Diagnosis Of Adenoma Research Articles

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Can biochemical markers help in the differential diagnosis of pheochromacytoma-adrenocortical adenoma

Can biochemical markers help in the differential diagnosis of pheochromacytoma-adrenocortical adenoma

GLUCOCORTICOIDS AND MINERALOCORTICOIDS IN BLOOD PLASMA AS MARKERS FOR THE EARLY DIAGNOSIS OF ADRENAL CORTEX TUMORS

Summary: Aim: assessment of the pituitary-adrenal and renin-aldosterone systems state in patients with various types of adrenocortical adenomas. Object and methods: in 35 patients with adrenocortical adenomas, the hormonal status was evaluated by a direct quantitative immunoenzymatic analysis. The levels of glucocorticoids (cortisol) and mineralocorticoids (aldosterone) were determined. The levels of adrenocorticotropic hormone (ACTH) and renin were assessed by immunochemical methods using monoclonal antibodies specific for ACTH and renin. Results: increasing level of the cortisol against the background of a decreasing level of the ACTH in patients with cortisol-producing adrenocortical adenomas was revealed. In patients with aldosterone-producing adenomas, aldosteronism develops against the background of an unchanged level of renin and an increase in the aldosterone-renin ratio. Conclusions: the occurrence of hormone-dependent adenomas in the adrenal cortex disrupts the functioning of the pituitary-adrenal and renin-aldosterone systems, which serves as a criterion for the early diagnosis of adrenocortical adrenal adenomas.

Cytodiagnosis of pleomorphic adenoma in ectopic salivary gland in neck: a case report

Encounter with ectopic salivary is a rarity in clinical practice. The ectopic salivary tissue harbouring neoplastic pathology is infrequent phenomenon. The literature reports about are scarce. The present case report is unique for the reasons of diagnosis of pleomorphic adenoma in ectopic salivary tissue in the anterior triangle of the neck on fine needle aspiration cytology (FNAC) which was later confirmed on surgically excised tumor mass.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Abstract P009: Plasma concentrations of multiple oxysterols and risk of colorectal adenomas

Abstract Oxysterols are metabolites of cholesterol and intermediates in pathways for primary bile acid synthesis that regulate homeostasis of cholesterol, fatty acids, and glucose by interacting with widely expressed nuclear receptors. These metabolites are generated throughout the body, either enzymatically or from oxidative stress, and are detectable in peripheral circulation at concentrations much lower than total cholesterol. We previously reported that circulating 27-hydroxycholesterol (27-OHC), the most abundant oxysterol in circulation and an endogenous selective estrogen receptor modulator, may be a risk factor for colorectal adenomas. Here, we report on four other circulating oxysterols: 25-hydroxycholesterol (25-OHC), 24(S)-hydroxycholesterol (24(S)-OHC), 7ɑ-hydroxycholesterol (7ɑ-OHC), and 4β-hydroxycholesterol (4β-OHC). We used high-sensitivity liquid chromatography-mass spectrometry to measure oxysterol concentrations in fasting plasma collected at baseline from 1,440 participants of the Vitamin D/Calcium Polyp Prevention Study, a completed randomized clinical trial that enrolled men and women recently diagnosed with colorectal adenomas with follow-up timed to colonoscopic surveillance intervals. Advanced adenomas were defined as tubulovillous or villous lesions, ≥1 cm in diameter, with high-grade dysplasia, or invasive adenocarcinoma. Risk ratios (RR) with 95% confidence intervals (CI) of new colorectal adenomas occurring during follow-up were estimated using repeated-measures log-linear regression for log-transformed circulating oxysterols. Primary analyses adjusted for multiple potential confounding factors and the five circulating oxysterols simultaneously, including 27-OHC. One geometric standard deviation (SD) higher circulating 7ɑ-OHC at the time of initial adenoma diagnosis was associated with 9% and 20% higher subsequent risk of any adenomas and advanced adenomas, respectively (RR of any adenomas per SD circulating 7ɑ-OHC, 1.09; 95% CI, 1.03-1.15 and RR of advanced adenomas, 1.20; 95% CI, 1.04-1.39). The positive association with adenoma risk that we previously reported for circulating 27-OHC persisted controlling for the other oxysterols including 7ɑ-OHC (RR of any adenomas per SD circulating 27-OHC 1.07; 95% CI, 0.99-1.15 and RR of advanced adenomas, 1.23; 95% CI, 1.03-1.48). No statistically significant associations were observed for circulating 25-OHC, 24(S)-OHC, and 4β-OHC. We conclude that circulating 7ɑ-OHC and 27-OHC may be independently associated with colorectal adenoma risk. Given these two oxysterols are the initial products of the classic (neutral) and alternative (acidic) pathways for primary bile acid synthesis, respectively, our findings provide additional evidence in support of a role for bile acids in the development of colorectal neoplasia. Novel colorectal cancer prevention strategies may target oxysterol formation. Citation Format: Michael N. Passarelli, Bonne M. Thompson, Jeffrey G. McDonald, Thomas J. Palys, Judy R. Rees, Elizabeth L. Barry, John A. Baron. Plasma concentrations of multiple oxysterols and risk of colorectal adenomas. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P009.

