Endocrinology and Metabolism

Original Articles

Thyroid
Efficacy and Safety of Long-Term Methimazole versus Radioactive Iodine in the Treatment of Toxic Multinodular Goiter: Fereidoun Azizi, Navid Saadat, Mir Alireza Takyar, Hengameh Abdi, Ladan Mehran, Atieh Amouzegar; Endocrinol Metab. 2022;37(6):861-869. Published online November 23, 2022; DOI: https://doi.org/10.3803/EnM.2022.1476

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Background
This study compared the degree of sustained control of hyperthyroidism in patients with toxic multinodular goiter (TMNG) treated with long-term methimazole (LT-MMI) or radioactive iodine (RAI).
Methods
In this clinical trial, 130 untreated patients with TMNG were randomized to either LT-MMI or RAI treatment. Both groups were followed for 108 to 148 months, with median follow-up durations of 120 and 132 months in the LT-MMI and RAI groups, respectively. Both groups of patients were followed every 1 to 3 months in the first year and every 6 months thereafter.
Results
After excluding patients in whom the treatment modality was changed and those who were lost to follow-up, 53 patients in the LT-MMI group and 54 in the RAI group completed the study. At the end of the study period, 50 (96%) and 25 (46%) patients were euthyroid, and two (4%) and 25 (46%) were hypothyroid in LT-MMI and RAI groups, respectively. In the RAI group, four (8%) patients had subclinical hyperthyroidism. The mean time to euthyroidism was 4.3±1.3 months in LT-MMI patients and 16.3± 15.0 months in RAI recipients (P<0.001). Patients treated with LT-MMI spent 95.8%±5.9% of the 12-year study period in a euthyroid state, whereas this proportion was 72.4%±14.8% in the RAI-treated patients (P<0.001). No major treatment-related adverse events were observed in either group.
Conclusion
In patients with TMNG, LT-MMI therapy is superior to RAI treatment, as shown by the earlier achievement of euthyroidism and the longer duration of sustained normal serum thyrotropin.

Citations

Citations to this article as recorded by

Mechanism of Huatan Sanjie Fang in improving goiter in Graves' disease mice based on the Hippo signaling pathway
Huimin Yuan, Wenxin Ma, Yifei Song, Hang Wang, Shuxin Yan, Silan Hao, Xiaoyun Zhu, Yang Tang
Journal of Traditional Chinese Medical Sciences.2023; 10(3): 289. CrossRef

Clinical Study
A 5-Year Prospective Follow-Up Study of Lipid-Rich Adrenal Incidentalomas: No Tumor Growth or Development of Hormonal Hypersecretion: Camilla Schalin-Jäntti, Merja Raade, Esa Hämäläinen, Timo Sane; Endocrinol Metab. 2015;30(4):481-487. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.481

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Background

Current guidelines for follow-up of adrenal incidentalomas are extensive and hampered by lack of follow-up studies. We tested the hypothesis that small lipid-rich adrenal incidentalomas, initially characterized by tumor size <40 mm and <10 Hounsfield units (HUs) on unenhanced computed tomography (CT) may not demonstrate excessive growth/hormonal hypersecretion on follow-up.

Methods

Sixty-nine incidentalomas in 56 patients were restudied with unenhanced CT and screening for hypercortisolism (dexamethasone suppression test [DST], plasma adrenocorticotropic hormone) and pheochromocytoma (24-hour urinary metanephrines and normetanephrines) 5 years later. Primary hyperaldosteronism was excluded at base-line.

Results

Tumor (n=69) size was similar before and after 5 years follow-up (19±6 mm vs. 20±7 mm). Mean tumor growth was 1±2 mm. Largest increase in tumor size was 8 mm, this tumor was surgically removed and histopathology confirmed cortical adenoma. DST was normal in 54 patients and two patients (3.6%) were still characterized by subclinical hypercortisolism. Initial tumor size was >20 mm for the patient with largest tumor growth and those with subclinical hypercortisolism. All patients had normal 24-hour urinary metanephrines and normetanephrines. Low attenuation (<10 HU) was demonstrated in 97% of 67 masses re-evaluated with unenhanced CT.

Conclusion

None of the patients developed clinically relevant tumor growth or new subclinical hypercortisolism. Biochemical screening for pheochromocytoma in incidentalomas demonstrating <10 HU on unenhanced CT is not needed. For such incidentalomas <40 mm, it seems sufficient to perform control CT and screen for hypercortisolism after 5 years.

