 Mar-Apr;7(2):149-152. Epub 2020 Dec 28.

Section of Endocrinology, Diabetes and Metabolism, Temple University Hospital, Philadelphia, Pennsylvania.

Objective: Our objective is to present a case of Cushing's disease (CD) with 2 adrenocorticotropic hormone (ACTH)-secreting pituitary tumors. Multiple monohormonal pituitary tumors are rare. This case supports a consideration of repeat transsphenoidal surgery (TSS) in patients with initial surgical failure. Read More

Abdom Radiol (NY) 2021 May 25. Epub 2021 May 25.

Department of Radiology, Tongde Hospital of Zhejiang Province, No.234, Gucui Road, Xihu Distinct, Hangzhou, 310012, Zhejiang Province, China.

Purpose: To evaluate the diagnostic performance of biphasic contrast-enhanced CT in differentiation of lipid-poor adenomas from pheochromocytomas.

Methods: 129 patients with 132 lipid-poor adenomas and 93 patients with 97 pheochromocytomas confirmed by pathology were included in this retrospective study. Patients underwent unenhanced abdominal CT scan followed by arterial and venous phase. Read More

J Pediatr Hematol Oncol 2021 May 18. Epub 2021 May 18.

Departments of Pediatric Endocrinology Pediatric Haematology and Oncology Histopathology Pediatric Surgery Radiology, Cambridge University Hospitals NHS Foundation Trust Department of Pathology, University of Cambridge Department of Pediatrics, East Suffolk and North Essex NHS Foundation Trust, Essex, UK.

Background: Adrenal masses are rare in children and most commonly present with clinical features of virilization in the absence of activation of the pituitary axis-gonadotrophin-independent precocious puberty.

Observations: We report an unusual case of a 7-year-old girl who presented with clinical signs suggestive of exposure to both androgens and estrogens. Imaging revealed a left-sided adrenal mass with no evidence of metastasis. Read More

Eur J Endocrinol 2021 Jun 5;185(1):155-165. Epub 2021 Jun 5.

Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Introduction: Although 18F-FDG PET was originally developed to evaluate benign and malignant tumors, the frequency of detection of benign adrenocortical adenomas showing FDG-PET accumulation has increased. However, the details of FDG-PET-accumulated benign adrenocortical adenomas have not been elucidated.

Methods: To elucidate the pathophysiology of FDG-PET-positive cortisol-producing adrenal tumors, we performed clinicopathological and genetic analyses of adrenocortical adenomas examing FDG-PET in 30 operated patients with unilateral cortisol-producing adrenal tumors (26 adrenal adenomas and 4 adrenal cancers). Read More

N Engl J Med 2021 Apr;384(16):1542-1551

From the Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.

Eur Rev Med Pharmacol Sci 2021 Apr;25(7):3028-3037

Endocrinology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Derince/Kocaeli, Turkey.

Objective: Few studies have used electrocardiography (ECG) to examine nonfunctional adrenal adenomas (NFAAs). No study has investigated the QRS-T angle in NFAA patients. We analyzed the frontal QRS-T angle of patients with incidentally discovered NFAAs. Read More

AACE Clin Case Rep 2021 Jan-Feb;7(1):61-64. Epub 2020 Dec 28.

Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, Louisiana.

Objective: In an adult endocrine clinic, the majority of patients referred for evaluation of an incidentally discovered adrenal mass are aged more than 30 years, for which many national and international societies have developed management guidelines. However, adrenal incidentalomas in children and young adults are uncommon. We report the case of an 18-year-old woman with an incidentally discovered right-sided adrenal mass. Read More

Pituitary 2021 Apr 9. Epub 2021 Apr 9.

Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA.

Purpose: To examine the clinical presentation and longitudinal outcome of Pituitary Apoplexy (PA) after gonadotropin-releasing hormone agonist (GnRHa) in a series of patients and compare to prior reports.

Methods: A retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed. Read More

Abdom Radiol (NY) 2021 Apr 8. Epub 2021 Apr 8.

Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA.

Purpose: To investigate the diagnostic performance of dual-layer dual-energy CT (dlDECT) in the evaluation of adrenal nodules.

Methods: In this retrospective study, 66 patients with triphasic dlDECT (unenhanced, venous phase (VP), delayed phase (DP)) for suspected adrenal lesions were included. Virtual unenhanced images (VUE) were derived from VP acquisitions. Read More

Neurology 2021 05 7;96(20):960-962. Epub 2021 Apr 7.

