Adrenal pheochromocytoma: Keys to radiologic diagnosis.

Pheochromocytomas are adrenal paragangliomas. Potentially malignant, these tumors have a low incidence but clear importance. They can appear in various hereditary syndromes, especially in von Hippel-Lindau syndrome, multiple endocrine neoplasia-2 (MEN2), and familial paraganglioma syndromes. In sporadic cases, underlying genetic alterations are often found, and these findings are changing our understanding of the disease. Although these tumors can manifest with a characteristic clinical presentation, in 13.1%-57.6% of cases, it is the radiologist who first suggests the diagnosis, indicating analyses for catecholamines or nuclear medicine examinations. Radiologists should suspect a pheochromocytoma on detection of a well-delimited adrenal mass with rapid, intense enhancement that typically shows cystic and hemorrhagic phenomena, high T2 signal intensity, and the absence of macroscopic or microscopic lipids. The behavior in diffusion-weighted imaging usually does not provide very useful information. Approximately one-third of lesions show late washout similar to that seen with adenomas on CT. Percutaneous puncture should be avoided to avoid the risk of unleashing a severe hypertensive crisis.

Feocromocitoma adrenal. Claves para el diagnóstico radiológico / Adrenal pheochromocytoma: keys to radiologic diagnosis

El feocromocitoma es un paraganglioma adrenal potencialmente maligno, con baja incidencia, pero relevancia evidente. Puede aparecer en varios síndromes hereditarios, especialmente von Hippel-Lindau, neoplasia endocrina múltiple 2 y paraganglioma familiar. En casos esporádicos subyacen también frecuentemente alteraciones genéticas que están cambiando el paradigma de la enfermedad.Aunque puede tener una presentación clínica característica, en un 13,1-57,6% de los casos es el radiólogo el primero en sugerirlo, indicando determinaciones analíticas de catecolaminas o exploraciones de Medicina Nuclear.Debe sospecharse ante una masa adrenal bien delimitada con realce intenso y rápido, mostrando característicamente fenómenos quísticos y hemorrágicos, alta señal en T2 y ausencia de lípidos macro o microscópicos. El comportamiento en difusión no suele aportar información muy relevante. Aproximadamente un tercio presentan lavado tardío similar al del adenoma en TC. Debe evitarse su punción percutánea ante su sospecha, por el riesgo de desencadenar una crisis hipertensiva grave.(AU)

Pheochromocytomas are adrenal paragangliomas. Potentially malignant, these tumors have a low incidence but clear importance. They can appear in various hereditary syndromes, especially in von Hippel-Lindau syndrome, multiple endocrine neoplasia-2 (MEN2), and familial paraganglioma syndromes. In sporadic cases, underlying genetic alterations are often found, and these findings are changing our understanding of the disease.Although these tumors can manifest with a characteristic clinical presentation, in 13.1% to 57.6% of cases, it is the radiologist who first suggests the diagnosis, indicating analyses for catecholamines or nuclear medicine examinations.Radiologists should suspect a pheochromocytoma on detection of a well-delimited adrenal mass with rapid, intense enhancement that typically shows cystic and hemorrhagic phenomena, high T2 signal intensity, and the absence of macroscopic or microscopic lipids. The behavior in diffusion-weighted imaging usually does not provide very useful information. Approximately one-third of lesions show late washout similar to that seen with adenomas on CT. Percutaneous puncture should be avoided to avoid the risk of unleashing a severe hypertensive crisis.(AU)

Suprimento arterial para as glândulas adrenais em caprinos (Capra hircus) da raça Saanen / Arterial supply to the adrenal glands of the goats (Capra hircus) of the saanen race

Estudaram-se em trinta fetos de caprinos da raça Saanen, machos e fêmeas, a origem e o número dos ramos arteriais destinados às glândulas adrenais. Após o preenchimento, mediante injeção, do seu sistema vascular arterial com solução corada de Neoprene látex, esses fetos foram fixados em solução aquosa de formol a 10 por cento e ulteriormente dissecados. A glândula adrenal esquerda foi atingida por ramos provenientes das artérias mesentérica cranial (93,33 por cento), renal esquerda (83,33 por cento), lombar II (80,00 por cento), celíaca (60,00 por cento), lombar III (46,66 por cento), lombar I (10,00 por cento), aorta abdominal (10,00 por cento), por ramos anastomóticos entre as lombares II e III (10,00 por cento), lombar IV (6,66 por cento), aorta torácica (6,66 por cento) e por ramos anastomóticos entre as lombares I e II (6,66 por cento). A glândula adrenal direita recebeu ramos oriundos das artérias lombar II (86,66 por cento), renal direita (83,33 por cento), celíaca (56,66 por cento), mesentérica cranial (50,00 por cento), lombar I (23,33 por cento), lombar III (23,33 por cento), aorta abdominal (10,00 por cento), por ramos anastomóticos entre as artérias lombares III e IV (6,66 por cento), entre as lombares II e III (6,66 por cento) e entre as lombares I, II e III (3,33 por cento) e da lombar IV (3,33 por cento).