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The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas

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Abstract

Purpose

Adrenocortical lesions are characterized through imaging, hormonal and histopathological analysis. Our aim was to compare the radiological features of adrenocortical lesions with their cortisol-secreting status and histopathological Weiss score.

Methods

Seventy five patients operated between 2004 and 2016 in the University Hospital of Nancy for either adrenocortical carcinomas (ACC) or adrenocortical adenomas (ACA) were enrolled in this study. We collected cortisol parameters, Computed Tomography (CT) scans (unenhanced density, wash-out (WO) analysis) and 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) datas. The histopathological Weiss score ultimately differentiates ACA (score ≤ 2) from ACC (score ≥ 3). One-way ANOVA, Fisher’s exact and unpaired t tests were used for statistical analysis with significancy reached at p < 0.05.

Results

There were 23 ACC and 52 ACA with 40 patients (53%) who had an autonomous secretion of cortisol. On CT scan, ACC were larger compared to ACA (108 vs. 37 mm, p < 0.0001). A roughly similar proportion of cortisol-secreting (22/25) and non-secreting (15/19) ACA were atypical (i.e., unenhanced density value ≥ 10 Hounsfield Units [HU]), however 85% of cortisol-secreting vs. 40% of non-secreting ACA were classified as benigns by the relative WO analysis (p = 0.08). Likewise, there was a trend for a higher 18F-FDG uptake in cortisol-secreting ACA compared to non-secreting ACA (p = 0.053).

Conclusions

The relative adrenal WO analysis consolidates the benign nature of an ACA, especially in case of cortisol oversecretion, a condition known to compromise the diagnostic accuracy of the 10 HU unenhanced CT attenuation threshold.

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Authors and Affiliations

  1. Department of Endocrinology, University Hospital of Nancy, Nancy, France

    Anne-Laure Humbert, Sophie Moog, Marc Klein & Thomas Cuny

  2. Department of Radiology, University Hospital of Nancy, Nancy, France

    Guillaume Lecoanet

  3. Department of Nuclear Medicine, University Hospital of Nancy, Nancy, France

    Fehd Bouderraoui & Elodie Chevalier

  4. Department of Endocrine and General Surgery, University Hospital of Nancy, Nancy, France

    Laurent Bresler & Laurent Brunaud

  5. Department of Anatomopathology, University Hospital of Nancy, Nancy, France

    Jean-Michel Vignaud

Authors
  1. Anne-Laure Humbert
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  2. Guillaume Lecoanet
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  3. Sophie Moog
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  4. Fehd Bouderraoui
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  5. Laurent Bresler
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  6. Jean-Michel Vignaud
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  7. Elodie Chevalier
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  8. Laurent Brunaud
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Correspondence to Thomas Cuny.

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Humbert, AL., Lecoanet, G., Moog, S. et al. The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas. Endocrine 59, 529–537 (2018). https://doi.org/10.1007/s12020-018-1522-7

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  • DOI: https://doi.org/10.1007/s12020-018-1522-7

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