Diagnostic algorithm of the subclinical forms of adrenal neoplasms

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The possibility of modifying the existing diagnostic algorithm of latent forms of hormone-active and potentially malignant formations in the adrenal glands using modern methods of laboratory diagnostics and radiation imaging is substantiated. In the clinic of a faculty of surgery and on its clinical base, experience in the examination and treatment of 1457 patients with various formations of the adrenal glands has been accumulated. Among them, 270 (14.9%) patients were selected, in whom precursor hormones of steroidogenesis and metabolites of catecholamines in the blood plasma were specially studied by high-performance liquid chromatography, tumor marker measurement, and three-phase computed tomography with intravenous contrast enhancement. Determination of steroidogenesis precursor hormones and catecholamine metabolites in the blood plasma by high-performance liquid chromatography in combination with traditional methods of laboratory diagnostics, use of computed tomography with intravenous contrast enhancement, construction of multiplanar reconstructions, and postprocessor image processing are the basis of a modified algorithm for verification of latent forms of hormone-active and potentially malignant tumors of the adrenal glands. The implementation of the diagnostic algorithm developed in the clinic made early diagnosis of the subclinical forms of NP neoplasms possible, as well as ensure the implementation of minimally invasive surgical interventions before the development of endocrine and metabolic disorders and consequently prevent the development of intraoperative and postoperative complications, which thereby reduce the duration of rehabilitation and disability of patients with good long-term treatment results and high quality of life.

Full Text

Restricted Access

About the authors

Sofya G. Blyumina

Military Medical Academy named after S.M. Kirov of the Ministry of Defence of the Russian Federation

Author for correspondence.
Email: sonechka.bliumina@yandex.ru
ORCID iD: 0000-0001-7028-2347
SPIN-code: 3612-5052

candidate of medical sciences

Russian Federation, Saint Petersburg

Pavel N. Romashchenko

Military Medical Academy named after S.M. Kirov of the Ministry of Defence of the Russian Federation

Email: romashchenko@rambler.ru
ORCID iD: 0000-0001-8918-1730
SPIN-code: 3850-1792

doctor of medical sciences, professor

Russian Federation, Saint Petersburg

Igor S. Zheleznyak

Military Medical Academy named after S.M. Kirov of the Ministry of Defence of the Russian Federation

Email: igzh@bk.ru
ORCID iD: 0000-0001-7383-512X
SPIN-code: 1450-5053

doctor of medical sciences

Russian Federation, Saint Petersburg

References

  1. Buryakina SA, Tarbaeva NV, Volevodz NN, et al. Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis. Therapeutic Archive. 2020;92(12):185–194. (In Russ.) doi: 10.26442/00403660.2020.12.200451
  2. Dedov II, Melnichenko GA. Clinical guidelines. Incidentaloma of the adrenal glands (diagnosis and differential diagnosis). Methodical recommendations for primary care physicians. Moscow; 2015. 16 p. (In Russ.).
  3. Molashenko NV, Platonova NM, Beltsevich DG, et al. Diagnosis and differential diagnosis of adrenal incidentalomas. Obesity and Metabolism. 2016;13(4):39–44. (In Russ.) doi: 10.14341/OMET2016439-44
  4. Fassnacht M, Arlt W, Bancos I, et al. Clinical Practice Guideline: Management of adrenal incidentalomas: ESE clinical practice guideline in collaboration with the ENSAT. European Journal of Endocrinology. 2016;175(4):34. doi: 10.1530/EJE-16-0467
  5. Romashchenko PN, Maistrenko NA, Zheleznyak IS, et al. Mesto komp’juternoj tomografii v algoritme diagnostiki novoobrazovanij nadpochechnikov. Hirurgicheskaja korrekcija jendokrinnyh narushenij. Sbornik trudov, posvjashhennyj 25-letiju otdelenija hirurgicheskoj jendokrinologii. Rjazan’: Rjazanskij gosudarstvennyj medicinskij universitet im. akad. Pavlova IP. 2017. P. 172–182.
  6. Romashchenko PN, Maistrenko NA, Bliumina SG, et al. Diagnostics and treatment of patients with subclinical forms of hormonally active adrenal tumors. Tavrichesky Medico-Biologicheskiy Vestnik. 2020;23(2):174–179. (In Russ.). doi: 10.37279/2070-8092-2020-23-2-181-186
  7. Eisenhofer G, Masjkur J, Peitzch M, et al. Plasma steroid metabolome is profiling for diagnosis and subtyping patients with Cushing syndrome. Clinical Chemistry. 2018;64(3):586–596. doi: 10.1373/clinchem.2017.282582
  8. Kelsall A, Iqbal A, Newell-Price J, et al. Adrenal incidentalomas: Cardiovascular and metabolic effects of mild cortisol excess. Gland Surgery. 2020;9(1):94–104. doi: 10.21037/gs.2019.11.19
  9. Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guidelines. J Clin Endocrinol Metab. 2014;99(6):1915–1942. doi: 10.1210/jc.2014-1498
  10. Li T, Li W, Fang X, et al. Comprehensive analysis on 559 cases of adrenal incidentalomas in the eldery Chinese. Aging Medicine. 2018;1(1):35–38. doi: 10.1002/agm2.12006
  11. Morelli V, Reimondo G, Giordano R, et al. Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab. 2014;99(3):827–834. doi: 10.1210/jc.2013-3527
  12. Velikanova LI, Shafigullina ZR, Vorokhobina LI, et al. Differential diagnostics of adrenocortical incidentalomas with different laboratory technologies. Herald of the Northwestern State Medical University named after Mechnikov II. 2015;7(4):52–57. (In Russ.).
  13. Velikanova LI, Shafigullina ZR, Vorokhobina LI, et al. Gas chromatography–mass spectrometry analysis of urinary steroid metabolomics for detection of early signs of adrenal neoplasm malignancy in patients with cushing’s syndrome. Experimental Biology and Medicine Bulletin. 2019;167(5):621–625. (In Russ.).
  14. Vorochobina NV, Ivanushko MA, Velikanova LI, et al. Mineralocorticoid functional of adrenal cortex in patients with pheochromocytoma. Herald of the Northwestern State Medical University named after Mechnikov II. 2018;10(1):67–71. (In Russ.). doi: 10.17816/mechnikov201810167-71
  15. Romashchenko PN, Maistrenko NA, Pashchenko OB, et al. «Nemye» feohromocitomy. Bulletin of Surgery Named after II Grekov. 2004;163(3):22–27. (In Russ.).
  16. Maystrenko NA, Romashchenko PN, Pryadko AS, et al. Diagnostics and treatment with chromaffin. Bulletin of surgery named after II Grekov. 2005;164(4):31–41. (In Russ.).
  17. Romashchenko PN. Sovremennye podhody k diagnostike i hirurgicheskomu lecheniju hromaffinnyh opuholej. [Dissertation] Saint Petersberg: 2007. 42 p. (In Russ.).
  18. Reimondo G, Muller A, Ingargiola E, et al. Is follow-up of adrenal incidentalomas always mandatory? Endocrinol Metab (Seoul). 2020;35(1):26–35. doi: 10.3803/EnM.2020.35.1.26
  19. Szychlinska M, Baranowska-Jurkun A, Matuszewski W, et al. Markers of subclinical cardiovascular disease in patients with adrenal incidentalomas. Medicina. 2020;56(2):69. doi: 10.3390/medicina56020069

Copyright (c) 2021 Blyumina S.G., Romashchenko P.N., Zheleznyak I.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies