scholarly journals Subclinical characteristics and analytical indications of the laparoscopic adrenalectomy for benign adrenal incidentaloma

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Thành Vinh Nguyễn ◽  
Đức Tiến Nguyễn
Keyword(s):  
Adrenal Gland ◽  
Laparoscopic Adrenalectomy ◽  
Adrenal Adenoma ◽  
Young Patients ◽  
Adrenal Incidentaloma ◽  
University Hospital ◽  
Indications For Surgery ◽  
Risk Of Malignancy ◽  
Average Tumor Size

Tóm tắt Đặt vấn đề: Nghiên cứu đặc điểm cận lâm sàng và phân tích chỉ định phẫu thuật nội soi (PTNS) điều trị u tuyến thượng thận (TTT) lành tính không triệu chứng. Phương pháp nghiên cứu: Nghiên cứu tiến cứu 64 người bệnh (NB) u TTT lành tính không triệu chứng được điều trị bằng PTNS tại Bệnh viện Hữu nghị Việt Đức từ tháng 10/2015 đến tháng 10/2018. Kết quả: Tuổi trung bình 45,7. Nam/nữ: 3/5. Kích thước u trung bình 3,0 ± 2,1 cm. 57,8% u không hoạt động nội tiết. 73,4% u tuyến vỏ thượng thận, 17,2% u tủy thượng thận (Pheochromocytoma). Chỉ định mổ: 42,2% do u hoạt động nội tiết, 25% u thay đổi kích thước khi theo dõi, 17,2% u ≥ 4cm và 15,6% u < 4cm (Nghi ngờ Pheochromocytoma) trên cắt lớp vi tính (CLVT). Kết luận: Chỉ định PTNS cắt bỏ tuyến thượng thận nên được khuyến nghị cho những khối u có kích thước lớn hơn 4cm hoặc thay đổi chức năng nội tiết vì tăng nguy cơ ác tính, đặc biệt là ở những người bệnh trẻ tuổi. Đánh giá nội tiết nên được thực hiện ở tất cả các người bệnh để xác định tình trạng tăng tiết hormon mà chưa có biểu hiện lâm sàng. Abstract Introduction: Research of subclinical characteristics and analytical indications of the laparoscopic adrenalectomy for benign adrenal incidentaloma. Materials and Methods: Prospective research in 64 patients with adrenal incidentaloma underwent laparoscopic adrenalectomy at Viet Duc University Hospital from 10/2015 to 10/2018. Results: The average of age was 45,7 years old, male / female was 3/5. Average tumor size was 3,0 ± 2,1cm. Benign non-functional accounted for 57,8%. Adenoma is 73,4% and Pheochromocytoma in 17,2%. Indications for surgery: 42,2% of secretion tumors, 25% tumors changed in size during follow-up time, 17,2% tumors sized ≥ 4cm and 15,6% tumors sized < 4cm (suspect Pheochromocytoma) in CT scan check. Conclusion: Indications of laparoscopic adrenalectomy should be recommended for adrenal incidentaloma size over 4 cm because of the risk of malignancy, especially in young patients. Endocrine evaluation should be performed in all patients to identify silent states of hormone excess. Keywords: Adrenal adenoma, adrenal gland.

scholarly journals SAT-199 Diagnostic Dilemma: An Adrenal Incidentaloma in a Young Adult

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sonia Sharma ◽  
Steven N Levine ◽  
Xin Gu
Keyword(s):  
Adrenal Gland ◽  
Adrenal Mass ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Significant Loss ◽  
Phase Imaging ◽  
African American Female ◽  
Hounsfield Units ◽  
Diagnostic Dilemma ◽  
Ki 67

