echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Antitumor Therapy > "Expert Consensus on Multidisciplinary Management of Adrenal Accidental Tumor" was released, involving 24 recommendations and three flowcharts

    "Expert Consensus on Multidisciplinary Management of Adrenal Accidental Tumor" was released, involving 24 recommendations and three flowcharts

    • Last Update: 2021-09-30
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com

    Introduction: The management of Adrenal Accidental Tumor (AI) requires multidisciplinary collaboration such as the Department of Endocrinology, Imaging, Urology, Pathology, and Oncology
    .

    In view of the increasing trend of the detection rate of Adrenal Accidental Tumor (AI), in order to promote the comprehensive management of AI, after many discussions, the AI ​​Multidisciplinary Management Expert Group formulated the "Expert Consensus on Multidisciplinary Management of Adrenal Accidental Tumor" for readers’ reference.
    "Consensus" was recently published in "Chinese Journal of Endocrine Surgery"
    .

    (Download link attached at the end of the article) Strength of recommendation and level of evidence: ➤Strong recommendation uses "recommendation", weak recommendation uses "recommendation"; ➤Evidence quality: Very low quality evidence is ●○○○, ●●○○ is low quality Evidence, ●●●○ is medium-quality evidence, ●●●● is high-quality evidence; ➤Usually, the advantages of processing in accordance with the “strong recommendation” standard outweigh the disadvantages, and the “weak recommendation” requires the decision of the best plan based on the patient’s individual circumstances
    .

    1.
    Definition and Classification of Adrenal Accidental Tumor (AI) 1.
    Definition of Adrenal Accidental Tumor Adrenal Accidental Tumor (AI) refers to an adrenal nodule with a maximum diameter of ≥1cm found due to health examination or non-adrenal diseases
    .

    AI is an imaging definition, and its pathological changes may be tumors, nodular hyperplasia, cysts, or inflammatory nodules
    .

    Although there is insufficient evidence to define AI using 1cm, it is generally believed that only further inspections are needed for AIs ≥1cm
    .

    For nodules with a maximum diameter of less than 1 cm, if the patient has clinical manifestations such as hypertension, hypokalemia, Cushing appearance, or possible malignancy, further examination should be performed
    .

    Adrenal nodules (or adrenal space-occupying lesions) found due to suspected adrenal disease can also be managed with reference to this consensus
    .

    2.
    Classification of adrenal accidental tumors ➤According to whether the nodule secretes hormones, AI can be divided into non-functional nodules and functional nodules, of which non-functional nodules account for more than 70%
    .

    Functional nodules include autonomous secretion of aldosterone (primary aldosteronism, referred to as "protoaldosteronism" PA), autonomous cortisol secretion (ACS), pheochromocytoma (PCC), etc.
    ; ➤ According to benign and malignant, AI can be divided It is benign and malignant nodules, among which benign includes adenoma, hyperplasia, cyst, medullary lipoma, hemorrhage or hematoma, infectious disease, etc.
    , malignant includes adrenal cortical carcinoma, metastatic carcinoma, pheochromocytoma, lymphoma, neuroblast Cell tumor and so on
    .

    2.
    Benign and malignant assessment of adrenal accidental tumors Recommendation 1: All AIs should be assessed for benign and malignant tumors as soon as possible (●●●○)
    .

    Recommendation 2: CT plain scan is a preliminary assessment of AI benign and malignant (●●●○)
    .

    Recommendation: CT value ≤ 10 HU can basically exclude malignancy, CT value> 20 HU must consider the possibility of malignancy (●●○○) Recommendation 3: CT plain scan to initially assess AI benign and malignant (●●●○)
    .

    Recommendation: CT value ≤ 10 HU can basically exclude malignancy, and CT value> 20 HU must consider the possibility of malignancy (●●○○) Recommendation 4: Ultrasound imaging is difficult to distinguish between normal adrenal glands and retroperitoneal fat, and it cannot accurately identify adrenal tumors and Diffuse lesions
    .

    Ultrasound is not recommended as a routine imaging diagnostic method for the diagnosis of AI (●○○○)
    .

    Recommendation 5: Due to the limited clinical value of adrenal gland biopsy guided by CT or ultrasound, it is not recommended as a routine method for the assessment of benign and malignant adrenal glands (●○○○)
    .

    3.
    Functional evaluation of adrenal accidental tumor Recommendation 6: All AIs should undergo functional evaluation to understand whether they have related hormone secretion abnormalities (●●○○)
    .

