CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma

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Title:	CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma
Author(s):	Canu, L.; Hemert, J.A.W. Van; Kerstens, M.N.; Hartman, R.P.; Khanna, A.; Kraljevic, I.; Kastelan, D.; Badiu, C.; Ambroziak, U.; Tabarin, A.; Haissaguerre, M.; Buitenwerf, E.; Visser, A. de ; Mannelli, M.; Arlt, W.; Chortis, V.; Bourdeau, I.; Gagnon, N.; Buchy, M.; Borson-Chazot, F.; Deutschbein, T.; Fassnacht, M.; Hubalewska-Dydejczyk, A.; Motyka, M.; Rzepka, E.; Casey, R.T.; Challis, B.G.; Quinkler, M.; Vroonen, L.; Spyroglou, A.; Beuschlein, F.; Lamas, C.; Young, W.F., Jr.; Bancos, I.; Timmers, H.J.L.M.
Publication year:	2019
Source:	Journal of Clinical Endocrinology and Metabolism, vol. 104, iss. 2, (2019), pp. 312-318
ISSN:	0021-972X
DOI:	https://doi.org/10.1210/jc.2018-01532
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : http://hdl.handle.net/2066/202882
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Subject:	Radboudumc 16: Vascular damage RIMLS: Radboud Institute for Molecular Life Sciences
Organization:	Condensed Matter Science (HFML) Internal Medicine
Journal title:	Journal of Clinical Endocrinology and Metabolism
Volume:	vol. 104
Issue:	iss. 2
Page start:	p. 312
Page end:	p. 318
Abstract:	Background: Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with CT characteristics of an adrenocortical adenoma (ACA). Aim: To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT. Methods: For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield units (HU), absolute percentage washout (APW), and relative percentage washout (RPW) were collected in addition to clinical parameters. Results: Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0.5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of </=10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU > 10 and available washout data, 22 (28.9%) had a high APW and/or RPW, suggestive of ACA. Conclusion: Based on the lack of PCCs with an unenhanced attenuation of <10 HU and the low proportion (0.5%) of PCCs with an attenuation of 10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation of </=10 HU. The assessment of contrast washout, however, is unreliable for ruling out PCC.