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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

BMC Infect Dis 2021 Jun 7;21(1):537. Epub 2021 Jun 7.

Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.

Background: Invasive aspergillosis of the central nervous system is a rare but increasingly prevalent disease. We present the unusual case of an immunosuppressed patient suffering from unexpected superinfected invasive aspergillosis with cerebral, pulmonal, and adrenal manifestations, mimicking a metastasized bronchial carcinoma. This report reveals the importance of including aspergillosis in the differential diagnosis of a cerebral mass lesion in the light of unspecific clinical findings. Read More

BMJ Case Rep 2021 Jun 2;14(6). Epub 2021 Jun 2.

Universidade Nova de Lisboa Faculdade de Ciências Médicas, Lisboa, Portugal

Adrenocortical carcinoma (ACC) is a rare malignancy, with an estimated annual incidence of 0.7-2 cases per million and a median overall survival of 3-4 years. Hormone-secreting ACCs represent most cases; of these, only a small minority presents with virilisation alone. Read More

Exp Ther Med 2021 Jul 18;22(1):772. Epub 2021 May 18.

Discipline of Pediatric Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Independent Cushing's adrenocorticotropic hormone (ACTH) syndrome can have several causes, including adrenal carcinoma or simple adrenal hyperplasia. Although the distinction between malignant and benign can be effectively made through imaging investigations, in the situation where there are bilateral formations, their hormonal activity is impossible to appreciate via non-invasive techniques. The present study includes the presentation of a clinical case on the basis of which a literature review was made. Read More

Endocr J 2021 May 18. Epub 2021 May 18.

Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920-8641, Japan.

The adrenal glands are one of the most common sites of malignant tumor metastasis. However, metastatic adrenal carcinoma of unknown primary origin with localized adrenal gland involvement is an extremely rare condition. Herein, we reported two cases of carcinoma of unknown primary origin with isolated adrenal metastasis. Read More

BMJ Case Rep 2021 May 19;14(5). Epub 2021 May 19.

Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India

Computed tomography (CT) scan is a useful and widely performed diagnostic modality to evaluate adrenal masses. Nature of the mass determines the degree of attenuation both in unenhanced and in different phases of contrast enhancement. Benign neurogenic tumours like ganglioneuroma mimicks pheochromocytoma and adrenocortical carcinoma in non-contrast CT scan. Read More

Cureus 2021 Apr 1;13(4):e14235. Epub 2021 Apr 1.

Endocrinology, Diabetes and Metabolism, Faculty of Medical Sciences, Lebanese University, Beirut, LBN.

Incidentalomas are commonly encountered adrenal lesions. However, adrenocortical carcinoma (ACC) represents a rare etiology of adrenal incidentalomas (AI). The diagnosis of AI is generally based on laboratory data and imaging results, Fine needle aspiration (FNA) is not usually indicated in the workup of incidentaloma. Read More

In Vivo 2021 May-Jun;35(3):1805-1810

Department of Oncology-Radiotherapy, "Prof. Dr. Alexandru Trestioreanu" Institute of Oncology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

Background/aim: Kidney cancers account for about 2% of human malignancies. In recent decades, the incidence of this cancer type has gradually increased, mainly due to advances in imaging. The metastatic potential of these cancers is significant: a quarter of patients will immediately present with metastases and more than one third of patients treated with nephrectomy for a localized disease will develop metastases during their course. Read More

Radiol Case Rep 2021 Jun 3;16(6):1329-1334. Epub 2021 Apr 3.

Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.

Adrenocortical carcinoma (ACC) is a rare malignancy that arises from the adrenal cortex and can be classified as either non-functioning or functioning. A patient with non-functioning ACC may present no specific symptoms. Imaging analysis can provide some information to a clinician who suspects ACC, such as tumor size, density, washout, necrosis, hemorrhage, and calcification. Read More

N Engl J Med 2021 Apr;384(16):e57

Mount Sinai Hospital, Toronto, ON, Canada

Endocr Pract 2020 Nov 14;26(11):1366-1383. Epub 2020 Dec 14.

Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan. Electronic address:

Objective: The aim of this Disease State Clinical Review is to provide a practical approach to patients with newly diagnosed adrenocortical carcinoma, as well as to follow-up and management of patients with persistent or recurrent disease.

Methods: This is a case-based clinical review. The provided recommendations are based on evidence available from randomized prospective clinical studies, cohort studies, cross-sectional and case-based studies, and expert opinions. Read More

Rev Med Chil 2020 Nov;148(11):1679-1683

Facultad de Medicina, Universidad de Antofagasta, Antofagasta, Chile.

We report a previously healthy 34-year-old woman, presenting with a seven-month history of arterial hypertension, amenorrhea, weight gain, facial edema, acne, hirsutism and low back pain. A CT scan showed a right adrenal mass of 18 × 13 × 12.5 cm, and multiple vertebral and rib fractures. 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

J Clin Oncol 2021 Apr 6:JCO2002871. Epub 2021 Apr 6.

Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.

Purpose: Adrenocortical carcinoma (ACC) is a rare aggressive pediatric malignancy with distinct biology. Its treatment follows the principles developed for adults; pediatric-specific studies are scarce.

Patients And Methods: Prospective single-arm risk-stratified interventional study. Read More

Am J Case Rep 2021 Apr 4;22:e928875. Epub 2021 Apr 4.

4th Academic Department of General Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece.

BACKGROUND Adrenocortical carcinomas are rare and aggressive tumors often diagnosed as incidentalomas. The malignancy can present with abnormal hormone secretion or the tumor may be non-functioning and present as a palpable mass causing discomfort. Here, we present a case of an adrenal cortical carcinoma originally identified as an incidentaloma. Read More

Cancers (Basel) 2021 Mar 31;13(7). Epub 2021 Mar 31.

