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Orlo H Clark - One of the best experts on this subject based on the ideXlab platform.
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adrenal Incidentaloma does an adequate workup rule out surprises
Surgery, 2010Co-Authors: Raymon H Grogan, Elliot J Mitmaker, Menno R Vriens, Avital Harari, Jessica E Gosnell, Wen T Shen, Orlo H ClarkAbstract:Background Adrenal Incidentaloma remains a diagnostic challenge. Despite well-established management guidelines, the long-term results of following these guidelines are unknown. We sought to determine how accurately these guidelines identify functioning Incidentalomas and how often these guidelines result in adrenalectomy for benign tumors. Methods We catalogued adrenal Incidentalomas from a retrospective review of 500 consecutive adrenalectomies at a single institution. The outcome measures studied were patient demographics, preoperative biochemical analysis, imaging characteristics, tumor size, type of operation performed, and postoperative histologic diagnosis. Results Eighty-one of the 500 adrenalectomies performed were for Incidentalomas. Size was the only significant characteristic that distinguished cortical cancers from benign adenomas. Only 1 out of 26 functioning tumors was incorrectly identified on preoperative workup. We also found that 25% of cortisol-secreting Incidentalomas were cystic, and that benign adenomas accounted for 42% of all tumors resected. Conclusion Current guidelines accurately predict the functional status of adrenal Incidentalomas. Some cystic lesions may be functioning and should therefore be screened for hormonal hypersecretion. However, even with the most up-to-date diagnostic tools available, most adrenal Incidentalomas resected are benign tumors.
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adrenal Incidentaloma borderline elevations of urine or plasma metanephrine levels and the subclinical pheochromocytoma
Archives of Surgery, 2007Co-Authors: Rasa Zarnegar, Wen T Shen, Electron Kebebew, Orlo H ClarkAbstract:Objective To assess the risk of pheochromocytoma in patients with borderline-elevated urine or plasma metanephrine levels. Design Retrospective review. Setting University tertiary care center. Patients Forty-two consecutive patients with adrenal Incidentalomas (defined as adrenal tumors identified during routine imaging for another condition) who were treated at the UCSF (University of California, San Francisco) Medical Center between January 1, 1995, and July 31, 2005. Patients with genetic syndromes were excluded. Intervention Laparoscopic adrenalectomy for adrenal Incidentaloma based on size criteria and preoperative hormonal test results. Main Outcomes Measures Urine or plasma metanephrine and catecholamine levels, tumor size, and presence of pheochromocytoma. Results Of 42 patients, 14 (33%) had a pheochromocytoma (11 of whom had clear-cut elevations in urine or plasma metanephrine levels defined as greater than 2 times the upper limit of normal) and 28 did not. Ten of the 42 patients (24%) had borderline elevations in urine or plasma metanephrine levels (defined as 1-2 times the upper limit of normal), 3 of whom had a pheochromocytoma (30%). Of patients with borderline elevations, mean ± SD tumor size was 5.4 ± 3.1 and 4.8 ± 1.9 cm for patients with and without pheochromocytoma, respectively ( P = .37). In these 10 patients, no clinical factors (age, sex, hypertension, presence of symptoms, number of antihypertensive medications, preoperative hemodynamics, or size of tumor on computed tomographic scan) allowed differentiation between those with and without pheochromocytoma. Conclusions Thirty percent of patients with adrenal Incidentaloma and borderline-elevated urine or plasma metanephrine levels had a pheochromocytoma. Clinical factors cannot distinguish between those with and without pheochromocytoma. In this group of patients, we advocate either routine alpha-blockade preoperatively or further diagnostic tests to better characterize the tumor.