Pitfalls in the Diagnosis of Primary Hyperparathyroidism in a Sudanese Adolescent Boy; a case disguised as rickets

BackgroundJuvenile primary hyperparathyroidism (PHPT) is a rare endocrine disease. Its diagnosis might be masked by clinical, biochemical, and radiological features of rickets.Case presentationA 12-year-old Sudanese boy presented with progressive lower limbs deformity and difficulty in walking for six months. It was associated with fatigability, poor appetite, and generalized bone pain. On examination, he was thin, disproportionately short and pubertal, and had bilateral genu valgum deformity. X-rays showed osteopenia and signs of rickets. Biochemical workup revealed mildly elevated serum calcium, low phosphate, high alkaline phosphatase, and high parathyroid hormone with low 25-hydroxy vitamin D3. Celiac screening, liver function test and renal profile were normal. Serum calcium rose dramatically after vitamin D therapy. Genetic testing was negative for CYP2R1 and MEN1 genes. Ultrasound neck showed left inferior parathyroid adenoma which was surgically excised. Histopathology confirmed the diagnosis of parathyroid adenoma. Postoperatively, he had hypocalcemia which was treated with calcium and alfacalcidol. Corrective surgery is planned for the genu valgum deformity which markedly improved after parathyroidectomy.ConclusionAlthough PHPT is extremely rare in the young population, it should be considered in patients with rickets and elevated serum calcium at baseline or after initiating vitamin D therapy.

Prioritizing Pituitary Adenoma Care in Pakistan: Analysis from an Epidemiological Study.

To identify symptoms and risk factors and promptly diagnose, treat, and manage pituitary adenomas. Prioritizing care for pituitary adenomas will reduce the prolonged disability. Patients with a histopathological diagnosis of a pituitary adenoma that presented at 32 tertiary care neurosurgical centres were included. The information recorded included demographics, treatment methods, adjuvant chemoradiotherapy and loss to follow-up. Data on tumour size, functionality, and laterality were collected. Of the 32 hospitals surveyed, 24 operated on pituitary adenomas, and treated 277 patients. The mean age at diagnosis was 39.8 ± 13 years, with a majority of males (63.5%) being diagnosed than females. Paediatric cases constituted only 4.7% of the total pituitary adenomas operated upon. Gross total resection was reported for 155 (56%) of all pituitary adenoma patients. Majority of the patients affected by pituitary adenomas (80.1%) were from the working class. Highlighting care for non-malignant brain tumours is important for Pakistan's health system. Evidence pertaining to gender and age disparities indicates that males in the younger age groups are predominantly affected, which takes a large socio-economic toll on patients and their households. This study also highlights the need to incorporate digital health technologies for postoperative follow-up and adjuvant treatment.