From the Departments of Neurology (S.M.L., S.Y.M.), Endocrinology (Y.J.C.), Ophthalmology (K.L.), Thyroid Endocrinology Surgery (H.K.K.), Cardiology (J.-S.P.), Neurosurgery (Y.C.L.), and Pathology (J.-H.K.), Ajou University School of Medicine; and Department of Medical Sciences (S.M.L.), Graduate School of Ajou University, Suwon, Republic of Korea.

Front Endocrinol (Lausanne) 2021 16;12:645488. Epub 2021 Mar 16.

Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan.

The hypothalamus-pituitary-adrenal (HPA) axis plays an important role in primary aldosteronism. Aldosterone biosynthesis is regulated not only by angiotensin II in the renin-angiotensin-aldosterone system, but also by adrenocorticotropic hormone (ACTH), one of the key components of the HPA axis. Although previous studies have reported cortisol cosecretion in primary aldosteronism, particularly aldosterone-producing adenoma (APA), the clinical relevance of such aldosterone and cortisol cosecretion from APA and hypertension or other metabolic disorders has not been fully established. Read More

J Hum Hypertens 2021 Mar 30. Epub 2021 Mar 30.

Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.

Although the aldosterone/renin ratio (ARR) is the preferred screening test for primary aldosteronism (PA), patients with non-suppressed renin and a falsely negative ARR on non-interfering medications have occasionally been reported. This report describes the clinical characteristics and outcomes of seven patients with proven aldosterone-producing adenoma (APA) and non-suppressed renin.Chart review of seven PA patients with an APA and a non-suppressed plasma renin concentration (PRC > 8. Read More

Int J Gen Med 2021 1;14:673-680. Epub 2021 Mar 1.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Purpose: Primary aldosteronism (PA) is mainly comprised of aldosterone-producing adenoma and bilateral idiopathic adrenal hyperplasia. Current guidelines recommend adrenal venous sampling (AVS) as a gold standard method to classify the subtypes. However, because of technical challenges in AVS including invasiveness of AVS and a wide range of success rate for cannulation, it is not uncommon that appropriate decisions could not be made depending on AVS. Read More

BJS Open 2021 01;5(1)

Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology DISCOG, University Hospital of Padova, Padua, Italy.

Background: The main challenge in the management of indeterminate incidentally discovered adrenal tumours is to differentiate benign from malignant lesions. In the absence of clear signs of invasion or metastases, imaging techniques do not always precisely define the nature of the mass. The present pilot study aimed to determine whether radiomics may predict malignancy in adrenocortical tumours. Read More

Mayo Clin Proc 2021 03;96(3):529-530

Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.

Endocr J 2021 Mar 4. Epub 2021 Mar 4.

Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan.

Advances in imaging technology and its widespread use have increased the number of identified patients with bilateral adrenal incidentalomas. The pathology of bilateral adrenal incidentalomas is gradually elucidated by its increased frequency. Although there is no consensus regarding the optimal management of bilateral adrenal lesions, adrenal lesions that are a suspected adrenocortical carcinoma on the basis of radiological imaging require surgical resection. Read More

J Endocr Soc 2021 Apr 25;5(4):bvab007. Epub 2021 Jan 25.

Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA.

Context: Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH-independent Cushing syndrome (CS) associated mostly with Carney complex (CNC), a rare autosomal dominant multiple neoplasia syndrome. More than two-thirds of familial cases and approximately one-third of sporadic cases of CNC harbor germline inactivating defects. Increasingly sensitive technologies for the detection of genetic defects such as next-generation sequencing (NGS) have further highlighted the importance of mosaicism in human disease. Read More

Abdom Radiol (NY) 2021 07 23;46(7):3523-3524. Epub 2021 Feb 23.

Hypertension and Emergency Unit, Department of Medicine - DIMED, University of Padua, Via Giustiniani, 2, 35126, Padova, Italy.

BMJ Case Rep 2021 Feb 23;14(2). Epub 2021 Feb 23.

Department of Radiology, University of Utah Health, Salt Lake City, UT, USA.