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observation or laparoscopic adrenalectomy for adrenal Incidentaloma a surgical decision analysis
Medical Science Monitor, 2006Co-Authors: Laurent Brunaud, Rasa Zarnegar, Frederic Sebag, Electron Kebebew, Orlo H ClarkAbstract:BACKGROUND: The optimal strategy remains controversial for adrenal Incidentaloma, 4 to 6 cm in size, nonfunctioning, and without malignant imaging characteristics. A decision analysis model was used to identify relevant variables for selecting the optimal management (observation versus adrenalectomy). MATERIAL/METHODS: Risk/benefit analysis in tertiary care center. The probabilities of each health outcome states were determined by a review of the literature from 1980 to 2002 (n=2844 patients); and from a retrospective review of experience at University of California San Francisco (UCSF). RESULTS: The baseline probabilities of morbidity after laparoscopic unilateral adrenalectomy and a new indication developing during initial observation (hypersecretion, size increase, malignancy) were 7.8% and 3.1%, respectively. We found observation to be the preferred approach when using baseline probabilities and utilities. Laparoscopic adrenalectomy becomes the preferred approach however if: (1) The morbidity rate from laparoscopic unilateral adrenalectomy is 7.5%, 3) A patient's perspective of observation has a utility of lower than 98.6%, and (4) A patient views having a complication from adrenalectomy is not much deleterious (utility > 88.1%). CONCLUSIONS: This decision analysis model identifies the important variables for selecting the optimal management approach for adrenal Incidentalomas. These results can be used to select the optimal management strategy based on individual patient preference and surgeon-specific complication rate.
Joel M Gelfand - One of the best experts on this subject based on the ideXlab platform.
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prevalence of clinically significant incidental findings by whole body fludeoxyglucose f 18 positron emission tomography computed tomography scanning in moderate to severe psoriasis patients participating in clinical trials
Journal of The American Academy of Dermatology, 2019Co-Authors: Drew A Torigian, Abass Alavi, Judith Alvarez, Zelma Chiesa C Fuxench, Maryte Papadopoulos, Daniel B Shin, Junko Takeshita, Thomas J Werner, Nehal N Mehta, Joel M GelfandAbstract:Background There has been an increase in the number of psoriasis treatments being investigated in clinical trials. Patients may have undiagnosed issues at the start of a study which may become identified during follow-up as incident medicinal conditions. The prevalence of incidental findings in patients with moderate-to-severe psoriasis presenting for clinical trials is unknown. Objective Determine the prevalence of Incidentalomas and rate of malignancy identified by fludeoxyglucose F 18 (FDG) positron emission tomography/computed tomography (PET/CT) imaging in clinical trial patients with moderate-to-severe psoriasis. Methods A cross-sectional secondary analysis of patients with moderate-to-severe psoriasis who underwent FDG PET/CT scans at the baseline visit, before randomization, for 3 phase 4 clinical trials on vascular inflammation in psoriasis. Only patients without active infection, malignancy, or uncontrolled comorbidities were eligible for the clinical trials. Results A total of 259 healthy patients with moderate-to-severe psoriasis underwent an FDG PET/CT scan as part of the study procedures. In all, 31 patients (11.97%) (95% confidence interval [CI], 8.28-16.56) had clinically significant Incidentalomas on the baseline FDG PET/CT scan. Univariate logistic regression demonstrated that with every increase of 10 years of age, there was an approximate 30% increased risk of discovery of an Incidentaloma (odds ratio, 1.30; 95% CI, 1.01-1.68). Of those patients with findings suggestive of malignancy (n = 28), 6 were confirmed to have cancer, resulting in a 2.31% (95% CI, 0.9-5.0) prevalence of malignancy. The positive predictive value of a true cancer was 31.58% (range, 21%-54%). Limitations Generalizability and lost to follow-up. Conclusion Incidentalomas on FDG PET/CT imaging are common in otherwise healthy, asymptomatic patients with moderate-to-severe psoriasis in clinical trials. Our results can help inform interpretation of clinical trial safety data and emphasize the importance of compliance with cancer screening recommendations.
Bo Ahren - One of the best experts on this subject based on the ideXlab platform.