Computed tomography in the differential diagnosis of adrenal tumors

Background. Modern methods of topical diagnostics have high accuracy and can determine the morphological structure of the adrenal tumor with high probability before surgery, but none of them has 100% sensitivity and specificity. Contrast-enhanced computed tomography is most commonly used by clinicians. The criteria for the malignancy of an adrenal tumor determined by this method continue to be discussed.The aim is to evaluate the effectiveness of contrast-enhanced computed tomography in the preoperative diagnosis of adrenal tumors and to analyze errors.Materials and methods. Contrast-enhanced computed tomography was performed in 69 patients with adrenal tumors. After morphological examination of the removed tumors, the effectiveness of preoperative diagnostics was evaluated with the determination of sensitivity and specificity of the method. If the pre- and postoperative diagnosis did not match, the causes of errors were analyzed.Results. The attenuation on unenhanced CT in adenomas ranged from 5 to 36 HU, in adrenocortical cancer — from 26 to 80 HU, in pheochromocytomas — from 25 to 99 HU. The attenuation of adenomas on unenhanced CT was significantly less than with pheochromocytomas (p=0.005) and adrenocortical cancer (p=0.012). In the venous phase, no significant differences were found, and in the delayed phase, the attenuation of adenomas was also significantly less than in malignant tumors (p=0.008, p=0.008). The median of absolute percent contrast washout in adenomas was 85%, in pheochromocytes — 59%, in adrenocortical cancer — 57%. When comparing the diagnosis before and after surgery, its non-coincidence was found in 8 cases (10.39%). Two patients (2.59%) with small tumors (diameter of 15 mm) were diagnosed with adenoma in ­combination with pheochromocytoma and adenoma before surgery. After morphological examination, the diagnosis was changed to adrenocortical cancer in combination with adenoma and «mute» pheochromocytoma.Conclusion. The sensitivity and specificity of contrast-enhanced CT in the diagnosis of adenomas was 95.61% and 94.82%, pheochromocytomas — 95% and 95.08%, adrenocortical cancer — 92.31 and 98.48%. Diagnostic errors of «mute» pheochromocytoma and adrenocortical cancer occurred with small sizes (15 mm) of adrenal tumors.

Risk prediction model establishment with tri-phasic CT image features for differential diagnosis of adrenal pheochromocytomas and lipid-poor adenomas: Grouping method.

The purpose of this study was to establish a risk prediction model for differential diagnosis of pheochromocytomas (PCCs) from lipid-poor adenomas (LPAs) using a grouping method based on tri-phasic CT image features. In this retrospective study, we enrolled patients that were assigned to a training set (136 PCCs and 183 LPAs) from two medical centers, along with an external independent validation set (30 PCCs and 54 LPAs) from another center. According to the attenuation values in unenhanced CT (CTu), the lesions were divided into three groups: group 1, 10 HU < CTu ≤ 25 HU; group 2, 25 HU < CTu ≤ 40 HU; and group 3, CTu > 40 HU. Quantitative and qualitative CT imaging features were calculated and evaluated. Univariate, ROC, and binary logistic regression analyses were applied to compare these features. Cystic degeneration, CTu, and the peak value of enhancement in the arterial and venous phase (DEpeak) were independent risk factors for differential diagnosis of adrenal PCCs from LPAs. In all subjects (groups 1, 2, and 3), the model formula for the differentiation of PCCs was as follows: Y = -7.709 + 3.617*(cystic degeneration) + 0.175*(CTu ≥ 35.55 HU) + 0.068*(DEpeak ≥ 51.35 HU). ROC curves were drawn with an AUC of 0.95 (95% CI: 0.927-0.973) in the training set and 0.91 (95% CI: 0.860-0.929) in the external validation set. A reliable and practical prediction model for differential diagnosis of adrenal PCCs and LPAs was established using a grouping method.

Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis

Disparities in treatment and outcomes disproportionately affect minority ethnic and racial populations in many surgical fields. Although substantial research in racial disparities has focused on outcomes, little is known about how surgeon recommendations can be influenced by patient race. The aim of this study was to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors. In this registry-based cohort study, we used data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) and the American College of Surgeons National Cancer Database (NCDB) in the USA for independent analysis. Adults (aged ≥20 years) with a new diagnosis of meningioma, glioblastoma, pituitary adenoma, vestibular schwannoma, astrocytoma, and oligodendroglioma, with information on tumour size and surgical recommendation were included in the analysis. The primary outcome of this study was the odds of a surgeon recommending against surgical resection at diagnosis of primary brain neoplasms. This outcome was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. This study included US national data from the SEER (1975-2016) and NCDB (2004-17) databases of adults with a new diagnosis of meningioma (SEER n=63 674; NCDB n=222 673), glioblastoma (n=35 258; n=104 047), pituitary adenoma (n=27 506; n=87 772), vestibular schwannoma (n=11 525; n=30 745), astrocytoma (n=5402; n=10 631), and oligodendroglioma (n=3977; n=9187). Independent of clinical and demographic factors, including insurance status and rural-urban continuum code, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (adjusted odds ratio 1·13, 95% CI 1·06-1·21, p<0·0001), glioblastoma (1·14, 1·01-1·28, p=0·038), pituitary adenoma (1·13, 1·05-1·22, p<0·0001), and vestibular schwannoma (1·48, 1·19-1·84, p<0·0001) when compared with White patients in the SEER dataset. Additionally, patients of unknown race had significantly higher odds of recommendation against surgical resection for pituitary adenoma (1·80, 1·41-2·30, p<0·0001) and vestibular schwannoma (1·49, 1·10-2·04, p=0·011). Performing a validation analysis using the NCDB dataset confirmed these significant results for Black patients with meningioma (1·18, 1·14-1·22, p<0·0001), glioblastoma (1·19, 1·12-1·28, p<0·0001), pituitary adenoma (1·21, 1·16-1·25, p<0·0001), and vestibular schwannoma (1·19, 1·04-1·35, p=0·0085), and indicated and indicated that the findings are independent of patient comorbidities. When further restricted to the most recent decade in SEER, these inequities held true for Black patients, except those with glioblastoma (meningioma [1·18, 1·08-1·28, p<0·0001], pituitary adenoma [1·20, 1·09-1·31, p<0·0001], and vestibular schwannoma [1·54, 1·16-2·04, p=0·0031]). Racial disparities in surgery recommendations in the USA exist for patients with primary brain tumours, independent of potential confounders including clinical, demographic, and select socioeconomic factors. Further studies are needed to understand drivers of this bias and enhance equality in surgical care. None.

“Scarless” excision of a nipple adenoma case report—a good aesthetic outcome after a circular nipple excision with purse-string closure technique

: Complete surgical excision of nipple adenoma with clear margins offers the lowest risk of recurrence of this locally infiltrative yet benign entity. A thorough triple assessment including histological assessment is crucial to exclude any malignant pathology, and confirm the diagnosis. There are many excisional and ablative techniques published that can give clear resection margins, but there remains a paucity of data on acceptable aesthetic outcomes. It is important to balance between adequate surgical margins to prevent recurrence and a good aesthetic outcome, particularly in a young patient. We wish to highlight a good aesthetic outcome following a simple circular excision with purse-string closure of the nipple defect. We present a 28-year-old lady with a progressively ulcerative lesion that involved the entire nipple. Ultrasound did not show any other underlying lesions or intraductal extension. Punch biopsy confirms the diagnosis of a benign nipple adenoma. She was counselled for complete nipple excision and the defect was primarily closed with purse-string technique. This may not be a novel technique as it has been described for closure of other defects. However, the benefit of a purse-string closure of a circular nipple excision defect to reduce scarring may be underreported in the literature. This technique helps to conceal the scar within the areola, retain its natural corrugated appearance, and prevent distortion to the overall shape of the areolar complex. The final outcome of a complete nipple excision resembles that of a ‘scarless’ excision and remains aesthetically pleasing. We hope to allay fears of clinician and patients faced with similar condition by offering a safe, easily reproducible, single staged technique that offers high patient satisfaction in selected patients. Using this technique may even preclude the need for further nipple reconstruction.

Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling.

The purpose of this study was to assess the surgical outcomes of patients with primary aldosteronism when surgery was based only on CT finding of unilateral adenoma without adrenal vein sampling (AVS). This is a retrospective review of the records of patients who had undergone retroperitoneal laparoscopic adrenalectomy for primary aldosteronism based on CT scan finding of unilateral adenoma and had a follow-up of at least 6-12 months from January 2012 to December 2020 in a single center; decision for adrenalectomy was based on CT scan, and AVS was not used. The clinical and biochemical outcomes were accessed using the standardized primary aldosteronism surgical outcome (PASO) criteria. Patient's demographics and preoperative factors were analyzed to assess for independent predictor of surgical success. According to the PASO criteria, 172 patients finally enrolled in the training dataset, and 20 patients enrolled in the validation dataset. In the training dataset, complete clinical success was achieved in 71 patients (41.3%), partial success in 87 (50.6%), and absent success in 14 (8.1%). Biochemical outcomes showed that 151 patients (87.8%) were completely cured, 14 patients (8.1%) got a partial biochemical success, and an absent biochemical success was found in seven patients (4.1%). Multivariate logistic regression analysis showed that age, body mass index (BMI), tumor size, mean arterial pressure (MAP), and serum potassium were the most independent factors for incomplete biochemical success. Based on the results of statistical analysis, our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. Laparoscopic adrenalectomy for patients with primary aldosteronism base on CT scan finding of a unilateral adenoma without AVS had a high rate of complete biochemical cure at 12 months. Risk factors for incomplete biochemical success include age, BMI, tumor size, MAP, and serum potassium. Our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. The nomogram accurately and reliably predicted the incomplete biochemical success.

