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May an adrenal incidentaloma change its nature?

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Abstract

Background

Up to 70% of adrenal masses detected in patients affected by extra-adrenal malignancy are metastatic lesions. Therefore, detection of an adrenal mass in patients with active or previous malignancy requires a careful differential diagnostic workup. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is increasingly being used to determine the malignant potential of adrenal lesions.

Clinical case

We report the case of a 64-year-old man who had a single adrenal metastasis due to non-small-cell lung carcinoma developing on a pre-existing benign adrenal lesion. This metastasis occurred in a phase of perceived oncological remission and was detected thanks to 18F-FDG-PET/CT showing a focal adrenal uptake. Contrast-enhanced computed tomography (CT), performed as part of oncological follow-up, and MRI with chemical shift sequences did not lead to the correct diagnosis. The patient underwent laparoscopic adrenalectomy and the pathological evaluation confirmed a lung carcinoma metastasis.

Conclusion

The present case highlights the peculiarity of the follow-up of adrenal masses in cancer patients and the primary role of 18F-FDG-PET/CT in the management of such patients.

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Author information

Author notes

  1. A. Pia and G. Reimondo have equally contributed as senior authors.

Authors and Affiliations

  1. Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy

    A. Müller, E. Ingargiola, S. Puglisi, M. Terzolo, A. Pia & G. Reimondo

  2. Radiology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy

    F. Solitro

  3. Pathology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy

    E. Bollito

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  1. A. Müller
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  2. E. Ingargiola
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Contributions

Clinical management of the patient: AP; imaging review: FS; pathological review: EB; drafting of the manuscript: AM, EI; critical review of the manuscript: SP, AP, GR, MT; supervision: AP, GR, MT.

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Correspondence to S. Puglisi.

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All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

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Müller, A., Ingargiola, E., Solitro, F. et al. May an adrenal incidentaloma change its nature?. J Endocrinol Invest 43, 1301–1307 (2020). https://doi.org/10.1007/s40618-020-01219-3

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