Department of Diagnostic and Interventional Imaging, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France.

The major prognosis factor of adrenocortical carcinoma (ACC) is the completeness of surgery. The aim of our study was to identify preoperative imaging features associated with direct liver involvement (DLI) by right-sided ACC. Two radiologists, blinded to the outcome, independently reviewed preoperative CT and MRI examinations for eight signs of DLI, in patients operated for right-sided ACC and retrospectively included from November 2007 to January 2020. Read More

N Engl J Med 2021 Apr;384(13):e50

AJR Am J Roentgenol 2021 Mar 24. Epub 2021 Mar 24.

Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.

This article reviews the essential role of imaging in clinical staging and restaging of renal cell carcinoma (RCC). To completely characterize and stage an indeterminate renal mass, renal CT or MRI without and with IV contrast administration is recommended. The critical items for initial clinical staging of an indeterminate renal mass or of a known RCC according to the TNM staging system are tumor size, renal sinus fat invasion, urinary collecting system invasion, perinephric fat invasion, venous invasion, adrenal gland invasion, invasion of the perirenal (Gerota's) fascia, invasion into other adjacent organs, the presence of enlarged or pathologic regional (retroperitoneal) lymph nodes, and the presence of distant metastatic disease. Read More

Curr Opin Endocrinol Diabetes Obes 2021 Jun;28(3):291-302

Adrenal Research Laboratory, The Discipline of Pharmacology and Therapeutics, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Ireland.

Purpose Of Review: To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland.

Recent Findings: Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma.

Summary: Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Read More

J Clin Endocrinol Metab 2021 Mar 19. Epub 2021 Mar 19.

Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.

Context: The adrenal cortex produces specific steroid hormones including steroid sulfates such as dehydroepiandrosterone sulfate (DHEAS), the most abundant steroid hormone in the human circulation. Steroid sulfation involves a multi-step enzyme machinery that may be impaired by inborn errors of steroid metabolism. Emerging data suggest a role of steroid sulfates in the pathophysiology of adrenal tumors and as potential biomarkers. Read More

Medicine (Baltimore) 2021 Mar;100(10):e24010

Department of Urology, Tongji Hospital Affiliated Tongji Medical College of Huazhong University of Science and Technology (HUST), 1095 Jiefang Avenue, Wuhan, China.

Rationale: Renal-occupying lesions positive for urine fluorescence in situ hybridization (FISH) are usually considered urothelial carcinomas. Here, we describe 2 cases of renal metastases with chromosome duplications in urine exfoliated cells.

Patient Symptoms: Patient 1, a 56-year-old male with a history of esophageal cancer, was admitted to our hospital on May 2017 after presenting with right back pain with microscopic hematuria for 1 month. Read More

Int J Surg Case Rep 2021 Apr 5;81:105729. Epub 2021 Mar 5.

Department of Surgery, Shiga General Hospital, Moriyama, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan. Electronic address:

Introduction And Importance: Definitive diagnosis of functioning neuroendocrine neoplasms (NENs) in the pancreas is challenging. Adrenocorticotropic hormone (ACTH) regulates adrenal cortisol production. Ectopic ACTH secretion by functioning NENs may cause hypercortisolism. Read More

Cancer Med 2021 04 9;10(7):2259-2267. Epub 2021 Mar 9.

Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institute of Biomedical Imaging and Bioengineering and National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.

Background: To evaluate outcomes and survival rates in patients with metastatic adrenocortical carcinoma (ACC) who were treated with image-guided locoregional treatments (IGLTs).

Purpose: To evaluate the overall survival (OS) and clinical impact of IGLT in the management of patients with advanced metastatic ACC.

Methods: Retrospective review of 39 patients treated with IGLT between 1999 and 2018 was performed. 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

BMJ Case Rep 2021 Mar 4;14(3). Epub 2021 Mar 4.

Acute Medicine, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK.

Adrenocortical carcinoma is a rare tumour but hypertension conversely is very common. We present the case of a woman in her 30s, with poorly controlled hypertension on four antihypertensive agents. She was referred to the accident and emergency department with hypokalaemia. Read More

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

Georgian Med News 2021 Jan(310):7-11

Sakarya University, Medicine Faculty, Department of Internal Medicine; Sakarya University, Turkey.

We present a case of androgen and glucocorticoid secreting adrenocortical carcinoma with concomitant myelolipoma. A giant adrenal tumor which was initially nonfunctional was reassessed four years later due to the patient's refusal to treat. The patient was a 48-year-old woman with hypertension and acne lesions on the face. Read More

Pol Arch Intern Med 2021 04 24;131(4):384-386. Epub 2021 Feb 24.

Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wrocław, Poland.

BMJ Case Rep 2021 Feb 22;14(2). Epub 2021 Feb 22.

Department of Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

We report two cases highlighting the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computerised tomography (18F FDG PET/CT) in the diagnostic and preoperative workup of indeterminate adrenal masses. Case 1: a 60-year-old man was diagnosed with a large left-sided adrenal mass with indeterminate radiological characteristics on CT. Biochemical investigations ruled out tumour hypersecretion. Read More

EJNMMI Res 2021 Feb 18;11(1):17. Epub 2021 Feb 18.

Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.

Background: Adrenocortical carcinoma (ACC) is an uncommon malignancy with an estimated 15,400 new cases annually across the globe. The prognosis is generally poor as the disease is often already advanced at initial diagnosis due to non-specific symptoms. Even for local disease, recurrence after surgical resection is high. Read More