Citations

Citations to this article as recorded by

European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors
Martin Fassnacht, Stylianos Tsagarakis, Massimo Terzolo, Antoine Tabarin, Anju Sahdev, John Newell-Price, Iris Pelsma, Ljiljana Marina, Kerstin Lorenz, Irina Bancos, Wiebke Arlt, Olaf M Dekkers
European Journal of Endocrinology.2023; 189(1): G1. CrossRef
Diagnostic Accuracy of CT Texture Analysis in Adrenal Masses: A Systematic Review
Filippo Crimì, Emilio Quaia, Giulio Cabrelle, Chiara Zanon, Alessia Pepe, Daniela Regazzo, Irene Tizianel, Carla Scaroni, Filippo Ceccato
International Journal of Molecular Sciences.2022; 23(2): 637. CrossRef
Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: the ICARO tool
Marianna Minnetti, Valeria Hasenmajer, Emilia Sbardella, Francesco Angelini, Chiara Simeoli, Nicola Di Paola, Alessia Cozzolino, Claudia Pivonello, Dario De Alcubierre, Sabrina Chiloiro, Roberto Baldelli, Laura De Marinis, Rosario Pivonello, Riccardo Pofi
European Journal of Endocrinology.2022; 187(5): 719. CrossRef
Approach to large adrenal tumors
Urszula Ambroziak
Current Opinion in Endocrinology, Diabetes & Obesity.2021; 28(3): 271. CrossRef
Frequently asked questions and answers (if any) in patients with adrenal incidentaloma
F. Ceccato, M. Barbot, C. Scaroni, M. Boscaro
Journal of Endocrinological Investigation.2021; 44(12): 2749. CrossRef
Draft of the clinical practice guidelines “Adrenal incidentaloma”
D. G. Beltsevich, E. A. Troshina, G. A. Melnichenko, N. M. Platonova, D. O. Ladygina, A. Chevais
Endocrine Surgery.2021; 15(1): 4. CrossRef
Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study
Filippo Ceccato, Irene Tizianel, Giacomo Voltan, Gianmarco Maggetto, Isabella Merante Boschin, Emilio Quaia, Filippo Crimì, Carla Scaroni
Frontiers in Endocrinology.2021;[Epub] CrossRef
Guía práctica sobre la evaluación inicial, seguimiento y tratamiento de los incidentalomas adrenales. Grupo de patología adrenal de la Sociedad Española de Endocrinología y Nutrición
Marta Araujo-Castro, Marta Iturregui Guevara, María Calatayud Gutiérrez, Paola Parra Ramírez, Paola Gracia Gimeno, Felicia Alexandra Hanzu, Cristina Lamas Oliveira
Endocrinología, Diabetes y Nutrición.2020; 67(6): 408. CrossRef
Practical guide on the initial evaluation, follow-up, and treatment of adrenal incidentalomas. Adrenal Diseases Group of the Spanish Society of Endocrinology and Nutrition
Marta Araujo-Castro, Marta Iturregui Guevara, María Calatayud Gutiérrez, Paola Parra Ramírez, Paola Gracia Gimeno, Felicia Alexandra Hanzu, Cristina Lamas Oliveira
Endocrinología, Diabetes y Nutrición (English ed.).2020; 67(6): 408. CrossRef
Endocrine Causes of Hypertension
Taniya de Silva, Gina Cosentino, Suneeta Ganji, Alejandra Riera-Gonzalez, Daniel S. Hsia
Current Hypertension Reports.2020;[Epub] CrossRef
Adrenocortical carcinoma: presentation and outcome of a contemporary patient series
Iiro Kostiainen, Liisa Hakaste, Pekka Kejo, Helka Parviainen, Tiina Laine, Eliisa Löyttyniemi, Mirkka Pennanen, Johanna Arola, Caj Haglund, Ilkka Heiskanen, Camilla Schalin-Jäntti
Endocrine.2019; 65(1): 166. CrossRef
CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma
Letizia Canu, Janna A W Van Hemert, Michiel N Kerstens, Robert P Hartman, Aakanksha Khanna, Ivana Kraljevic, Darko Kastelan, Corin Badiu, Urszula Ambroziak, Antoine Tabarin, Magalie Haissaguerre, Edward Buitenwerf, Anneke Visser, Massimo Mannelli, Wiebke
The Journal of Clinical Endocrinology & Metabolism.2019; 104(2): 312. CrossRef
The Evaluation of Incidentally Discovered Adrenal Masses
