Michele Zini Servizio di Endocrinologia - Arcispedale S. Maria Nuova, IRCCS Reggio Emilia michele.zini@asmn.re.it

1. FEOCROMOCITOMA
Michele Zini
Servizio di Endocrinologia
Arcispedale S. Maria Nuova, Reggio Emilia
michele.zini@asmn.re.it
Michele Zini 2009

2. EPIDEMIOLOGY
What is the frequency of incidental adrenal
masses in the general population?
 Clinical series:
 Male to female ratio:
3% in middle age
10% in the elderly
1.3 : 1.5
 Autopsy series:
<1% below 30 years of age
3% at 50 years
>7% around 70 years
 Side
right
left
bilateral
53% (50-60)
37% (30-40)
10% (7-15)
Michele Zini 2009

3. Terzolo M et al., Best Pract Res Clin Endocrinol Metab. 2009 Apr;23(2):233-43
Michele Zini 2009

4. ADENOMA 52%
CARCINOMA 12%
CYST 5%
MYELOLIPOMA 8%
OTHER 6%
METASTASIS 2%
PHEO 11%
GANGLIONEUROMA 4%

5. Incidentaloma surrenalico
Casistica di Orbassano, 1991-2005
ADENOMA 78%
181 pts
%
1%
6%
6%
s1
s
a
a
si
si
ta
ta
om
om
yt
yt
as
as
et
oc
et
oc
M
m
M
m
ro
ro
ch
ch
eo
eo
Ph
Ph
%
%
r2
r2
he
he
Ot
Ot
Ca
rci
no
ma
Cy
5%
st
M
3%
ye
lo
lip
om
a
5%

6. EPIDEMIOLOGY
What are the causes of incidental adrenal
masses in the general population?
Average percentage in the literature
• Adenoma
(33-96)
not-secreting
cortisol-secreting
aldosterone-secreting
estrogen/androgen-secreting
•
•
•
•
•
63%
75%
9.5%
2.5%
very rarely
(52-97)
(1-29)
(1.6-2.3)
Pheochromocytoma
Carcinoma
Myelolipoma
Cyst
Ganglioneuroma
7%
6.5%
8%
5%
4%
(1.5-23)
(1.2-11)
(7-15)
(4-22)
(0-6)

7. EPIDEMIOLOGY
Kopetschke R et al., European Journal of Endocrinology 161 355–361, 2009
Michele Zini 2009

8. INCIDENTALE RISCONTRO
≠
ASINTOMATICO
Michele Zini 2009

9. INCIDENTALOMA: CHE FARE ?
AACE/AAES Adrenal Incidentaloma Guidelines, Endocr Pract. 2009;15(Suppl 1)
Michele Zini 2009

10. ENDOCRINE ASSESSMENT
Why pheochromocytoma has to be
recognized?
 Life-threatening condition, particularly if undiagnosed.
 Premature mortality.
 High
morbidity (arrhythmias,
hypertension, hyperglycemia).
 Hypertensive
episodes
and
sustained
arrhythmias
or
can
paroxysmal
result
in
emergencies.
 Even clinically silent pheochromocytoma can be lethal.
 An increasing number of patients with pheochromocytoma
have low-grade hypertension or are normotensive.

11. Michele Zini 2009
Terzolo M et al., Best Pract Res Clin Endocrinol Metab. 2009 Apr;23(2):233-43

12. AACE/AAES Adrenal Incidentaloma Guidelines, Endocr Pract. 2009;15(Suppl 1)
Michele Zini 2009

13. Lee JA et al., Arch Surg. 2007;142(9):870-874
Michele Zini 2009

14. Lee JA et al., Arch Surg. 2007;142(9):870-874
(Calcolato 1 FN e 1 FP)
Valori borderline considerati come
pos.
neg.
esclusi
Sensibilità
93%
79%
92%
Specificità
75%
97%
95%
Potere predittivo positivo
67%
92%
92%
Potere predittivo negativo
95%
90%
95%
Rapporto di probabilità
del test positivo
3.7
23
20
Rapporto di probabilità
del test negativo
0.1
0.2
0.1
Michele Zini 2009

15. Sawka AM et al. A systematic review of the literature examining the diagnostic efficacy
of measurement of fractionated plasma free metanephrines in the biochemical
diagnosis of pheochromocytoma. BMC Endocrine Disorders.2004
Michele Zini 2009

16. Sawka AM et al. A systematic review of the literature examining the diagnostic efficacy
of measurement of fractionated plasma free metanephrines in the biochemical
diagnosis of pheochromocytoma. BMC Endocrine Disorders.2004
Michele Zini 2009

17. Authors' conclusions
A negative fractionated plasma metanephrine
measurement is highly effective in ruling out disease.
However, a positive test result only moderately
increases suspicion of disease
Sawka AM et al. A systematic review of the literature examining the diagnostic efficacy
of measurement of fractionated plasma free metanephrines in the biochemical
diagnosis of pheochromocytoma. BMC Endocrine Disorders.2004
Michele Zini 2009

18. INCIDENTALOMA
Il laboratorio
•
•
•
•
metanefrine urinarie
catecolamine plasmatiche
catecolamine urinarie
(metanefrine plasmatiche)
• PRA
• aldosterone
• elettroliti
•
•
•
•
cortisolemia
cortisoluria 24-ore
ACTH
test di soppressione
(desametazone 1 mg)
• DHEAS
• estradiolo
• testosterone
Michele Zini 2009

19. INCIDENTALOMA: PRIORITA’
• Escludere neoplasie maligne
(primitive o secondarie)
• Escludere feocromocitoma
• Valutazione funzionale corticale
Michele Zini 2009