Search Results (86)

Hypertension is a critical health concern as it affects millions of people worldwide and leads to increased risk factors for other diseases such as cardiovascular diseases and stroke. Hypertension is commonly categorized into primary hypertension and secondary hypertension, with the latter frequently curable when caused by the presence of a benign adrenal adenoma that produces excessive adrenal hormones. The incidence rate of these adrenal adenomas is relatively high, in keeping with the hyperplastic/hypermutable characteristic of the adrenal gland. One of the most common functional adrenal adenomas are the aldosterone-producing adenomas (APAs), which develop from the adrenal cortex and, as per the name, produce excessive amounts of the adrenal hormone aldosterone, leading to hypertension. Investigations of genetic causes of these adenomas have revealed that the de novo somatic mutations that commonly cause the increase in aldosterone production mostly involve changes in intracellular concentration. Herein, we review the somatic genetic alterations that have been reported in APAs over the decade. Full article

Pituitary adenomas, although predominantly benign, can lead to significant clinical complications due to endocrine imbalances and mass effects on adjacent structures. Traditional research has focused on intrinsic factors like genetic mutations and hormonal dysregulation; however, emerging evidence implicates environmental pollutants—particularly urban air contaminants—in pituitary tumorigenesis. This review consolidates current findings on how chronic exposure to pollutants such as benzene, di(2-ethylhexyl) phthalate (DEHP), and polychlorinated biphenyls (PCBs) may trigger neuroinflammation, disrupt the hypothalamic–pituitary–adrenal (HPA) axis, and alter pituitary cell proliferation and hormone secretion. We explore mechanistic pathways involving inflammatory cytokines, oxidative stress, and microenvironmental modifications that contribute to neoplastic transformation and tumor progression. Epidemiological studies, supported by in vitro experiments, suggest that air pollutants not only initiate the development of pituitary adenomas but may also enhance the secretory activity of functioning tumors, potentially increasing their aggressiveness. Given the escalating global burden of air pollution and its far-reaching public health implications, further investigation is essential to elucidate these complex interactions. Advancing our understanding in this area could inform preventive strategies and therapeutic interventions aimed at mitigating the environmental impact on pituitary tumor behavior. Full article

Adrenal lesions are common findings in abdominal imaging, with adrenal adenomas being the most frequent type. Accurate detection of adrenal adenomas is essential to avoid unnecessary diagnostic procedures and treatments. However, conventional imaging-based evaluation relies heavily on the expertise of radiologists and can be complicated by pseudo-lesions, overlapping imaging features, and suboptimal imaging techniques. To address these challenges, we propose an end-to-end machine learning pipeline that integrates deep learning-based lesion detection (FCOS) with an ensemble classifier for adrenal lesion classification in MRI. Our pipeline operates directly on broader regions of interest, eliminating the need for manual lesion segmentation. Our method was evaluated on a multi-sequence MRI dataset comprising 206 adenomas and 45 non-adenomas. The pipeline achieved 87.45% accuracy, 87.33% specificity, and 87.63% recall for adenoma classification, demonstrating competitive performance compared to prior studies. The results highlight strong non-adenoma identification while maintaining robust adenoma detection. Future research should focus on dataset expansion, external validation, and comparison with radiologist performance to further validate clinical applicability. Full article

Dual-energy CT (DECT) has emerged as a novel imaging modality that offers a multiparametric approach for noninvasive adrenal lesion characterization. This narrative review examines recent advances in DECT—including virtual non-contrast imaging, iodine density quantification, spectral curve analysis, and material density mapping—for differentiating benign adrenal adenomas from metastases. Conventional CT techniques rely primarily on unenhanced attenuation measurements and contrast washout kinetics; however, these methods may be limited in evaluating lipid-poor adenomas, and in cases where imaging features overlap with metastatic lesions. Although virtual non-contrast imaging with DECT tends to overestimate attenuation relative to true non-contrast scans, the recalibration of diagnostic thresholds and integration with complementary parameters, such as the iodine density-to-virtual non-contrast attenuation ratio, can significantly enhance sensitivity and specificity. Additional parameters, including fat fraction analysis and the evaluation of attenuation changes across energy spectra, further refine tissue characterization by quantifying intracellular lipid content and vascularity. Material density analysis has demonstrated near-perfect diagnostic accuracy in select studies. By tailoring imaging evaluation to the unique spectral and compositional features of each adrenal lesion, DECT contributes to a more personalized diagnostic approach. This individualization allows for better differentiation between benign and malignant findings, potentially avoiding unnecessary interventions and enabling more targeted clinical management. Despite these promising developments, challenges remain regarding the standardization of acquisition protocols, optimization of diagnostic thresholds, and minimization of interobserver variability. Emerging radiomics and machine learning applications may further automate lesion classification and improve diagnostic accuracy. Thus, DECT holds considerable potential to improve diagnostic confidence, reduce radiation exposure, and streamline the management of patients with adrenal incidentalomas, although further multicenter validation is warranted. Full article