Abstract Introduction: In an adult endocrine clinic, the majority of patients referred for evaluation of an adrenal incidentaloma are older than 30 years of age. It is important to be reminded that a patient may be diagnosed with an adrenal mass at any age but the etiology may vary depending on the age at presentation. Clinical case: An 18 year-old African American female with no significant past medical problems presented with a 2 month history of flank and abdominal pain associated with nausea and vomiting. An abdominal CT scan and a dedicated adrenal CT showed a right adrenal mass measuring 2.2 x 2.6 cm. The noncontrast Hounsfield units were 23, enhanced Hounsfield units 210, and delayed Hounsfield units 72. The calculated washout was 44%, not consistent with an adrenal adenoma. An MRI of the abdomen showed a 2.5 cm right adrenal nodule. The lesion did not demonstrate significant loss of signal between in and out of phase imaging, therefore the characteristics were not consistent with a lipid rich adenoma. Laboratory tests included an ACTH of 31 pg/mL (6-48 pg/mL), cortisol 8.7 ug/mL at 10:57 am (7-9 am 5.27-22.45 ug/mL), aldosterone 10.1 ng/dL (6-48 ng/dL), renin 2.2 ng/mL/hr (upright 0.5-4.0 ng/mL/hr), DHEA-sulfate 129 ug/dL (44-248 ug/dL), plasma free metanephrine 0.10 nmol/L (0.00-0.49 nmol/L), and plasma free normetaneprhine 0.41 nmol/L (0.00-0.89 nmol/L). The 24-hour urine norepinephrine, epinephrine, and metanephrine were all normal, however the 24-hour urine dopamine was elevated, 824 ug/24 hrs (52-480 ug/24 hrs). Subsequently, plasma dopamine, norepinephrine, and epinephrine were all within the reference range. The patient had a robotic-assisted right adrenalectomy removing a 5.7 x 3.5 x 1.7 cm gland, weighing 16.3 grams. The pathology demonstrated a ganglioneuroma within the right adrenal gland measuring 2.2 x 2.0 x 2.7 cm, negative for neuroblastoma or blastic components. Focal hemorrhage was noted, there was no tumor necrosis, and no mitotic figures were present. The tumor appeared to be encapsulated in the adrenal gland and the Ki-67 stain was negative in ganglioneuroma cells. Conclusion: Adrenal adenomas that appear as incidentalomas in young adulthood are extremely rare. Evaluating younger versus older adults found to harbor an adrenal “incidentaloma“ requires a unique approach for each age group, as the differential diagnosis varies widely. In our patient, the imaging was extremely concerning and diagnostic considerations included neuroblastoma, adrenocortical malignancy, pheochromocytoma, or ganglioneuroma. Adrenal ganglioneuromas are most frequently diagnosed in fourth and fifth decades of life. In younger adults ganglioneuromas are usually found in the retroperitoneum and posterior mediastinum. For our patient, surgical resection of the adrenal mass confirmed the pathologic diagnosis and provided definitive cure.

scholarly journals Pheochromocytoma: a retrospective study from a single center

2021 ◽  
Vol 55 (1) ◽  
pp. 16-21
Author(s):  
Neuza Alves Soares ◽  
Mariana Teixeira Pinto Ferreira Pacheco ◽  
Manuel Joao Rocha Ferreira Rodrigues de Sousa ◽  
Mariana Lopes Matos ◽  
Susana Alexandra Lourenco Ferreira
Keyword(s):  
Genetic Testing ◽  
Genetic Disorders ◽  
Positive Family History ◽  
Young Patients ◽  
Adrenal Incidentaloma ◽  
Multidisciplinary Care ◽  
University Hospital ◽  
Inherited Susceptibility ◽  
Work Up ◽  
Chromaffin Tissue

Abstract Objectives. Pheochromocytoma (PCC) is a neuroendocrine tumor derived from chromaffin tissue more frequently found in the adrenal medulla. Many discoveries over the last decade have significantly improved our understanding of PCC. Methods. We retrospectively reviewed all patients with a histological diagnosis of PCC at the Centro Hospitalar Universitario de Sao Joao, a tertiary and university hospital in Oporto, Portugal, between January 2009 and December 2017. Results. The study group included 33 patients. In most cases the diagnosis was suspected with more than half of patients presenting with hypertension and the third diagnosed during the work-up of an adrenal incidentaloma. About half of the patients was referred for genetic testing and 6 patients had a positive inherited susceptibility genetic pathogenic variant associated with classic cancer predisposition syndromes and also associated with newly described genes. In the incidentaloma group, genetic testing was performed in 3 (9%) patients with only 1 positive result. In the suspected group, 15 (45%) genetic tests were performed. Conclusions. In contrast to other studies, where only a minority of patients with PCC were referred for genetic counselling, in our study 54% of patients was referred for genetic testing. This study suggests that clinicians were correctly recognizing the need to refer young patients and patients with positive family history. However, opportunities for genetic testing are frequently missed due to low referral rates in patients with apparently sporadic PCC, particularly older than 30 years old. It is imperative that all the providers involved in the multidisciplinary care of patients with pheochromocytomas are aware of the genetic disorders associated with these unique tumors.

scholarly journals Tele-medicine versus face-to-face consultation in Endocrine Outpatients Clinic during COVID-19 outbreak: a single-center experience during the lockdown period