    Recommendation 7: All AI patients with hypertension complete the primary aldehyde screening (●●●○) Recommendation 8: Normal blood pressure AI patients complete the primary aldehyde screening (●○○○) Recommendation 9: ARR screening positive AI patients need to undergo at least one confirmatory test (●●○○) Recommendation 10: Diagnosis of primary aldehydes, age at diagnosis <40 years, CT confirmed as unilateral adenoma, significantly high aldosterone and low renin, combined with spontaneous hypokalemia For patients with hyperemia, direct surgery is recommended (●●○○); Recommendation 11: AI patients who are diagnosed with primary aldemia but do not meet the above conditions and are willing to operate should first receive blood from the adrenal vein (●●●○) imaging alone cannot Accurately distinguish between non-functional tumors and aldosterone tumors, and bilateral adrenal venous blood sampling (AVS) has high sensitivity and specificity, and has been recognized as the "gold standard" for distinguishing unilateral or bilateral high secretion of aldosterone
    .

    After AVS diagnosed as UPA and undergoing unilateral adrenalectomy, most patients' hyperaldosteronemia can return to normal, renin inhibition and hypokalemia can be corrected, and nearly 50% of patients can also get hypertension The clinical cure
    .

    Therefore, for AI patients who are willing to operate, AVS is recommended to determine whether there is a dominant secretory side
    .

    Studies have shown that in patients under 40 years of age with typical biochemical manifestations, AVS results are basically consistent with CT when CT is a typical unilateral adenoma, so it can be operated directly without AVS
    .

    In addition, AVS is not required for AI patients who are not willing to surgery, cannot tolerate surgery or suspect aldosterone cancer
    .

    The diagnosis and treatment process of primary aldehydes is shown in Figure 1
    .

    ACS refers to hypercortisolism caused by adrenal gland disease and is a type of Cushing syndrome
    .

    The causes of ACS caused by AI include adrenal cortical adenomas, adenocarcinoma, primary bilateral macronodular adrenal hyperplasia (PBMAH) and primary pigmented nodular adrenal disease (PPNAD), among which adrenal cortical adenomas are the most common.
    Common, mostly subclinical Cushing’s syndrome, not accompanied by typical clinical manifestations of Cushing’s syndrome such as hypertension, full moon face, plethora of blood, and central obesity
    .

    The chance of ACS progressing to classic Cushing’s syndrome is low, but it can hardly resolve spontaneously
    .

    Studies have shown that ACS is not only closely related to metabolic diseases such as hypertension, obesity, hyperlipidemia and type 2 diabetes, but also increases the risk of cardiovascular events and death
    .

    The diagnosis and treatment process of ACS is shown in Figure 2
    .

    Recommendation 12: All patients with AI should measure the blood cortisol and ACTH concentrations, and complete the 1 mg dexamethasone suppression test (●●○○)
    .

    Recommendation 13: Actively evaluate the complications of ACS (●○○○) Recommendation 14: All AI patients need to measure blood or urine catecholamine metabolites (●●○○) Recommendation 15: Blood epinephrine and norepinephrine are susceptible to emotions, Due to factors such as exercise and drugs, the accuracy of diagnosis is poor.
    It is not recommended to use these two catecholamine hormones for the diagnosis of pheochromocytoma (●○○○)
    .

    Recommendation 16: AI patients considering CAH need to be tested for sex hormones and other steroid hormones (●○○○) 4.
    Treatment of adrenal accidental tumor Recommendation 17: Nodule CT value> 20 HU and AI with malignant signs should be treated with surgery ( ●●●○) Recommendation 18: Patients with AI with nodules> 3 cm may consider surgery (●○○○) Recommendation 19: Patients with high risk of malignant AI may consider surgery (●○○○) Recommendation 20: Combined metabolism Abnormal ACS should be treated with surgery (●●○○) Recommendation 21: Surgical treatment should be performed after the diagnosis of UPA (●●○○) Recommendation 22: If surgery is feasible, all pheochromocytomas should be treated with surgery (●●○○ ) Recommendation 23: A benign AI with no hormone secretion function can be followed up once every 1 to 2 years (●○ ○ ○) 5.
    Multidisciplinary management of adrenal accidental tumor Recommendation 24: All AIs should be discussed by a multidisciplinary team (MDT) before surgery (●○○○) The two key points of AI diagnosis are benign and malignant discrimination and functional assessment
    .

    AI management involves multidisciplinary collaborations such as endocrinology, imaging, urology, pathology, oncology, etc.
    It is recommended that all AIs conduct MDT discussions to determine surgical indications, surgical methods, and perioperative management priorities, and ultimately improve patient prognosis
    .

    The "first task" after the discovery of AI is its benign and malignant assessment and hormone secretion function assessment
    .

    Most AIs are benign and non-functional, but suspected malignant lesions and abnormal hormone secretion functions often require surgical treatment
    .

    Multidisciplinary joint diagnosis and treatment, and a reasonable diagnosis and treatment process are crucial to the prognosis of patients
    .

    The diagnosis and treatment process of AI is shown in the figure below
    .

    Download link: http://guide.
    medlive.
    cn/guideline/24171 Literature index: Adrenal accidental tumor multidisciplinary management expert group.
    Adrenal accidental tumor multidisciplinary management expert consensus[J].
    Chinese Journal of Endocrine Surgery.
    August 2021 Volume 15 Number 4.

    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.