An adrenal mass discovered incidentally during imaging for unrelated clinical reasons is termed an “adrenal incidentaloma” (AI). AIs can be categorized as primary or metastatic, functioning or non-functioning, and benign or malignant. The primary goal of radiological evaluation is to exclude malignancy by differentiating between benign and malignant lesions. Most AIs are benign, with adenomas and macronodular bilateral adrenal hyperplasia being the most common types. Less common benign lesions include myelolipomas, pheochromocytomas, cysts, and hematomas. Malignant adrenal masses account for less than 10% of cases and often include metastases from other cancers or primary adrenal diseases, such as adrenocortical carcinoma and pheochromocytoma. Computed Tomography (CT) remains the gold standard for diagnosing adrenal incidentalomas, while Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) are utilized for indeterminate cases. Additionally, innovative imaging techniques such as texture analysis are gaining importance, as they can assess quantitative parameters that are not visible to the human eye. This review aims to provide an updated overview of malignant adrenal lesions on CT and MRI, emphasizing key imaging features suspicious for malignancy to aid in distinguishing between benign and malignant lesions. Furthermore, it highlights the growing role of radiomics as a supportive tool for radiologists. Full article

Objectives: This study aimed to evaluate the imaging and clinical characteristics of adrenal metastases detected by [68Ga]Ga-PSMA PET/CT in prostate cancer patients, with a focus on diagnostic accuracy and prognostic implications. Specifically, we examined the correlation between adrenal lesion characteristics and prognostic markers, such as prostate-specific antigen (PSA) levels and Gleason scores. This study also assessed the diagnostic performance of PSA, standardized uptake value maximum (SUVmax), and Hounsfield Unit (HU) values in differentiating adrenal metastases from benign adrenal adenomas. Materials and Methods: This retrospective study included 44 prostate cancer patients with adrenal lesions identified using [68Ga]Ga-PSMA PET/CT between January 2020 and October 2024. The patients were categorized into two groups: benign adrenal adenomas (n = 16) and adrenal metastases (n = 28). The PET/CT imaging was performed using a 5-ring Discovery IQ PET/CT scanner with QClear reconstruction, following the injection of 2.5 MBq/kg [68Ga]Ga-PSMA ligand and a standardized uptake time of 60 min. The imaging parameters (SUVmax and HU values), clinical characteristics (PSA levels, Gleason scores, and presence of lymphadenopathy), and patient outcomes were analyzed. A ROC analysis was conducted to evaluate the diagnostic performance of these key parameters. Results: Patients with adrenal metastases had significantly higher PSA levels (mean: 45.6 ± 12.4 ng/mL vs. 18.3 ± 6.7 ng/mL; p < 0.01) and Gleason scores (median: 8 vs. 6; p < 0.01) than those with benign adenomas. SUVmax values were significantly elevated in metastatic lesions (mean: 12.8 ± 4.3 vs. 3.4 ± 1.2; p < 0.001), and HU values were also higher (mean: 45 ± 15 vs. 18 ± 10; p < 0.01). The ROC analysis revealed that SUVmax had the highest diagnostic accuracy (AUC: 0.87), followed by PSA (AUC: 0.85) and HU (AUC: 0.80). Disease progression was observed in 67.9% of metastatic cases versus 18.8% in the adenoma group (p < 0.001), and median overall survival was shorter in metastatic cases (24 months vs. 38 months; p < 0.01). Conclusions: [68Ga]Ga-PSMA PET/CT is a valuable imaging modality for distinguishing adrenal metastases from benign adenomas in prostate cancer patients. The integration of PSA, SUVmax, and HU values into diagnostic workflows enhances diagnostic precision and improves clinical decision-making. Future research should focus on the prospective validation of these findings in larger cohorts and explore artificial intelligence-based approaches for automated lesion characterization. Full article