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adrenal Incidentaloma follow up results from a swedish prospective study
European Journal of Endocrinology, 2006Co-Authors: Birgitta Bulow, Svante Jansson, Claes Juhlin, Lars Steen, Marja Thoren, Hans Wahrenberg, Stig Valdemarsson, Bo Wangberg, Bo AhrenAbstract:Objectives: To examine the risk of developing adrenal carcinomas and clinically overt hypersecreting tumours during short-term follow-up in patients with adrenal Incidentalomas. Design: 229 (98 males and 131 females) patients with adrenal Incidentalomas were investigated in a prospective follow-up study (median time 25 months; range 3-108 months). The patients were registered between January 1996 and July 2001 and followed until December 2004. Twenty-seven Swedish hospitals contributed with follow-up results. Methods: Diagnostic procedures were undertaken according to a protocol including reinvestigation with Computed tomography scans after 3-6 months. 15-18 months and 27-30 months, as well as hormonal evaluation at baseline and after 27-30 months of follow-up. Operation was recommended when the Incidentaloma size increased or if there was a suspicion of a hypersecreting tumour. Results: The median age at diagnosis of the 229 patients included in the follow-up study was 64 years (range 28-84 years) and the median size of the adrenal Incidentalomas when discovered was 2.5 cm (range 1-8 cm). During the follow-up period, an increase in Incidentaloma size of >= 0.5 cm was reported in 17 (7.4%) and of >= 1.0 cm was reported in 12 (5.2%,) of the 229 patients. A decrease in size was seen in 12 patients (5.2%). A hypersecreting tumour was found in 2%, of the hormonally investigated patients: Cushing's syndrome (n = 2) and phaeochromocytoma (n = 1). Eleven patients underwent adrenalectomy, but no cases of primary adrenal malignancy were observed. Conclusions: Patients with adrenal Incidentaloma had a low risk of developing malignancy or hormonal hypersecretion during a short-term follow-up period.
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adrenal Incidentaloma experience of a standardized diagnostic programme in the swedish prospective study
Journal of Internal Medicine, 2002Co-Authors: Birgitta Bulow, Bo AhrenAbstract:Bulow B, Ahren B (Lund University, Lund, Sweden) on behalf of the Swedish Research Council Study Group of Endocrine Abdominal Tumours. Adrenal Incidentaloma - experience of a standardized diagnostic programme in the Swedish prospective study. J Intern Med 2002; 252: 239-246. OBJECTIVE: To report the 5-year experience of a diagnostic programme for adrenal Incidentaloma with special emphasis to diagnose hormonally active and malignant lesions. DESIGN: A prospective study in which new cases of adrenal Incidentalomas in Sweden have been evaluated by a standardized diagnostic protocol between January 1996 and July 2001. SETTING: Thirty-three different Swedish hospitals have contributed with cases. SUBJECTS: A total of 381 patients (217 females, 164 males) with adrenal Incidentalomas were studied. INTERVENTIONS: Diagnostic procedures were undertaken according to a standardized programme. Operation was recommended if the Incidentaloma had a size of more than 3-4 cm or if there was a suspicion of a hypersecreting tumour. MAIN OUTCOME MEASURES: The size of the Incidentaloma, clinical characteristics of the patients and results of biochemical diagnostic tests were registered. RESULTS: The median age of the patients was 64 years (18-84 years), and the median size of the Incidentalomas was 3 cm (1-20 cm). A total of 85(22%) patients were operated. Twenty of thesepatients were diagnosed with a benign hypersecreting tumour and 14 with a malignant tumour. Fourteen of 15 operated patients with diagnosed pheochromocytoma had elevated 24-h urinary noradrenaline and all of the patients operated because of a biochemical suspicion of aldosterone or cortisol hypersecretion (n = 6) were found to have adrenal adenomas. Of the 14 operated patients with malignant diseases, 10 were adrenal carcinomas (median size 10 cm; range 4-16 cm). In a multiple logistic regression model, Incidentaloma size was significantly associated with the risk of a malignant tumour (P = 0.009), and there was a tendency of an association between age/male sex and the risk of a malignancy (both, P = 0.07). CONCLUSION: In this Swedish multicentre study of 381 cases with adrenal Incidentalomas, 5% had benign hypersecreting tumours and nearly 4% had malignant tumours. The results of the biochemical diagnostic tests used had a high compatibility with the histological diagnosis found at operation in the patients with hypersecreting tumours. Tumour size, male gender and high age were predictive for the risk of a malignant tumour. A follow-up of the patients is warranted in order to establish whether there are undiscovered cases of malignant or hypersecreting tumours amongst the nonoperated patients.
