Clinical Management Of Adrenal Tumors

This book presents an overview of adrenal tumors written by a multidisciplinary team of world experts who provide comprehensive, evidence-based perspective of their topics in this field and current approaches to the management of adrenal tumors. The areas discussed in this book include an overview of adrenal incidentalomas, unusual presentations of adrenal tumors, genetic basis of pheochromocytomas and paragangliomas, pathophysiology, and medical and surgical treatment and approaches to patients with benign and malignant adrenal tumors. Each chapter written by these experts provides clinical evidence, treatment recommendations, and algorithms. Clinical Management of Adrenal Tumors will serve as a valuable resource of current information regarding adrenal tumors for medical students, residents in training, physicians, and researchers.

Imaging of the adrenal gland has made tremendous progress in the last decade as new technologies continue to evolve. Adrenal Imaging highlights the pertinent clinical and pathological information that underpins the accurate interpretation and use of adrenal imaging. Written by a prestigious group of international contributors, individual chapters in Adrenal Imaging serve as a relevant and up-to-date reference of adrenal imaging findings, algorithms and techniques in CT, MR nuclear medicine, intervention and trauma. Summary sections at the end of each chapter illuminate key teaching points to enhance retention.

The vast amount of literature and rapid developments in the understanding and man agement of adrenal diseases have outpaced the ability of physicians to assimilate and utilize these advances in clinical settings. This book is designed to bring these developments to those interested in adrenal diseases and to assist clinicians in caring for patients with such diseases. The recent advances in the understanding of steroids, catecholamines, and utilization of computed tomography and magnetic resonance imaging have rendered disease of the adrenal gland more rewarding in terms of early detection. Although a number of basic and clinical improvements have been achieved in these diseases, there are still a number of unresolved problems, including the lack of effective cytotoxic agents for therapy of various disseminated adrenal malignancies. The natural history of certain diseases of the adrenal glands and their proximity to the genitourinary system makes these essential organs very attractive to urologic surgeons. Furthermore, for a number of diseases such as adrenogenital syndrome, hypertension, and certain tumors of these glands it is obviously desirable that urologic surgeons are familiar with diseases of "the adrenal glands." The first part of this book is an overview of the relevant embryology, anatomy, physiology, markers, pathology, imaging, and current progress. The second part covers specific diseases of the adrenal cortex and medulla. We hope that this volume will assist the physician in the diagnosis and management of patients with adrenal disease.

This book is designed to present a comprehensive and state-of the-art approach to the management of adrenal neoplasms that provides a resource to the broad group of providers that will encounter such a patient. Sections address issues that are faced by providers who encounter a patient with an adrenal neoplasm. These areas include an overview of the genetic basis and familial cancer syndrome-associated with adrenal neoplasms, pathobiology, advanced and tumor specific imaging approaches and technologies, biochemical analysis, standard medical and surgical therapies, and emerging technology and treatment approaches to benign and malignant adrenal neoplasms. Written by experts in the field, each of these sections address level of clinical evidence and provide recommendations and treatment algorithms. Extensive illustrations make this an interactive text. Management of Adrenal Masses in Children and Adults will serve as a very useful resource for all providers dealing with, and interested in this common but challenging tumor. It will provide a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts.

This open access book deals with imaging of the abdomen and pelvis, an area that has seen considerable advances over the past several years, driven by clinical as well as technological developments. The respective chapters, written by internationally respected experts in their fields, focus on imaging diagnosis and interventional therapies in abdominal and pelvic disease; they cover all relevant imaging modalities, including magnetic resonance imaging, computed tomography, and positron emission tomography. As such, the book offers a comprehensive review of the state of the art in imaging of the abdomen and pelvis. It will be of interest to general radiologists, radiology residents, interventional radiologists, and clinicians from other specialties who want to update their knowledge in this area.