Situs anomalies, including situs inversus and situs ambiguous (SAMB), are rare congenital conditions typically noted in pediatric populations, with SAMB being particularly uncommon in adults. This case study addresses the incidental discovery of situs ambiguous with polysplenia in a 65-year-old man evaluated for suspected adrenal adenoma. The patient’s medical history included benign prostatic hyperplasia and tuberculous pleurisy. Methods included a thorough physical examination and laboratory tests, which showed normal cortisol levels and ACTH rhythm. Contrast-enhanced CT imaging revealed multiple spleens near the right adrenal region, altered liver positioning, a truncated pancreas, and a right-sided stomach, while the right adrenal gland was not visualized. Notably, the patient exhibited minimal symptoms despite these significant anatomical anomalies. The findings underscore the rarity of situs ambiguous in adults and its unexpected association with endocrine pathology. This case highlights the importance of comprehensive imaging and a multidisciplinary approach in managing patients with unusual anatomical presentations. It suggests that situs anomalies may be more prevalent in adult populations than previously recognized and emphasizes the need for increased clinical awareness and evaluation in similar cases. Full article

The CYP11B2 gene is sporadically expressed in the zona glomerulosa (ZG), whereas the CYP11B1 gene is detected in the zona fasciculata (ZF)/reticularis (ZR), with predominant expression in the ZF. We studied the association between DNA methylation and adrenal zonation. Next, the CYP11B2 methylation statuses in the adrenal medulla (n = 4) and pheochromocytomas (n = 7) were examined. The expression of CYP11B2 in pheochromocytomas and non-functioning adenomas (NFAs) (n = 4) was also studied. Adrenals from five autopsy subjects were assessed for immunohistochemically defined adrenal zonation. We used laser capture microscopy to isolate DNA from each zone in adrenal tissues. CYP11B1 was predominantly unmethylated in the ZF but heavily methylated in the ZG and the ZR. In contrast, CYP11B2 was hypomethylated in the ZG compared with in the ZF and the ZR. In terms of the expression site and strength, the promoter methylation patterns for CYP11B2 and CYP11B1 showed capacities to express CYP11B enzymes. The DNA methylation patterns of the CYP11B2 and CYP11B1 promoters were closely associated with adrenal zonation. The unmethylated CpGs of CYP11B2 were found in the adrenal medulla and pheochromocytomas. Gene expression of CYP11B2 was detected in the pheochromocytomas. These results indicate the possibility that the synthesis of aldosterone occurs in the adrenal medulla. Further study is necessary to elucidate the pathophysiological roles for the synthesis of aldosterone in the adrenal medulla. Full article

Myelolipomas are described as small tumors, with some authors referring to sizes less than 4 cm in diameter. However, when greater than 10 cm, myelolipomas are labeled as giant tumors and thus, have a definite indication for surgical resection. Myelolipomas represent a small percentage of adrenal tumors. Giant myelolipomas are usually discovered incidentally during imaging studies performed for other conditions. They are often slow-growing and may reach sizes that significantly distort the anatomy of the affected area. Despite their large size, they are usually benign and do not spread to other parts of the body. Adrenal myelolipoma is a benign tumor with a scarce number of detailed cases reported in literature. It is frequently discovered by chance, covering a variety of differential diagnoses. Imaging techniques and histopathological examinations are of great importance in the differential diagnosis of adrenal gland lesions, including retroperitoneal lipoma and liposarcoma, adrenal myelolipoma, adrenal lymphoma, adrenal adenoma, adrenocortical carcinoma, pheochromocytoma or metastasis. We performed a comprehensive review on PubMed of all cases of giant adrenal myelolipoma reported in literature with more than 10 cm in diameter, in order to estimate the incidence, diagnosis and treatment of giant myelolipoma. So far, only 15 cases of truly giant adrenal myelolipoma have been reported between 1981 and 2023. Full article

