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Endocrine Reviews Dec 2020An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients... (Review)
Review
An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup, and clinical symptoms and signs are required in every case. Adrenocortical carcinoma remains a real concern but is restricted to <2% of all cases. Functional adrenal incidentaloma lesions are commoner (but still probably <10% of total) and the greatest challenge remains the diagnosis and optimum management of autonomous cortisol secretion. Modern-day surgery has improved outcomes and novel radiological and urinary biomarkers will improve early detection and patient stratification in future years to come.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Humans
PubMed: 32266384
DOI: 10.1210/endrev/bnaa008 -
Cancer Cell Nov 2020Neuroblastoma (NB), which is a subtype of neural-crest-derived malignancy, is the most common extracranial solid tumor occurring in childhood. Despite extensive...
Neuroblastoma (NB), which is a subtype of neural-crest-derived malignancy, is the most common extracranial solid tumor occurring in childhood. Despite extensive research, the underlying developmental origin of NB remains unclear. Using single-cell RNA sequencing, we generate transcriptomes of adrenal NB from 160,910 cells of 16 patients and transcriptomes of putative developmental cells of origin of NB from 12,103 cells of early human embryos and fetal adrenal glands at relatively late development stages. We find that most adrenal NB tumor cells transcriptionally mirror noradrenergic chromaffin cells. Malignant states also recapitulate the proliferation/differentiation status of chromaffin cells in the process of normal development. Our findings provide insight into developmental trajectories and cellular states underlying human initiation and progression of NB.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Cell Differentiation; Cell Proliferation; Chromaffin Cells; Gene Expression Profiling; Gene Expression Regulation, Neoplastic; Humans; Neuroblastoma; Phenotype; Sequence Analysis, RNA; Single-Cell Analysis
PubMed: 32946775
DOI: 10.1016/j.ccell.2020.08.014 -
Hormones (Athens, Greece) Jul 2017The adrenal gland is a key component of the stress system in the human body. Multiple direct and paracrine interactions between different cell types and their... (Review)
Review
The adrenal gland is a key component of the stress system in the human body. Multiple direct and paracrine interactions between different cell types and their progenitors take place within the adrenal gland microenvironment. These unique interactions are supported by high vascularization and the adrenal cortex extracellular matrix. Alterations in the adrenal gland microenvironment are known to influence the progression of several pathological conditions, such as obesity and sepsis, and to be influenced by these disorders. For example, it has been suggested that activation of immune-adrenal crosstalk during sepsis induces elevated adrenal glucocorticoid levels, whereas crosstalk between adrenocortical cells and sonic hedgehog responsive stem cells was found to contribute to the increased size of the adrenal cortex during obesity. By contrast to sepsis, where activation of adrenal glucocorticoid production has protective effects, chronic exposure to high levels of glucocorticoids induces adverse effects, typically manifested in patients with Cushing syndrome, such as increased body weight, dyslipidemia, glucose intolerance, and hypertension. Therefore, a better understanding of factors involved in the regulation of the adrenal gland microenvironment is crucial. This review highlights bidirectional interactions occurring between the adrenal gland microenvironment and systemic responses during obesity and sepsis. Furthermore, it presents and discusses recent advancements and challenges in attempts to restore or regenerate adrenal gland function, including the use of oxygenated immune-isolating devices.
Topics: Adrenal Gland Diseases; Adrenal Glands; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Regeneration
PubMed: 29278511
DOI: 10.14310/horm.2002.1744 -
Journal of Cystic Fibrosis : Official... Oct 2019Cystic fibrosis (CF) is not known to directly affect the adrenal gland, but commonly used CF therapies do impact the function of the hypothalamic-pituitary-adrenal (HPA)... (Review)
Review
Cystic fibrosis (CF) is not known to directly affect the adrenal gland, but commonly used CF therapies do impact the function of the hypothalamic-pituitary-adrenal (HPA) axis. By binding to the glucocorticoid receptor, medications such as inhaled and oral corticosteroids can enhance the systemic effects of cortisol and result in iatrogenic Cushing syndrome. Prolonged use suppresses the body's ability to make cortisol, resulting in iatrogenic adrenal insufficiency upon medication discontinuation. Chronic use of inhaled and oral corticosteroids can negatively affect bone health, growth, and glucose metabolism. This chapter provides practical guidelines regarding the screening, diagnosis, and treatment of iatrogenic adrenal insufficiency. As the guidelines are mainly derived from the asthma literature, this chapter also highlights the need for studies to evaluate the impact of CF therapies on adrenal function and other CF-endocrinopathies.
