Adrenal incidentaloma (AI) refers to an otherwise unsuspected adrenal mass found in up to 5 % of patients undergoing radiological imaging. As high as one in five incidentalomas are functional; hypersecretion of cortisol causing Cushing’s or Subclinical Cushing’s Syndrome (SCS), catecholamines leading to pheochromocytoma, aldosterone resulting in primary aldosteronism (Conn’s syndrome), androgens leading to virilization of patients, and in very rare cases renin manifesting as secondary aldosteronism.
Renin is a proteolytic enzyme that is synthesized by juxtaglomerular cells. Its release into the bloodstream can be triggered by sympathetic stimulus, decreased arterial blood pressure monitored via baroreceptors or decreased sodium levels in the …show more content…
AIs are being picked up with increasing frequency due to the widespread use of radiological imaging tests such as abdominal ultrasonography, CT, and MRI. Autopsy series have quoted the incidence of clinically inapparent adrenal tumours in 1.4-8.7 % of general population. Prevalence is noted to increase with age, from 1 % prior to age of 30 to 7-10 % beyond age of 70. The vast majority of these adrenal masses are in fact non-functional benign cortical adenomas that require no treatment (see Table 1). However, an adrenal incidentaloma still requires investigation and …show more content…
Certain morphological features such as nuclear grade, venous invasion and sinusoidal invasion were shown to be persistently poor with minimal improvement of intra-observer agreement even post education. (Tissier et al.) Weiss scoring criteria for malignancy was reduced from four (as described in original paper) to three in 1989 when cases with lower Weiss scores were noted to behave in a malignant fashion. Unfortunately, cut-off at three still does not achieve a sensitivity and specificity of 100%. This is reflected in case 2 where despite scoring only two criteria, concerns were raised given that endocrine neoplasms do not always correlate with the histopathological features. Given the large tumour size and weight in conjunction with clinically concerning presentations of hormonal hypersecretion, a benign clinical course was uncertain. This is reflected by the rigorous follow-up and ongoing endocrine and radiological surveillance by the
Renin is a proteolytic enzyme that is synthesized by juxtaglomerular cells. Its release into the bloodstream can be triggered by sympathetic stimulus, decreased arterial blood pressure monitored via baroreceptors or decreased sodium levels in the …show more content…
AIs are being picked up with increasing frequency due to the widespread use of radiological imaging tests such as abdominal ultrasonography, CT, and MRI. Autopsy series have quoted the incidence of clinically inapparent adrenal tumours in 1.4-8.7 % of general population. Prevalence is noted to increase with age, from 1 % prior to age of 30 to 7-10 % beyond age of 70. The vast majority of these adrenal masses are in fact non-functional benign cortical adenomas that require no treatment (see Table 1). However, an adrenal incidentaloma still requires investigation and …show more content…
Certain morphological features such as nuclear grade, venous invasion and sinusoidal invasion were shown to be persistently poor with minimal improvement of intra-observer agreement even post education. (Tissier et al.) Weiss scoring criteria for malignancy was reduced from four (as described in original paper) to three in 1989 when cases with lower Weiss scores were noted to behave in a malignant fashion. Unfortunately, cut-off at three still does not achieve a sensitivity and specificity of 100%. This is reflected in case 2 where despite scoring only two criteria, concerns were raised given that endocrine neoplasms do not always correlate with the histopathological features. Given the large tumour size and weight in conjunction with clinically concerning presentations of hormonal hypersecretion, a benign clinical course was uncertain. This is reflected by the rigorous follow-up and ongoing endocrine and radiological surveillance by the