The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas.

Abstract

CONTEXT:

Computed tomography (CT) unenhanced attenuation value of <10 Hounsfield units (HU) has an excellent specificity (98%) to diagnose lipid-rich adrenocortical adenomas (ACAs) with a weaker sensitivity (71%).

OBJECTIVE:

To determine from a routine clinical perspective if unenhanced attenuation value is influenced by cortisol secretion in ACAs.

DESIGN:

This was a retrospective study of cases collected between 2009 and 2012.

SETTING:

This study was conducted in a tertiary-care university hospital.

PATIENTS:

Seventy-two patients operated on for an ACA (Weiss score ≤ 2) were analysed. Thirty-four patients had an ACA oversecreting cortisol (Cush-ACA). Thirty-eight patients had an ACA without cortisol oversecretion (Non Hyper-ACA).

MAIN OUTCOME MEASURE:

CT unenhanced attenuation value was correlated with the functional status. The Weiss score items were analysed.

RESULTS:

Among the 34 patients with a Cush-ACA a minority (n = 7) had an unenhanced attenuation value under 10 HU. Among the high precontrast density (> 10 HU) Cush-ACAs, washout analysis after contrast administration was consistent with the benign nature of the tumor in ∼ 60% of the cases. Less than 25% clear cells (lipid-rich cells), a Weiss score item, was present in 50% of the Cush-ACAs in favour of a lipid-poor content.

CONCLUSIONS:

Unenhanced attenuation value has a poor sensitivity to diagnose an ACA in case of cortisol oversecretion due to poor lipid content. Nevertheless, the accuracy of washout analysis was preserved in the group of Cush-ACAs.

• Authors: Claire Chambre, Emily McMurray, Camille Baudry, Marine Lataud, Laurence Guignat, Sébastien Gaujoux, Najiba Lahlou, Jean Guibourdenche, Frédérique Tissier, Mathilde Sibony, Bertrand Dousset, Xavier Bertagna, Jérôme Bertherat, Paul Legmann, Lionel Groussin
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 173 Issue 3 Pg. 325-32 (Sep 2015) ISSN: 1479-683X [Electronic] England
• PMID: 26243637 (Publication Type: Journal Article)
• Copyright: © 2015 European Society of Endocrinology.

Chemical References

• Hydrocortisone

Topics

• Adrenal Cortex Neoplasms (diagnosis, diagnostic imaging, metabolism)
• Adrenocortical Adenoma (diagnosis, diagnostic imaging, metabolism)
• Adult
• Aged
• Cohort Studies
• Female
• Humans
• Hydrocortisone (metabolism)
• Male
• Middle Aged
• Retrospective Studies
• Sensitivity and Specificity
• Tomography, X-Ray Computed (methods)