Difficulties of diagnostics of parothoid adenoma in the background of combined treatment of advanced thyroid cancer

In clinical practice, the most common sporadic variant of solitary parathyroid adenoma. Atypical adenomas of the parathyroid glands are a rare form and present the greatest difficulty in determining the potential for malignancy, the extent of surgical treatment, and the patients dynamic follow-up regimen. They are not characterized by the classic signs of malignant growth invasion beyond the formation capsule or the presence of metastases. Specific clinical and prognostic phenotypes of parathyroid adenomas are highly individual.&#x0D; No more than 3% of parathyroid adenomas are associated with papillary thyroid cancer. Awareness of such a combination of pathology allows us to assess possible risks and determine the scope of surgical intervention as the only method of radical treatment of pathologically altered parathyroid tissue. With early detection of recurrence of thyroid cancer, it is necessary to conduct additional monitoring of hormonal activity and radiation diagnosis of tumor pathology of the parathyroid glands.&#x0D; The presented clinical case showed that the cytological and histological diagnosis of parathyroid adenoma against the background of recurrence of advanced thyroid cancer can fundamentally differ at different stages of the morphological study. With parathyroid adenoma in the preoperative period, there may be a discrepancy between these methods of radiation and intraoperative diagnostics and the results of an urgent and planned histological examination. The uncharacteristic course of solitary parathyroid adenoma after thyroidectomy in combination with false positive results due to ultrasound location of thyroid nodules (residual tumors and cancer recurrences, as well as paratracheal metastases) and nervous tissue (paraganglioma) contributes to incorrect preoperative diagnosis of thyroid bed tumors. At the preoperative stage of diagnosing tumor pathology of the parathyroid glands, it is advisable to perform scintigraphy of the parathyroid glands with a simultaneous combination of ultrasound, which will increase the sensitivity of the diagnosis.&#x0D; After surgical treatment of tumor pathology of the parathyroid tissue, in some cases, the result of differential diagnosis is an immunohistochemical study to form a final diagnosis and determine further patient management tactics.

Differential diagnostic value of plain CT scan in adrenal adenoma and non-adenoma: A two-center control study of mean attenuation value, minimum attenuation value, and CT histogram.

To investigate the value of mean attenuation value (AVmean), minimum attenuation value (AVmin), and CT histogram (CTH) for the differential diagnosis of adrenal adenoma and non-adenoma in two medical centers. The plain CT data of 403 cases of adrenal adenoma and 141 cases of non-adenoma in center A were retrospectively analyzed, and compared with data of 86 cases of adenoma and 71 cases of non-adenoma in center B. All cases were confirmed by pathology or clinical follow-up. The diagnostic efficacy of AVmean ≤ 10 Hounsfield units (HU), AVmin ≤ 0 HU, and CTH negative pixels ≥ 10% for adrenal adenoma, and AVmin and CTH for adenoma with AVmean > 10Hu were compared between the two medical centers. In medical centers A and B, the AUC of AVmean for the differential diagnosis of adenoma and non-adenoma was 0.956 and 0.956, respectively, and the corresponding sensitivity, specificity, and accuracy were, 0.591 and 0.663, 1.000 and 1.000, 0.697, and 0.815, respectively, when the threshold was ≤ 10 HU. The AUC of AVmin was 0.941 and 0.958, respectively, and the corresponding sensitivity, specificity, and accuracy were 0.869 and 0.826, 0.986, and 0.972, 0.899, and 0.892, respectively, when the threshold was ≤ 0 HU. The AUC of CTH negative pixels was 0.948 and 0.952, respectively, and the corresponding sensitivity, specificity, and accuracy were 0.759 and 0.674, 1.000 and 1.000, 0.822, and 0.822, respectively, when the threshold was ≥ 10%. Among adenoma with AVmean >10 HU, the best threshold of AVmin in center A and center B were -0.250HU and 2.375HU, and the corresponding AUC, sensitivity and specificity were 0.858 and 0.846, 0.691 and 0.586, 0.986 and 0.958; the best threshold of CTH in center A and center B were 0.895% and 0.775%, and the corresponding AUC, sensitivity and specificity were 0.873 and 0.822, 0.818 and 0.724, 0.837 and 0.915. AVmean, AVmin, and CTH are all important parameters for differentiating adrenal adenoma from non-adenoma. Even for adenomas with AVmean > 10 HU, AVmin and CTH still had high diagnostic efficiency. The three parameters are complementary, assisting clinicians to develop personalized treatments.

PSUN61 Primary Aldosteronism Presenting as Chronic Hypokalemia in a Normotensive Patient

Abstract Introduction Conn first described the hallmark features of primary aldosteronism (PA) as a state of aldosterone excess in the setting of hypertension and hypokalemia. Recent work has shed light on a wide spectrum of disease that likely includes normotensive patients with elevated aldosterone and suppressed renin. Mineralocorticoid excess appears to be the main driver of disease progression; however, it is not known whether individual differences in intra-arterial plasticity and effective sodium potassium exchange alter the overt clinical presentation. Here, we describe a patient with chronic hypokalemia and normal blood pressure with the diagnosis of a unilateral aldosterone-producing adenoma. Clinical Case A 47-year-old woman with no significant medical history was referred to endocrinology for evaluation of isolated hypokalemia since 2012. Her potassium was 2.8mEq/L at its lowest a month prior to her visit and had numerous other values less than 3.5mEq/L over the past 10 years. She did not carry a diagnosis of hypertension nor was she hypertensive at the time of her initial and subsequent evaluations. Results on initial endocrinology evaluation demonstrated a potassium of 3.2mEq/L (3.5-5.0mEq/L), Plasma Aldosterone Concentration (PAC) of 29ng/dL (≤21ng/dL), Plasma Renin Activity (PRA) of 0.42ng/mL/h (0.25-5.82ng/mL/h), and Aldosterone Renin Ratio (ARR) of 69. PA was suspected based on hypokalemia with an ARR &amp;gt;30 and PAC &amp;gt;20ng/dL. Further work-up was pursued to confirm the diagnosis as the patient did not have hypertension. She underwent 3-day oral sodium loading. 24-hour urine collection at the conclusion revealed adequate sodium loading with a urine sodium content of 208mEq/24hr (&amp;gt;200mEq/24hr) and aldosterone secretion of 41.3mcg/24hr (&amp;lt;12mcg/24hr). She subsequently underwent a CT abdomen demonstrating a 1.3×0.8 cm right adrenal nodule. Adrenal venous sampling was performed (continuous cosyntropin infusion with simultaneous adrenal venous sampling) which revealed a cortisol-corrected aldosterone lateralization ratio (right to left) of 406 at -5 minutes, 368 at 0 minutes, 33 at 10 minutes and 85 at 15 minutes. Results were consistent with strong lateralization to the right with contralateral suppression. Diagnosis of a right-sided aldosterone-producing adenoma was confirmed and she was referred to surgery for right adrenalectomy. Conclusion This case highlights one of the many presentations of PA. The persistent hypokalemia for a decade suggests a history of longstanding untreated PA prior to eventual diagnosis, yet the patient has remained normotensive. Though normotensive PA is a recognized entity, most patients develop hypertension within 5 years. The ability to remain normotensive despite intravascular volume expansion may highlight the patient's highly compliant vasculature and kidneys that have likely adapted to excrete high sodium loads in the setting of sodium excess. This case emphasizes that isolated hypokalemia in patients without hypertension should prompt consideration of PA and that patients with PA may maintain normotension for multiple years. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PMON126 Null Cell Adenoma With Low Ki-67 Presenting as Recurrent Pituitary Mass