Topics: Adrenal Cortex Hormones; Adrenal Glands; Adrenal Insufficiency; Cystic Fibrosis; Humans; Iatrogenic Disease
PubMed: 31679732
DOI: 10.1016/j.jcf.2019.08.023 -
Endocrinology and Metabolism (Seoul,... Dec 2020The adrenal gland plays a pivotal role in an organism's health span by controlling the endocrine system. Decades of research on the adrenal gland have provided... (Review)
Review
The adrenal gland plays a pivotal role in an organism's health span by controlling the endocrine system. Decades of research on the adrenal gland have provided multiscale insights into the development and maintenance of this essential organ. A particularly interesting finding is that founder stem/progenitor cells participate in adrenocortical development and enable the adult adrenal cortex to regenerate itself in response to hormonal stress and injury. Since major advances have been made in understanding the dynamics of the developmental process and the remarkable regenerative capacity of the adrenal gland, understanding the mechanisms underlying adrenal development, maintenance, and regeneration will be of interest to basic and clinical researchers. Here, we introduce the developmental processes of the adrenal gland and discuss current knowledge regarding stem/progenitor cells that regulate adrenal cortex remodeling and regeneration. This review will provide insights into the fascinating ongoing research on the development and regeneration of the adrenal cortex.
Topics: Adrenal Cortex; Adrenal Glands; Adult; Animals; Embryonic Development; Gene Expression Regulation, Developmental; Humans; Regeneration; Signal Transduction; Stem Cells
PubMed: 33397037
DOI: 10.3803/EnM.2020.403 -
Frontiers in Endocrinology 2022Mixed corticomedullary tumor (MCMT) of the adrenal gland is an extremely rare tumor characterized by an admixture of steroidogenic cells and chromaffin cells in a single... (Review)
Review
Mixed corticomedullary tumor (MCMT) of the adrenal gland is an extremely rare tumor characterized by an admixture of steroidogenic cells and chromaffin cells in a single tumor mass simultaneously producing adrenocortical hormones and catecholamines; it is associated with ectopic adrenocorticotropic hormone (ACTH) in some cases. We reviewed and summarized clinicopathological data of 28 MCMTs, including four metastatic tumors in 26 previous reports. These reports included 21 females and 7 males, and the average tumor sizes were 4.8 ± 2.5 cm and 12.6 ± 6.4 cm in the non-metastatic and metastatic groups, respectively (P<0.001). The clinical manifestations and laboratory data were as follows: Cushing or subclinical Cushing syndrome, 58% (14/24); hypertension, 71% (17/24); elevated adrenocortical hormones, 75% (18/24); elevated catecholamines, 75% (18/24); and ectopic ACTH, 71% (10/14). All four patients with metastatic MCMTs had poor prognoses and elevated adrenocortical hormone levels; however, only two patients had elevated catecholamine levels. Immunohistochemistry was essential for the pathologic diagnosis of MCMTs. In this study, using an improved technique, we detected ectopic ACTH-producing cells in the same paraffin-embedded sections reported to be negative in our previous reports. As MCMT is composed of cells with embryologically different origins, its pathogenesis has been explained by various hypotheses. We compared MCMT to the adrenal gland of birds and the early stage of human fetuses, in which nests of chromaffin cells and steroidogenic cells admix without the formation of cortex and medulla. MCMT is characterized by the immaturity of organogenesis and might be classified as an adrenal embryonal tumor.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Adrenocorticotropic Hormone; Catecholamines; Female; Humans; Male; Pheochromocytoma
PubMed: 36187098
DOI: 10.3389/fendo.2022.1026918 -
Frontiers in Endocrinology 2022The adrenal gland is a common organ involved in metastasis. This study aimed to compare adrenal metastases (AMs) and adrenal benign masses (ABMs) of patients with...
BACKGROUND AND OBJECTIVES
The adrenal gland is a common organ involved in metastasis. This study aimed to compare adrenal metastases (AMs) and adrenal benign masses (ABMs) of patients with extra-adrenal malignancies during the staging or follow-up.
METHODS
We retrospectively collected data from 120 patients with AMs and 87 patients with ABMs. The clinical characteristics, imaging features, pathology, and treatment regimes were analyzed.
RESULTS
The most common types of extra-adrenal malignancies in patients with ABMs included thyroid, kidney, and gynecological cancers. On the other hand, lung and kidney cancers and lymphoma were the most frequent primary cancers of AMs. The age and incidence of symptoms were significantly higher in patients with AM. Radiological analysis showed that AMs tended to have larger tumor sizes and higher attenuation values than ABMs on pre-contrast computed tomography (CT). The diagnostic accuracy of positron emission tomography-CT for AM was 94.1%. An adrenal biopsy had a diagnostic accuracy of 92.5%. A multivariate logistic regression model demonstrated that the origins of extra-adrenal malignancies, the enhancement pattern, and attenuation values in pre-contrast CT were independent predictors of AMs. The sensitivity and specificity of this predictive model of combination was 92.5% and 74.1%, respectively.
CONCLUSIONS
The differential diagnosis between AMs and ABMs is extremely important. The combination of origin of first malignancy, enhancement pattern and CT value in non-enhanced phase is a valuable model for predicting AMs.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Diagnosis, Differential; Humans; Neoplasms, Second Primary; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 36246921
DOI: 10.3389/fendo.2022.978730 -
Medical Ultrasonography May 2017Adrenal gland ultrasonography is one of the corner stones of the abdominal ultrasonography examination for many medical specialties. The adrenal areas can be easily... (Review)
Review
Adrenal gland ultrasonography is one of the corner stones of the abdominal ultrasonography examination for many medical specialties. The adrenal areas can be easily overlooked though adrenal gland pathology is diverse. We present the normal aspects and various transabdominal ultrasonography findings of the adrenal glands, both common and rare. Even though ultrasound examination is operator and patient dependent, we consider the examination of the adrenal glands very important, due to relatively frequent incidental detection of an adrenal mass.
Topics: Adrenal Gland Diseases; Adrenal Glands; Humans; Ultrasonography
PubMed: 28845499
DOI: 10.11152/mu-978 -
Cancer Imaging : the Official... Mar 2010With the increasing use of abdominal cross-sectional imaging, incidental adrenal masses are being detected more often. The important clinical question is whether these... (Review)
Review
With the increasing use of abdominal cross-sectional imaging, incidental adrenal masses are being detected more often. The important clinical question is whether these lesions are benign adenomas or malignant primary or secondary masses. Benign adrenal masses such as lipid-rich adenomas, myelolipomas, adrenal cysts and adrenal haemorrhage have pathognomonic cross-sectional imaging appearances. However, there remains a significant overlap between imaging features of some lipid-poor adenomas and malignant lesions. The nature of incidentally detected adrenal masses can be determined with a high degree of accuracy using computed tomography (CT) and magnetic resonance imaging (MRI) alone. Positron emission tomography (PET) is also increasingly used in clinical practice in characterizing incidentally detected lesions. We review the performance of the established and new techniques in CT, MRI and PET that can be used to distinguish benign adenomas and malignant lesions of the adrenal gland.
Topics: Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Biopsy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 20299300
DOI: 10.1102/1470-7330.2010.0012 -
The British Journal of Radiology Nov 2021Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying... (Review)
Review
Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms. Other reported less common causes of AH are COVID-19 and neonatal stress. Clinical diagnosis of AH is challenging due to its non-specific presentation and occurrence in the setting of acute medical illness. Therefore, most cases are diagnosed incidentally on imaging. Having high clinical suspicion in the proper clinical setting for AH is crucial to avoid life-threatening adrenal insufficiency that occurs in 16-50% of patients with bilateral AH. We discuss the clinical situations that predispose to AH, review the imaging features on different imaging modalities, highlight a variety of clinical cases, imaging features that should be concerning for an underlying neoplasm, and outline the potential role of interventional radiology in management of AH.
Topics: Adrenal Gland Diseases; Adrenal Glands; Diagnostic Imaging; Hemorrhage; Humans
PubMed: 34464549
DOI: 10.1259/bjr.20210753