We studied the application of CT texture analysis in adrenal incidentalomas with baseline characteristics of benignity that are highly suggestive of adenoma to find whether there is a correlation between the extracted features and clinical data. Patients with hormonal hypersecretion may require medical attention, even if it does not cause any symptoms. A total of 206 patients affected by adrenal incidentaloma were retrospectively enrolled and divided into non-functioning adrenal adenomas (NFAIs, n = 115) and mild autonomous cortisol secretion (MACS, n = 91). A total of 136 texture parameters were extracted in the unenhanced phase for each volume of interest (VOI). Random Forest was used in the training and validation cohorts to test the accuracy of CT textural features and cortisol-related comorbidities in identifying MACS patients. Twelve parameters were retained in the Random Forest radiomic model, and in the validation cohort, a high specificity (81%) and positive predictive value (74%) were achieved. Notably, if the clinical data were added to the model, the results did not differ. Radiomic analysis of adrenal incidentalomas, in unenhanced CT scans, could screen with a good specificity those patients who will need a further endocrinological evaluation for mild autonomous cortisol secretion, regardless of the clinical information about the cortisol-related comorbidities. Full article

Adrenal tumors, such as adrenocortical carcinoma (ACC), adrenocortical adenoma (ACA), and pheochromocytoma (PCC) are complex diseases with unclear causes and treatments. Mitochondria and mitochondrial-derived peptides (MDPs) are crucial for cancer cell survival. The primary aim of this study was to analyze samples from different adrenal diseases, adrenocortical carcinoma, adrenocortical adenoma, and pheochromocytoma, and compare them with normal adrenal tissue to determine whether the expression levels of the mitochondrial open reading frame of the 12S rRNA type-c (MOTS-c) gene and protein vary between different types of adrenal tumors compared to healthy controls using qPCR, ELISA, and IHC methods. Results showed decreased MOTS-c mRNA expression in all adrenal tumors compared to controls, while serum MOTS-c protein levels increased in ACA and PCC but not in ACC. The local distribution of MOTS-c protein in adrenal tissue was reduced in all tumors. Notably, MOTS-c protein expression declined with ACC progression (stages III and IV) but was unrelated to patient age or sex. Tumor size and testosterone levels positively correlated with MOTS-c mRNA but negatively with serum MOTS-c protein. Additionally, serum MOTS-c protein correlated positively with glucose, total cholesterol, HDL, LDL, and SHGB levels. These findings suggest disrupted expression of MOTS-c in the spectrum of adrenal diseases, which might be caused by mechanisms involving increased mitochondrial dysfunction and structural changes in the tissue associated with disease progression. This study provides a detailed examination of MOTS-c mRNA and protein in adrenal tumors, indicating the potential role of MDPs in tumor biology and progression. Full article

The aim of the study was to evaluate the diagnostic and prognostic significance of leptin receptor isoforms in adrenal tumors. In a single-center study, 96 patients (19 with adrenal cortical carcinoma and 77 with benign tumors) underwent an adrenalectomy. A total of 14 unaffected adrenal gland tissues from kidney donors were used as controls. Fasting blood samples were collected for laboratory tests, and mRNA expressions of leptin receptor isoforms were assessed by RT-qPCR. The study analyzed correlations between mRNA expressions and clinical data and measured NCI-H295R cell proliferation via a real-time cell analyzer. All adrenal lesions expressed leptin receptor isoforms. Significantly lower LepR1 expression was observed in carcinoma tissues than in adenomas and controls (p = 0.016). Expressions of LepR3&LepR6 were correlated with overall survival (p = 0.036), while LepR2&LepR4 and LepR5 expressions were inversely related to morning serum cortisol levels (p = 0.041). Leptin reduced NCI-H295R cell proliferation (p < 0.0001). The study highlights the diagnostic and prognostic significance of leptin receptor isoforms in adrenal tumors. Specifically, LepR1 may serve as a diagnostic marker for carcinomas, while LepR3&LepR6 have potential use as prognostic markers. Full article

Hyperandrogenism is a condition in which the levels of androgen hormones in the blood are significantly increased and could be of an adrenal or ovarian origin. The adrenal androgens, normally secreted by the zona reticularis, are steroid hormones with weak androgen activity. The causes of hyperandrogenism are diverse and could be endogenous and exogenous. Androgen excess affecting different tissues and organs results in clinical features such as acne, hirsutism, virilization, and reproductive dysfunction such as oligomenorrhoea/amenorrhoea. Although androgen excess is rarely associated with adrenal tumours, it is important as it could be predictive of malignancy. A careful evaluation of the androgen pattern, also in patients with clear signs of hyperandrogenism, could be useful. Laboratory evaluation should focus on measuring total testosterone levels, followed by the estimation of other androgens such as dehydroepiandrosterone and androstenedione, and using visualisation procedures in the further management. The treatment of adrenal hyperandrogenism is eminently surgical, in consideration of the frequent malignant origin. The aim of this review is to elaborate and summarize the prevalence and clinical management of hyperandrogenism of an adrenal origin by describing the physiological mechanisms of adrenal androgen steroidogenesis, the clinical manifestations of hyperandrogenism with a special reference to hyperandrogenism in adrenal adenomas and carcinomas, and the diagnostic methods that will lead us to establishing the correct diagnosis and different treatment options to manage this condition according to the clinical presentation of the patient. Full article