Anand Vaidya, Amir Hamrahian, Irina Bancos, Maria Fleseriu, Hans K. Ghayee
Endocrine Practice.2019; 25(2): 178. CrossRef
Evaluation of quantitative parameters for distinguishing pheochromocytoma from other adrenal tumors
Youichi Ohno, Masakatsu Sone, Daisuke Taura, Toshinari Yamasaki, Katsutoshi Kojima, Kyoko Honda-Kohmo, Yorihide Fukuda, Koji Matsuo, Toshihito Fujii, Akihiro Yasoda, Osamu Ogawa, Nobuya Inagaki
Hypertension Research.2018; 41(3): 165. CrossRef
Long term follow-up of non functional adrenal incidentalomas in size: a single center experience
Güven Barış Cansu, Bengür Taşkıran, Eylem Bahadır
Ortadoğu Tıp Dergisi.2018; 10(4): 506. CrossRef
Unenhanced CT imaging is highly sensitive to exclude pheochromocytoma: a multicenter study
Edward Buitenwerf, Tijmen Korteweg, Anneke Visser, Charlotte M S C Haag, Richard A Feelders, Henri J L M Timmers, Letizia Canu, Harm R Haak, Peter H L T Bisschop, Elisabeth M W Eekhoff, Eleonora P M Corssmit, Nanda C Krak, Elise Rasenberg, Janneke van den
European Journal of Endocrinology.2018; 178(5): 431. CrossRef
The impact of an adrenal incidentaloma algorithm on the evaluation of adrenal nodules
Leslie S. Eldeiry, Marina M. Alfisher, Catherine F. Callahan, Nancy N. Hanna, Jeffrey R. Garber
Journal of Clinical & Translational Endocrinology.2018; 13: 39. CrossRef
Adrenal incidentaloma: differential diagnosis and management strategies
Valentina Morelli, Serena Palmieri
Minerva Endocrinologica.2018;[Epub] CrossRef
Adrenal Imaging
Mishal Mendiratta-Lala, Anca Avram, Adina F. Turcu, N. Reed Dunnick
Endocrinology and Metabolism Clinics of North America.2017; 46(3): 741. CrossRef
Update on the risks of benign adrenocortical incidentalomas
Guido Di Dalmazi
Current Opinion in Endocrinology, Diabetes & Obesity.2017; 24(3): 193. CrossRef
Management Scheme for Adrenal Incidentalomas: Who Gets What?
Glenda G. Callender, Robert Udelsman
Current Surgery Reports.2016;[Epub] CrossRef
Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors
Martin Fassnacht, Wiebke Arlt, Irina Bancos, Henning Dralle, John Newell-Price, Anju Sahdev, Antoine Tabarin, Massimo Terzolo, Stylianos Tsagarakis, Olaf M Dekkers
European Journal of Endocrinology.2016; 175(2): G1. CrossRef

Case Report

Thyroid
Papillary Thyroid Carcinoma: Four Cases Required Caution during Long-Term Follow-Up: Hea Min Yu, Jae Min Lee, Kang Seo Park, Tae Sun Park, Heung Young Jin; Endocrinol Metab. 2013;28(4):335-340. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.335

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Due to the increased prevalence of papillary thyroid carcinoma (PTC), difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.

Citations

Citations to this article as recorded by

Induction of epithelial-mesenchymal transition in thyroid follicular cells is associated with cell adhesion alterations and low-dose hyper-radiosensitivity
Ankit Mathur, Vijayakumar Chinnadurai, Param Jit Singh Bhalla, Sudhir Chandna
Tumor Biology.2023; 45(1): 95. CrossRef
Thyroglobulin Level in Fine-Needle Aspirates for Preoperative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma: Two Different Cutoff Values According to Serum Thyroglobulin Level
Min Ji Jeon, Won Gu Kim, Eun Kyung Jang, Yun Mi Choi, Yu-Mi Lee, Tae-Yon Sung, Jong Ho Yoon, Ki-Wook Chung, Suck Joon Hong, Jung Hwan Baek, Jeong Hyun Lee, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Thyroid.2015; 25(4): 410. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

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