Q. How to differentiate if an adrenal node is benign or malignant?
Hello doctor,
I recently underwent a routine CT scan without contrast, which revealed a 2.8 adrenal node with a measurement of 41 HU. I want to clarify whether I have a history of cancer as I am currently experiencing no symptoms. The rest of the pelvic abdominal scan results were within the normal range. I am aware that cancer occurrences in the adrenal gland are exceedingly uncommon, often stemming from metastases originating elsewhere in the body. Despite this knowledge, I find myself deeply concerned.
As part of the ongoing assessment, my healthcare provider has recommended blood and urine tests, along with a contrast CT scan. While I understand that a high HU reading can sometimes be associated with malignancies, I am curious if there are other potential explanations for this finding.
Please clarify.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and I can understand your concern.
I would suggest considering an MRI (magnetic resonance imaging) of the adrenal gland, which could provide clear insights to determine the nature of the condition – whether it is benign or not. It is crucial to note that adrenal incidentalomas measuring less than 1.57 inches should be monitored over time. In cases where the size exceeds 1.57 inches, and the Hounsfield Units (HU) measurement is greater than 10, along with irregular borders, then there could be a possibility of malignancy.
For a more accurate confirmation, it is essential to examine the results of the blood tests as well. While there seems to be a suspicion of adenoma, making a definitive assessment without an MRI scan is challenging.
I understand that this information might be concerning, and I apologize for the unsettling news. However, a more comprehensive evaluation is necessary to move forward. Further assessment will provide a clear understanding of the situation.
I hope this helps.
Thank you.
Hello doctor,
Thank you for the reply.
My doctor had suggested that I do blood tests first but she thinks that it is most likely to be a benign adenoma and the chance of malignancy is unlikely.
Hi,
Welcome back to icliniq.com.
Glad to have you back.
I am optimistic that the results will indeed show a benign adenoma, as the characteristics observed so far are not strongly indicative of malignancy.
I wish you good health.
Thank you.
Hi doctor,
Most of the tests came out normal except for a few that were borderline. I was not asked to restrict any food or caffeine before the test. I have absolutely no symptoms. I am under a lot of stress as my body is trying to recover from a spinal cord contusion. What would be the next steps to manage this conservatively?
Hi,
Welcome back to icliniq.com.
I just went through your reports (attachments removed to protect the patient's identity), and they are fairly acceptable and do not seem to be a cause for concern. I do not understand why there was xxxxxx on metanephrines and normetanephrines. I was also hoping to see an MRI of the adrenal gland as well. I feel sorry to hear about your injury. I hope physiotherapy will be helpful in such cases. Nothing else needs to be done at the moment. You would require a regular follow-up scan.
I hope this helps. Do get back if you have any further queries.
Thank you.
Hello doctor,
Thank you for the reply.
Yes, physiotherapy has helped but I have mainly nerve damage (tingly, numbness) and a really tight tone (spasticity) following the C6 contusion. I was struck by a car nine months back while crossing the street. I hope for more recovery as it has been only nine months. I was told that it would take 12-24 months to recover but it had been extremely stressful and challenging. I am trying not to lose hope.
The doctor incidentally found the adrenal node while viewing the CT scan after my accident. My doctor said that he would refer my reports to an endocrinologist. Thank you for your opinion. I do not think I could undergo any more tests or procedures right now since the anxiety over this makes my neuropathy much worse.
Thank you.
Hello,
Welcome back to icliniq.com.
I am very sorry for your symptoms, but I suggest you take Baclofen 10 mg thrice daily for spasticity provided you do not have any contraindications like pregnancy or allergy. Yes, you can just wait and have a yearly checkup yearly for your adenoma.
I hope you feel better soon.
thank you.
Hello doctor,
I hate to bother you again but I just want to be clear. My 24-hour metanepherine is 575 nmol/L which is higher than the standard 399 nmol/L and the cortisol level is 1.8 mcg/dL which is slightly higher than the cutoff value of 1.7 mcg/dL. Is this still acceptable? Also, yes I am on tablet Baclofen and it is the only medicine that I take for my symptoms.
Hi,
Welcome back to icliniq.com.
I did mention in my reply above that the metanephrines value was xxxxxx and I could not understand why it was hidden for me. Yes, it is high and it suggests pheochromocytoma if the value is high. In such cases, your blood pressure should be closely monitored. So, this could explain the adrenal adenoma as pheochromocytoma is a tumor that arises from the adrenal gland. The definitive treatment involves blood pressure monitoring and surgical excision of the tumor. Your cortisol levels are acceptable.
I wish you good health.
Thank you.
Hello doctor,
Thank you for the reply.
Would they always have to remove it, or could they retest or monitor? Is not this a very rare tumor?
Hi,
Welcome back to icliniq.com.
Yes, it is a very rare tumor. It appears from your metanephrine result interpretation that it could be a pheochromocytoma. Of course, an MRI of the adrenal gland is required for a definitive diagnosis. Yes, it has to be removed once it is confirmed. The clinical symptoms need to be assessed by the clinicians who examine you as well.
I have only mentioned the likelihood as indicated by the raised metanephrines and the CT (computed tomography) scan reports. It has to be confirmed by MRI and clinical examination and thorough history.
I wish you good health.
Thank you.
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