Difference between revisions of "Adrenal metastases"

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(Differentiating Adrenal metastases from other Diseases)
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*Adrenal metastases  must be differentiated from other diseases that cause tumors in adrenal gland such as:
 
*Adrenal metastases  must be differentiated from other diseases that cause tumors in adrenal gland such as:
 
:*Nonfunctional adenoma
 
:*Nonfunctional adenoma
:*Adrenal metastasis
 
 
:*Primary carcinoma in adrenal glands
 
:*Primary carcinoma in adrenal glands
 
:*[[Adrenal cyst]]
 
:*[[Adrenal cyst]]
:*Nonfunctional [[pheochromocytoma]]
+
:*Non-functional [[pheochromocytoma]]
  
 
==Epidemiology and Demographics==
 
==Epidemiology and Demographics==

Revision as of 14:58, 25 April 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

The pathogenesis of adrenal metastases is characterized by metastases from renal cell carcinoma, melanoma, lung cancer, colorectal cancer, breast cancer and lymphoma. On gross pathology, unilateral, small asymptomatic lesion are characteristic findings of adrenal metastases. Adrenal metastases must be differentiated from other diseases that cause tumors in adrenal gland such as nonfunctional adenoma, primary carcinoma in adrenal glands, adrenal cyst, and non-functional pheochromocytoma. Adrenal metastases are thought to be present in up to 27% of patients with known malignant epithelial tumors at autopsy. Symptoms of adrenal metastases may include dizziness, faintness, fatigue, weakness, and weight loss. CT is the imaging modality of choice for adrenal metastases. The mainstay of therapy for adrenal metastases is chemotherapy.

Pathophysiology

  • The pathogenesis of adrenal metastases is characterized by metastases from renal cell carcinoma, melanoma, lung cancer, colorectal cancer, breast cancer and lymphoma.
  • On gross pathology, unilateral, small asymptomatic lesion are characteristic findings of adrenal metastases.

Differentiating Adrenal metastases from other Diseases

  • Adrenal metastases must be differentiated from other diseases that cause tumors in adrenal gland such as:

Epidemiology and Demographics

  • Adrenal metastases are thought to be present in up to 27% of patients with known malignant epithelial tumors at autopsy.

Natural History, Complications and Prognosis

  • If left untreated, 20-35% of patients with cancer may progress to develop adrenal metastases.[1]
  • Common complication of adrenal metastases are central necrosis with adrenal hemorrhage and paraneoplastic leukemoid reaction.

Diagnosis

Symptoms

  • Symptoms of adrenal metastases may include the following:

Physical Examination

  • Patients with adrenal metastases usually appear cachectic.
  • Physical examination may be remarkable for:
  • Abdominal mass

Laboratory Findings

  • There are no specific laboratory findings associated with adrenal metastases.

Imaging Findings

  • CT is the imaging modality of choice for adrenal metastases.
  • On CT, adrenal metastases may demonstrate less than 50% washout.
  • On MRI, adrenal metastases may demonstrate:
  • T1: usually exhibit low signal intensity
  • T2: usually exhibit high signal intensity
  • T1 C+ (Gd): usually has progressive enhancement after administration of contrast material.

Treatment

Medical Therapy

  • The mainstay of therapy for adrenal metastases is chemotherapy.

Surgery

  • Adrenalectomy in conjunction with chemotherapy is the most common approach to the treatment of adrenal metastases if primary disease is well controlled and the only site of metastasis if adrenal gland.

Prevention

  • There are no primary preventive measures available for adrenal metastases.

References

  1. Lam KY, Lo CY (2002). "Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital". Clin Endocrinol (Oxf). 56 (1): 95–101. PMID 11849252.

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