Seungyong Jeong - One of the best experts on this subject based on the ideXlab platform.
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prevalence and risk of cancer of focal thyroid Incidentaloma identified by 18f fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects
The Journal of Clinical Endocrinology and Metabolism, 2003Co-Authors: Keon Wook Kang, Hansung Kang, Seungyong JeongAbstract:We performed a retrospective review of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) examination to determine the prevalence of thyroid FDG-PET Incidentaloma in a patient group evaluated for metastasis of cancer and in a group of healthy subjects who underwent voluntary cancer screening. We also evaluated the risk of malignancy in focal thyroid FDG-PET Incidentaloma and its association with standard uptake values (SUVs) (maximum and greater than 0.75 threshold). A total of 1330 subjects underwent FDG-PET for metastasis evaluation (n = 999) and cancer screening (n = 331). Twenty-nine of 1330 subjects (2.2%) showed focal (n = 21) or diffuse (n = 8) thyroid FDG-PET Incidentaloma. There was no significant difference in the prevalence of thyroid FDG-PET Incidentaloma between the two groups (19 of 999 vs. 10 of 331; P > 0.05). Four of 15 focal Incidentalomas (26.7%) whose histological diagnoses were available showed papillary thyroid cancer. The maximum SUV (16.5 ± 4.70) and greater than 0.75 th...
Wen T Shen - One of the best experts on this subject based on the ideXlab platform.
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Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions
JAMA Surgery, 2015Co-Authors: Jesse D. Pasternak, Jessica E Gosnell, Carolyn D. Seib, Natalie Seiser, J. Blake Tyrell, Robin M. Cisco, Wen T ShenAbstract:Importance Adrenal Incidentalomas are found in 1% to 5% of abdominal cross-sectional imaging studies. Although the workup and management of unilateral lesions are well established, limited information exists for bilateral Incidentalomas. Objective To compare the natural history of patients having bilateral Incidentalomas with those having unilateral Incidentalomas. Design, Setting, and Participants Retrospective analysis of a prospective database of consecutive patients referred to an academic multidisciplinary adrenal conference. The setting was a tertiary care university hospital among a cohort of 500 patients with adrenal lesions between July 1, 2009, and July 1, 2014. Main Outcomes and Measures Prevalence, age, imaging characteristics, biochemical workup, any intervention, and final diagnosis. Results Twenty-three patients with bilateral Incidentalomas and 112 patients with unilateral Incidentalomas were identified. The mean age at diagnosis of bilateral lesions was 58.7 years. The mean lesion size was 2.4 cm on the right side and 2.8 cm on the left side. Bilateral Incidentalomas were associated with a significantly higher prevalence of subclinical Cushing syndrome (21.7% [5 of 23] vs 6.2% [7 of 112]) ( P = .009) and a significantly lower prevalence of pheochromocytoma (4.3% [1 of 23] vs 19.6% [22 of 112]) ( P = .003) compared with unilateral lesions, while rates of hyperaldosteronism were similar in both groups (4.3% [1 of 23] vs 5.4% [6 of 112]) ( P > .99). Only one patient with bilateral Incidentalomas underwent unilateral resection. The mean follow-up was 4 years (range, 1.2-13.0 years). There were no occult adrenocortical carcinomas. Conclusions and Relevance Bilateral Incidentalomas are more likely to be associated with subclinical Cushing syndrome and less likely to be pheochromocytomas. Although patients with bilateral Incidentalomas undergo a workup similar to that in patients with unilateral lesions, differences in their natural history warrant a greater index of suspicion for subclinical Cushing syndrome.