Primary aldosteronism (PA), a significant and curable cause of secondary hypertension, is seen in 5–10% of hypertensive patients, with its prevalence contingent upon the severity of the hypertension. The principal aetiologies of PA include bilateral idiopathic hypertrophy (BIH) and aldosterone-producing adenomas (APAs), while the less frequent causes include unilateral hyperplasia, familial hyperaldosteronism (FH) types I-IV, aldosterone-producing carcinoma, and ectopic aldosterone synthesis. This condition, characterised by excessive aldosterone secretion, leads to augmented sodium and water reabsorption alongside potassium loss, culminating in distinct clinical hallmarks: elevated aldosterone levels, suppressed renin levels, and hypertension. Notably, hypokalaemia is present in only 28% of patients with PA and is not a primary indicator. The association of PA with an escalated cardiovascular risk profile, independent of blood pressure levels, is notable. Patients with PA exhibit a heightened incidence of cardiovascular events compared to counterparts with essential hypertension, matched for age, sex, and blood pressure levels. Despite its prevalence, PA remains frequently undiagnosed, underscoring the imperative for enhanced screening protocols. The diagnostic process for PA entails a tripartite assessment: the aldosterone/renin ratio (ARR) as the initial screening tool, followed by confirmatory and subtyping tests. A positive ARR necessitates confirmatory testing to rule out false positives. Subtyping, achieved through computed tomography and adrenal vein sampling, aims to distinguish between unilateral and bilateral PA forms, guiding targeted therapeutic strategies. New radionuclide imaging may facilitate and accelerate such subtyping and localisation. For unilateral adrenal adenoma or hyperplasia, surgical intervention is optimal, whereas bilateral idiopathic hyperplasia warrants treatment with mineralocorticoid antagonists (MRAs). This review amalgamates established and emerging insights into the management of primary aldosteronism. Full article

Background and Objectives: Primary adrenal tumors (AT) are a heterogeneous group of neoplasms due to their functional heterogeneity, which results in the diverse clinical presentation of these tumors. The purpose of this study was to examine cross-sectional imaging characteristics using multi-detector computed tomography (MDCT) to provide insight into the lesion characterization and functional status of these tumors. The radionuclide imaging using Technetium-99m radiolabeled hydrazinonicotinylacid-d-phenylalanyl¹-tyrosine3-octreotide (^99mTc-HYNIC-TOC), was also used in the diagnostic evaluation of these tumors. Materials and Methods: This cross-sectional study included 50 patients with confirmed diagnoses of AT (21 hormone-secreting and 29 non-functional) at the University Clinical Center, Kragujevac, Serbia, during the 2019–2022 year period. The morphological and dynamic characteristics using MDCT were performed, using qualitative, semi-quantitative, and quantitative analysis. Absolute washout (APW) and relative washout (RPW) values were also calculated. A semi-quantitative analysis of all visual findings with ^99mTc-HYNIC-TOC was performed to compare the tumor to non-tumor tracer uptake. Results: A statistically significant difference was found in the MDCT values in the native phase (p < 0.05), the venous phase (p < 0.05), and the delayed phase (p < 0.001) to detect the existence of adrenal tumors. Most of these functional adrenocortical lesions (n = 44) can be differentiated using the delayed phase (p < 0.05), absolute percentage washout (APW) (p < 0.05), and relative percentage washout (RPW) (p < 0.001). Furthermore, ^99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumor existence (p < 0.001). There is a positive correlation between radionuclide imaging scan and APW to detect all AT (p < 0.01) and adrenocortical adenomas as well (p < 0.01). Conclusions: The results can be very helpful in a diagnostic algorithm to quickly and precisely diagnose the expansive processes of the adrenal glands, as well as to learn about the advantages and limitations of the mentioned imaging modalities. Full article