Myelolipomas are benign tumours typically occurring in the adrenal glands, made up of fat and trilineage haematopoeitic cells resembling bone marrow. Their aetiology is not well understood; however, they have a clear association with elevated serum adrenocorticotropic hormone (ACTH). Extra-adrenal myelolipomas are rare, and to our knowledge there are no previously reported cases of multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease. Read More

Internist (Berl) 2021 Mar 18;62(3):245-251. Epub 2021 Feb 18.

Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.

Aldosterone is produced in the adrenal cortex and governs volume and electrolyte homeostasis. Hyperaldosteronism can occur either as primary aldosteronism (renin-independent) or secondary aldosteronism (renin-dependent). As the commonest cause of secondary hypertension, primary aldosteronism is associated with increased cardiovascular risk. Read More

J Med Imaging Radiat Oncol 2021 Feb 17. Epub 2021 Feb 17.

Department of Radiology, St. Vincent's Hospital, Fitzroy, Victoria, Australia.

Our patient was a 53-year-old male with borderline resectable pancreatic adenocarcinoma who on his initial staging CT and subsequent MRI was found to have an incidental adrenal adenoma. Following completion of six cycles of neoadjuvant chemotherapy over a three-month period, the patient returned for restaging. The adrenal nodule had increased in size and had undergone necrosis with just a fine cuff of residual viable lesion at the margins. Read More

J Clin Res Pediatr Endocrinol 2021 Feb 15. Epub 2021 Feb 15.

Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey.

Silent corticotroph tumors are composed of corticotroph cells, but do not manifest any biochemical or clinical evidence of hypercortisolism. A choristoma is a benign, congenital proliferation of histologically mature tissue elements normally not present at the site of occurrence. The existence of adrenocortical cells within the pituitary gland, which can be explained as a choristoma, is a very rare entity, and the co-occurrence of these two entities have only been reported in few cases. Read More

J Clin Endocrinol Metab 2021 Apr;106(5):e2087-e2095

Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden.

Context: Current clinical guidelines suggest that adrenal venous sampling (AVS) may not be mandatory in young patients with primary aldosteronism (PA) and a solitary adrenal adenoma on imaging.

Objective: The aim of this study was to further elucidate whether conventional imaging alone is sufficient to distinguish unilateral from bilateral PA among patients aged 40 years or younger.

Methods: This was a retrospective study where data from 45 patients with PA, aged between 26 and 40 years, who underwent successful AVS between 2005 and 2019, were analyzed. Read More

BMJ Case Rep 2021 Jan 25;14(1). Epub 2021 Jan 25.

Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, MAHE, Manipal, Karnataka, India

Conn's syndrome is an important endocrine cause for secondary hypertension. Hypokalaemia paralysis and rhabdomyolysis with accelerated hypertension may be the presenting symptoms of Conn's syndrome. Here, we present one such case of a 38-year-old woman presenting with accelerated hypertension and acute onset quadriplegia. Read More

Clin Nucl Med 2021 04;46(4):350-352

From the Department of Nuclear Medicine and Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine.

Abstract: CXC chemokine receptor type 4 as a G-protein-coupled receptor has been confirmed to be highly expressed in functional adrenocortical adenomas. 68Ga-pentixafor, a CXC chemokine receptor type 4-specific ligand, has been reported as a promising tracer to evaluate functional nature of adrenal adenomas. We report intense 68Ga-pentixafor activity of cortisol-producing adrenal adenomas in 2 patients with adrenocorticotropic hormone-independent Cushing syndrome. Read More

Endocr Pract 2020 Aug;26(8):891-899

From the Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address:

Objective: We prospectively investigated the accuracy of the seated saline suppression test (SSST) in 113 patients with hypertension (including 93 primary aldosteronism [PA] and 20 essential hypertension patients) in the Department of Endocrinology and Metabolism.

Methods: Each patient underwent a recumbent saline suppression test (RSST) and SSST. The accuracy of the SSST for a confirmative PA diagnosis and subtype classification was evaluated and compared with the RSST. Read More

BMJ Case Rep 2021 Jan 18;14(1). Epub 2021 Jan 18.

Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Adrenal incidentalomas are incidentally detected adrenal lesions on imaging, which have a variety of differential diagnoses, the most common being a non-functioning adenoma. Surgical intervention for these lesions is needed when there is hypersecretion, for lesions larger than 4 cm and smaller lesions with suspicious characteristics. Here we present a young woman who was incidentally found to have a right suprarenal mass with loss of fat planes with the inferior vena cava (IVC). Read More