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adrenal Incidentaloma does an adequate workup rule out surprises
Surgery, 2010Co-Authors: Raymon H Grogan, Elliot J Mitmaker, Menno R Vriens, Avital Harari, Jessica E Gosnell, Wen T Shen, Orlo H ClarkAbstract:Background Adrenal Incidentaloma remains a diagnostic challenge. Despite well-established management guidelines, the long-term results of following these guidelines are unknown. We sought to determine how accurately these guidelines identify functioning Incidentalomas and how often these guidelines result in adrenalectomy for benign tumors. Methods We catalogued adrenal Incidentalomas from a retrospective review of 500 consecutive adrenalectomies at a single institution. The outcome measures studied were patient demographics, preoperative biochemical analysis, imaging characteristics, tumor size, type of operation performed, and postoperative histologic diagnosis. Results Eighty-one of the 500 adrenalectomies performed were for Incidentalomas. Size was the only significant characteristic that distinguished cortical cancers from benign adenomas. Only 1 out of 26 functioning tumors was incorrectly identified on preoperative workup. We also found that 25% of cortisol-secreting Incidentalomas were cystic, and that benign adenomas accounted for 42% of all tumors resected. Conclusion Current guidelines accurately predict the functional status of adrenal Incidentalomas. Some cystic lesions may be functioning and should therefore be screened for hormonal hypersecretion. However, even with the most up-to-date diagnostic tools available, most adrenal Incidentalomas resected are benign tumors.
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adrenal Incidentaloma borderline elevations of urine or plasma metanephrine levels and the subclinical pheochromocytoma
Archives of Surgery, 2007Co-Authors: Rasa Zarnegar, Wen T Shen, Electron Kebebew, Orlo H ClarkAbstract:Objective To assess the risk of pheochromocytoma in patients with borderline-elevated urine or plasma metanephrine levels. Design Retrospective review. Setting University tertiary care center. Patients Forty-two consecutive patients with adrenal Incidentalomas (defined as adrenal tumors identified during routine imaging for another condition) who were treated at the UCSF (University of California, San Francisco) Medical Center between January 1, 1995, and July 31, 2005. Patients with genetic syndromes were excluded. Intervention Laparoscopic adrenalectomy for adrenal Incidentaloma based on size criteria and preoperative hormonal test results. Main Outcomes Measures Urine or plasma metanephrine and catecholamine levels, tumor size, and presence of pheochromocytoma. Results Of 42 patients, 14 (33%) had a pheochromocytoma (11 of whom had clear-cut elevations in urine or plasma metanephrine levels defined as greater than 2 times the upper limit of normal) and 28 did not. Ten of the 42 patients (24%) had borderline elevations in urine or plasma metanephrine levels (defined as 1-2 times the upper limit of normal), 3 of whom had a pheochromocytoma (30%). Of patients with borderline elevations, mean ± SD tumor size was 5.4 ± 3.1 and 4.8 ± 1.9 cm for patients with and without pheochromocytoma, respectively ( P = .37). In these 10 patients, no clinical factors (age, sex, hypertension, presence of symptoms, number of antihypertensive medications, preoperative hemodynamics, or size of tumor on computed tomographic scan) allowed differentiation between those with and without pheochromocytoma. Conclusions Thirty percent of patients with adrenal Incidentaloma and borderline-elevated urine or plasma metanephrine levels had a pheochromocytoma. Clinical factors cannot distinguish between those with and without pheochromocytoma. In this group of patients, we advocate either routine alpha-blockade preoperatively or further diagnostic tests to better characterize the tumor.