Abstract Background Pituitary adenomas account for 10% to 15% of all intracranial masses. Among these, approximately one-third are identified as nonfunctioning pituitary adenomas (NFPA) which have a heterogenous profile and an increased potential for relapse one to five years after pituitary surgery. In a retrospective analysis by Almeida et al,multiple surgical resections, elevated ki-67 and cavernous sinus invasion were predictive of recurrence. They typically present with symptoms of mass effect and most are macroadenomas at time of diagnosis. Clinical Case A 65-year-old female initially presented with bitemporal hemianopsia, galactorrhea and amenorrhea 28 years prior. She subsequently underwent transsphenoidal hypophysectomy with resolution of symptoms post operatively. She was clinically stable until 12 years after the surgery when she noted new onset peripheral visual field loss. Upon reevaluation, she was diagnosed with non-functioning pituitary macroadenoma for which she was advised gamma knife surgery but she opted a repeat transsphenoidal pituitary surgery. Her vision improved and she remained asymptomatic thereafter. Sixteen years after her second surgery, she developed blurring of vision. Cranial MRI was done which showed lobulated, heterogeneous hyperdense sellar-suprasellar mass measuring 55×36×47 mm extending to the bilateral sphenoid and ethmoid sinuses, left pterygopalatine fossa, left superior orbital fissure, probably the left foramen lacerum, and left cavernous sinus with encasement of the left internal carotid artery and associated erosion of the adjacent osseous structures. Visual field testing showed mild reduction in field sensitivity with consideration of media opacity and/or uncorrected error of refraction. Baseline hormonal work up was unremarkable. Hence, endoscopic endonasal transphenoidal, transethmoidal parasellar excision of sellar mass, with reconstruction via Hadad Flap was done. There were no intraoperative nor postoperative complications. The specimen was sent for histopathology with provisional anatomic diagnosis of pituitary adenoma. Immunohistochemistry stained negative for chromogranin and any of the pituitary hormones which was consistent with null cell adenoma. The Ki-67, an independent marker of tumor progression and recurrence, was low at less than 1%. However, after 1 month, repeat MRI showed  no significant change in the lobulated, heterogeneously enhancing mass centered in the sellar-suprasellar region. Thus, she received adjuvant radiotherapy with total dose of 5040cGy divided in 28 fractions and was advised close monitoring of pituitary MRI and/or development of any new symptoms. Conclusion In this case, although with low Ki-67, the presence of multiple surgeries and high Knosp grade were recognized as risk factors for its recurrence.Treatment of recurrent NFPA is multimodal which includes re-operation, radiosurgery and radiation therapy. A multidisciplinary team approach is required for its comprehensive management and long-term follow-up. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Acute Pancreatitis Predating the Diagnosis of Parathyroid Adenoma

Acute Pancreatitis Predating the Diagnosis of Parathyroid Adenoma

Primary hyperparathyroidism, presenting with acute kidney injury in the first trimester of pregnancy; a case report

Primary hyperparathyroidism (PHPT) is the leading cause of hypercalcemia. Total serum calcium level &gt;3.5 mmol/L is associated with a high risk of a hypercalcemic crisis, manifesting with nausea, vomiting, dehydration, myalgia’s, abdominal pain, acute pancreatitis, acute kidney injury (AKI), cardiac rhythm disorders and disturbances of consciousness. We report here a case of PHPT, manifested with hypercalcemic crisis during pregnancy. A 30-year-old woman in the first trimester of pregnancy admitted complaining on loss of appetite, nausea, vomiting, lower abdomen pain, weakness, and leg pain during the last 10 days. She had a history of two uncomplicated pregnancies, and two episodes of renal colic, her kidney function was normal 2 weeks prior to admission. Work-up showed hypochloremia, hypokalemia, hyponatremia, total serum calcium was 5.34 mmol/L, and serum creatinine 226 µmol/L, and she underwent urgent hemodialysis (HD). Her parathyroid hormone (PTH) was 948 pg/mL, and imaging revealed missed miscarriage 9-10 weeks, soft tissue mass 30x20x33mm near the lower pole of the left lobe of the thyroid gland, small stones in renal calices, and polysegmental pneumonia. She received antibiotics, calcimimetics, and every-day hemodiafiltration (HDF), and underwent vacuum aspiration of uterine cavity and surgical removal of the parathyroidoma. Her PTH shortly returned to the reference level, and serum creatinine dropped to 140 µmol/L after kidney replacement therapy (KRT) secession. Pathology confirmed the diagnosis of parathyroid adenoma. PHPT should be included in the diagnostic algorithm of AKI in pregnancy along with vomiting of pregnant, sepsis, pre-eclampsia and other causes. Successful management of PHPT complications in pregnancy demands multidisciplinary team.