Dammit 1mm microadenoma

[Michael Scally MD]

Raappana A, Koivukangas J, Ebeling T, Pirila T. Incidence of Pituitary Adenomas in Northern Finland in 1992-2007. J Clin Endocrinol Metab 2010;95(9):4268-75.

Context: Data on the incidence of pituitary adenomas (PAs) are scant and outdated. A population-based regional cohort with thorough case identification was used to evaluate the incidence of clinically detected PAs in the era of magnetic resonance imaging.

Objective: The objective of the study was to describe the age- and sex-specific incidence of all PA subgroups, with data on incidentally found PAs, pituitary apoplexies, and time trends. Design, Settings, and Patients: This was a retrospective descriptive analysis of PA patients diagnosed during 1992-2007 in Northern Finland (NFi).

Main Outcome Measure: World Health Organization 2000-standardized incidence rates (SIRs) of PAs per 100,000 were measured.

Results and Conclusion: The final cohort consisted of 355 PAs. The incidence rates of the Oulu University Hospital regional district were used as a reference to assess the applicability of our case finding over the rest of NFi. Incidence rates of all PA subgroups except microprolactinomas were statistically equal between these areas; thus, all presented SIRs are based on the NFi's cohort except Oulu University Hospital regional district-based prolactinomas and PAs overall. Overall SIR of PAs was higher (4.0 per 100,000) than in previous reports. Prolactinomas had the highest SIR: 2.2 per 100,000, followed by clinically nonfunctioning PAs (1.0) and GH-secreting (0.34), ACTH-secreting (0.17), and TSH-secreting (0.03) PAs. The gender-specific SIR was 2.2 per 100,000 in males and 5.9 per 100,000 in females. Pituitary apoplexy occurred as a presenting symptom in 11% of clinically nonfunctioning PA patients. The SIR of incidentally discovered PAs increased significantly from 1992-1999 to 2000-2007 (0.59 to 1.6, respectively; P < 0.01), which accounted for the perceived increasing trend in the overall SIR of PAs (3.8 to 4.2; P > 0.05).

 

[virtuosa150]

Over summer I was doing a good job of putting in, come school time all I'm doing is going between classes and school lunch is not calorie dense at all and with wrestling I'm only allowed well basically jack shit. Maybe I need to stop wrestling.

I suggested to you in November 09 (or there about) to starty eating more and to go up a weight class. Do you got some JO coach keeping you at your present class? Eat some food and kick ass.

 

[Michael Scally MD]

D'Ercole M, Della Pepa GM, Carrozza C, Bianchi A, Doglietto F. Two Diagnostic Pitfalls Mimicking a Prolactin-Secreting Microadenoma. J Clin Endocrinol Metab 2010;95(12):5171-.

A 25-yr-old woman was admitted to the Neurosurgery Department with the diagnosis of a medically resistant prolactin (PRL)-secreting microadenoma.

Serum PRL levels ranging between 30 and 90 ng/ml had been discovered 2 yr before in a routine gynecological assessment. Magnetic resonance imaging (MRI) disclosed an image compatible with apituitary microadenoma (Fig. 1 ). The patient underwent medical treatment with cabergoline (up to 0.5 mg/d), without significant variations of both serum PRL and neuroimaging at 1 yr. Hence,medical therapy was withdrawn.

FIG. 1. A neuroradiological pitfall in microadenoma. Sellar MRI documenting a hypointense signal at the level of the left hemisella (white arrow), in all sequences (T1-weighted coronal with contrast shown). The signal alteration is at the level of a sphenoid septum attachment to the sellar floor (black arrow).

When she came to our attention, she denied any history of irregular menses and galactorrhea as well as drugs or other possible causes of hyperprolactinemia. She had had a normal pregnancy 3 yr before. Pituitary hormonal assessment documented normal values with the exception of PRL that was 54 ng/ml (normal values, 3.5–15.5 ng/ml). Testing for macroprolactin yielded positive results showing a 35% recovery, in line with the expected presence of macroprolactin.

A review of the patient’s MRIs showed that the signal alteration corresponded to the insertion of a sphenoid septum and was stable also in dynamic sequences. The patient was discharged home.

Macroprolactin should be suspected when a patient’s clinical history or radiological findings are inconsistent with the PRL values (1, 2, 3). A focal artifact on sellar MRI, closely related to the junction between sellar floor and sphenoidal septum, may mimic or obscure a microadenoma (4, 5).

In this case, we had the association of a biochemical and a neuroradiological pitfall. The clue for a correct diagnosis was given by the patient’s history and clinical status.

 

[Michael Scally MD]

Adrenal incidentalomas are adrenal masses discovered inadvertently when radiological imaging is performed for reasons other than suspected adrenal disease. Most adrenal incidentalomas are benign and nonfunctional. However, functional adrenal lesions secreting excess adrenal hormones, such as cortisol, aldosterone, catecholamine, sex hormones, or a combination of adrenal hormones, account for a significant proportion of cases, with increased morbidity if left untreated. Malignant adrenal lesions are uncommon and include primary adrenal cancers, adrenal metastases, or other rare malignant neoplasms. Although primary adrenal cancer is rare among the general population, early intervention when the carcinoma is small and still confined to the adrenal bed offers the best prognosis. It is therefore important to assess the functional status and malignant potential of every incidentally discovered adrenal lesion.


Ng VWS, Ma RCW, So W-Y, et al. Evaluation of Functional and Malignant Adrenal Incidentalomas. Arch Intern Med 2010;170(22):2017-20. Arch Intern Med -- Abstract: Evaluation of Functional and Malignant Adrenal Incidentalomas, Dec 13/27, 2010, Ng et al. 170 (22): 2017

Background Adrenal incidentalomas are adrenal masses discovered inadvertently. We undertook this study to review the clinical characteristics of patients with adrenal incidentalomas who presented to a tertiary endocrine center in Hong Kong.

Methods Retrospective review of all 139 cases of adrenal incidentalomas that were referred to the Endocrine Centre of the Prince of Wales Hospital between June 1, 2000, and May 31, 2007. We reviewed detailed patient history, physical examination findings, and symptoms and signs related to hormonal hypersecretion or malignant neoplasm and recorded clinical indications for performing diagnostic radiological imaging.

Results Sixty-one patients (43.9%) had nonfunctional benign adrenal adenomas, 52 (37.4%) had functional lesions, 15 (10.8%) had malignant adrenal lesions, and the remaining 11 (7.9%) had varying adrenal disease. Among those with functional lesions, 27 (19.4%) had lesions that secreted excess cortisol; 12 (8.6%), lesions that secreted aldosterone; 12 (8.6%), lesions that secreted excess catecholamines; and 1 (0.7%), a lesion that demonstrated excess secretion of cortisol and aldosterone. Only 5 of the 27 patients with cortisol-secreting adrenal incidentalomas had symptoms or signs of excess cortisol levels at presentation.

Conclusions Adrenal incidentaloma is a commonly encountered clinical problem. Functional or primary malignant adrenal incidentalomas can be detected at an earlier stage during hormonal and radiological evaluations, which provides an opportunity for further management.