Pheochromocytomas are rare, mostly benign tumors of the adrenal medulla whose symptoms are caused by a tumor-induced secretion of catecholamines. This book provides an overview of current knowledge on the clinical situation, diagnosis and therapy of the disease as well as an extensive discussion of novel aspects in the molecular basis of this disease such as the recognition of new tools in molecular biology. The endocrine diagnosis is based on precise knowledge of tumor metabolism of catecholamines and their metabolites and today comprises laboratory methods with a high sensitivity and specificity. As approximately one quarter of these tumors arise in the context of a familial disease, such as multiple endocrine neoplasia type 2, von Hippel-Lindau syndrome, neurofibromatosis type 1 or familial paragangliomas, the genetic diagnosis is becoming increasingly relevant. Equally indispensable are imaging methods such as 123I-MIBG scintigraphy or octreotide scintigraphy, which can be employed as a complementary approach in e.g. malignant tumors. The surgical therapy is clearly based on the nature of the disease; in sporadic unilateral as well as familial bilateral pheochromocytoma a lateral endoscopic approach is chosen. The treatment of malignant pheochromocytoma is mainly based on the use of nuclear medical techniques and selected chemotherapeutic approaches. This book is essential reading for clinicians and scientists in the fields of endocrinology as well as oncology, surgery and nuclear medicine.

This issue of Endocrinology and Metabolism Clinics, edited by Dr. Alice Levine, is devoted to Adrenal Disease. This issue will be broken down into 3 sections: Overview of Adrenal Cortical Development, Steroidogenesis, Comparative Anatomy and Molecular Pathophysiology; Benign Adrenal Tumors; and Adrenal Cortical Carcinoma. Articles in this issue include: Adrenal Cortical Zonal Development; Adrenal Steroidogenesis and Congenital Adrenal Hyperplasia; Animal Models of Adrenocortical Tumorigenesis; Genetics of Adrenal Cortical Tumors; Adrenal Incidentalomas; Aldosteronomas – Challenges in Diagnosis and Management; Mild Hypercortisolism Due to Adrenal Adenomas – Definitions and Therapeutic Options; Management of Adrenal Tumors in Pregnancy; Pathology of ACC; Diagnosis and Medical Management of ACC; and Surgical Management of ACC.

Adrenal Cortical Carcinoma is classically associated with a dismal prognosis. Yet its clinical presentation is changing (more and more classified as “incidentaloma”). New insights have emerged on its pathophysiological mechanisms (through the genetic elucidation of familial syndromes), and Reference Centers within National and European Networks are now offering more standardized and efficient multidisciplinary clinical management of these difficult patients. All these important aspects are described by experts in nine chapters dealing with epidemiology, prognosis, and clinical management, pathology, molecular pathophysiological mechanisms, modern imaging approaches, surgical and chemotherapeutical approaches of primary and secondary lesions, and the particular aspects of adrenal cortical carcinoma in children. This book, with its many figures and photographs, will be of major interest to endocrinologists, radiologists and nuclear medicine experts, pathologists, surgeons, oncologists, pediatricians. After a thorough reading, one will better recognize a suspicious adrenal “incidentaloma”, diagnose steroid hypersecretion, suspect a familial disease, consult with the pathologist and surgeon, manipulate difficult drugs like O,p'DDD, participate in multidisciplinary discussions with oncologists, radiotherapeutists, molecular biologists… Modern medicine in action!

We anticipate the book to be a definitive text on the subject that explores all aspects of the study of adrenal cancer and the treatment of patients with the disease. Chapters will cover epidemiology, pathogenesis, genetics, cancer stem cells, historic and emerging therapies, mouse models of adrenal cancer, new developments in tumor profiling, worldwide collaborative groups and tumor registries together with resources for the practitioner and community of adrenal cancer scientists. We do not wish this book to compete with the other larger books in the Endocrine and Endocrine Surgery literature. In addition, it is not expected to cover benign adrenal diseases that have been covered in detail in other venues. We envision this book to be a very specialized and exhaustive text on basic, translational and clinical aspects of adrenal cancer.