Computed tomography (CT) scan identified necrosis, but is it a reliable single parameter for discerning between malignant and benign adrenocortical tumors?

BACKGROUND: Adrenocortical carcinoma is a rare malignant tumor with a poor prognosis. Discernment of adrenocortical carcinoma in an adrenal mass through imaging studies is paramount for early surgical treatment. Recently, necrosis has been proposed as a single morphological parameter for adrenocortical carcinoma diagnosis. The aim of this study was to analyze the measures of diagnostic efficiency of necrosis and the different computed tomography-scan features related to adrenocortical carcinoma diagnosis. METHODS: We conducted a case-control study of patients surgically treated for an adrenal mass with histopathological report consistent with adrenocortical carcinoma (cases) and adrenocortical adenoma (control patients) between 1987 and 2019. Radiological features on computed tomography scan were collected. Bivariate and multivariate statistical analyses were performed for the different imaging features. The measures of diagnostic efficiency for each feature were calculated. Concordance analysis between image-detected and histopathological-identified necrosis was performed. RESULTS: Eighteen adrenocortical carcinoma and 41 adrenocortical adenomas were included. Differences between adrenocortical carcinoma and adrenocortical adenoma were found regarding heterogeneity (odds ratio 4.53, 95% confidence interval 2.3-8.9; P < .0001), tumor size ≥4 cm (odds ratio 3.5, 95% confidence interval 2.05-6.14; P < .0001), and attenuation index ≥10 Hounsfield units (odds ratio 1.9, 95% confidence interval 1.3-2.6; P = .001). Necrosis was the most important imaging feature significantly associated with adrenocortical carcinoma (odds ratio 35, 95% confidence interval 5.1-241.6; P < .0001), present in all adrenocortical carcinoma cases. After measures of diagnostic efficiency calculation, necrosis had the highest diagnostic accuracy (98%). Cohen's kappa for concordance between image-detected and histopathological-identified necrosis was 90.4% (P < .0001). CONCLUSION: Computed tomography scan-detected necrosis is a reliable radiological feature to discern adrenocortical carcinoma from adrenocortical adenomas.

Gasto urinario alto como predictor de hipoparatiroidismo tras tiroidectomía total.

OBJETIVO: Determinar la utilidad del gasto urinario alto como predictor temprano de bajo costo para hipoparatiroidismo posoperatorio. MÉTODO: Se realizó un estudio retrospectivo unicéntrico a 1 año en adultos sometidos a tiroidectomía total en The American British Cowdray Medical Center I.A.P., calculando el gasto urinario en 24 horas, utilizando valores de calcio sérico corregido por albúmina con una tabla de correlación e identificando a los pacientes que recibieron calcio suplementario en las primeras horas de posoperatorio. Se dividieron en pacientes con hipoparatiroidismo posoperatorio y con valores normales de calcio en el primer día, diferenciando a los que recibieron suplementación oral de calcio profiláctico. RESULTADOS: Se estudiaron 47 pacientes, 19 (40%) en el grupo con hipocalcemia posoperatoria y 28 (59.5%) en el grupo sin hipocalcemia posoperatoria. La media de gasto urinario en las primeras 8 horas de posoperatorio fue mayor en el grupo de hipocalcemia posoperatoria en comparación con el grupo sin hipocalcemia, sin diferencia significativa (p = 0.392), y tampoco durante las primeras 16 horas (p = 0.435). CONCLUSIONES: En nuestro estudio no existe relación entre el incremento del gasto urinario y la predicción de hipoparatiroidismo posoperatorio. Se necesitan estudios con muestras de mayor tamaño y con un diseño metodológico más fuerte (prospectivo) para determinar si en realidad la diferencia obtenida puede figurar como predictor. OBJECTIVE: to determine the usefulness of high urine output as a low-cost early predictor for postoperative hypoparathyroidism.. METHOD: A study was conducted inside The American British Cowdray Medical Center I.A.P. for a year in adult patients who underwent total thyroidectomy divided in two groups: those with post-surgical hypocalcemia and without post-surgical hypocalcemia using the 24-hour calcium levels. Urinary output of each patient was verified searching for the relation between this measurement and the probability of developing post-surgical hypoparathyroidism. RESULTS: A total of 47 patients were studied, of whom 19 (40%) were classified with post-surgical hypocalcemia and 28 (59.5%) with no post-surgical hypocalcemia. The urinary output mean on the first 8 hours post-operatory was higher in the post-surgical hypocalcemia group in comparison with the group with no evidence of hypocalcemia, showing no significant difference (p = 0.392). Urinary output 16 hours post-surgical was no significant either (p = 0.435). CONCLUSIONS: In our study, there was no relation found between the increase of the urinary output and the post-surgical hypoparathyroidism prediction. Further studies with a bigger sample and a stronger methodologic design (prospective) are needed to determine if the difference obtained may be useful as a predictor.