2020 ◽  
Author(s):  
F. Ceccato ◽  
G. Voltan ◽  
C. Sabbadin ◽  
V. Camozzi ◽  
I. Merante Boschin ◽  
...  
Keyword(s):  
Young Patients ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Emergency Plan ◽  
Aged Patients ◽  
Cross Sectional ◽  
Face To Face ◽  
Endocrine Diseases ◽  
Viral Spread

Abstract Context The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients’ visit. Objective We have developed and applied an emergency plan, tailored for Outpatients with endocrine diseases. Design Cross-sectional study from March to May 2020. Setting Referral University-Hospital center. Patients 1262 patients in 8 weeks. Interventions The emergency plan is based upon the endocrine triage, the stay-safe procedures and the tele-Endo. During endocrine triage every patient was contacted by phone to assess health status and define if the visit will be performed face-to-face (F2F) or by tele-Medicine (tele-Endo). In case of F2F, targeted stay-safe procedures have been adopted. Tele-Endo, performed by phone and email, is dedicated to COVID-19-infected patients, to elderly or frail people, or to those with a stable disease. Main outcome measure To assess efficacy of the emergency plan to continue the follow-up of Outpatients. Results The number of visits cancelled after endocrine triage (9%) is lower than that cancelled independently by the patients (37%, p < 0.001); the latter reduced from 47 to 19% during the weeks of lockdown (p = 0.032). 86% of patients contacted by endocrine-triage received a clinical response (F2F and tele-Endo visits). F2F visit was offered especially to young patients; tele-Endo was applied to 63% of geriatric patients (p < 0.001), visits’ outcome was similar between young and aged patients. Conclusions The emergency plan respects the WHO recommendations to limit viral spread and is useful to continue follow-up for outpatients with endocrine diseases.

Clinical Characteristics and Follow-Up Results of Adrenal Incidentaloma

2020 ◽  
Author(s):  
Nusret Yilmaz ◽  
Esin Avsar ◽  
Gokhan Tazegul ◽  
Ramazan Sari ◽  
Hasan Altunbas ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Adrenocortical Carcinoma ◽  
Clinical Characteristics ◽  
Adrenal Incidentaloma ◽  
Cortisol Secretion ◽  
Clinical Consequences ◽  
Mass Size ◽  
Autonomous Cortisol Secretion ◽  
Radiological Changes

AbstractIt is recommended that adrenal incidentaloma patients should be monitored for radiological changes, increase in size and new functionality that may occur in the future, even if they are benign and nonfunctional at the initial evaluation. Our aim is to evaluate the key clinical characteristics of adrenal incidentaloma patients focusing on changes during follow-up and associated clinical outcomes. A total of 755 patients (median age: 56 years), with an adrenal incidentaloma > 1 cm and underwent functionality tests, were included in the study. Clinical characteristics, functionality status and follow-up durations were recorded. During the course of follow-up, any changes in size and development of new functionality, and clinical consequences thereof were evaluated. In 71.8% of patients, incidentalomas were non-functional. Most frequent functionality (15.8%, n=119) was subclinical hypercortisolemia (SH) [10.9% (n=82) possible autonomous cortisol secretion (PACS) and 4.9% (n=37) autonomous cortisol secretion (ACS)] of all incidentalomas. Frequencies of Cushing’s syndrome (CS), pheochromacytoma and primary hyperaldosteronism were 4.9% (n=37), 3.8% (n=29) and 3.7% (n=28), respectively. Adrenocortical carcinoma frequency was 1.5% (n=11). Of 755 patients, 43% (n=325) were followed up regularly more than 6 months. Median follow-up duration was 24 months (6–120). A total of 17 (5.2%) patients, which had non-functional incidentalomas at baseline had developed new functionality during follow-up, of which 15 (4.6%) were SH [13 patients (4%) PACS and 2 patients (0.6%) ACS] and 2 (0.6%) were CS. During follow-up, 24% (n=78) of the patients had an increase in mass size between 5–9 mm, while 11.7% (n=38) of the patients had an increase of ≥10 mm. During follow-up, 4% (n=13) of the patients developed a new lesion with a diameter ≥10 mm on the opposite side. In patients with a follow-up duration of more than 2 years, frequencies of size increase and new lesion emerging at the opposite adrenal gland were higher. 14 patients (4.3% of the patients with regular follow-up) underwent surgery due to increase in size or development of new functionality during follow-up. Our study demonstrated that a necessity for surgery may arise due to increase in size and development of functionality during follow-up period in adrenal incidentaloma patients, and thus continuing patient follow-up, even with wider intervals, will be appropriate.

Under-Prescription of Medical Treatment for Peripheral Artery Disease in the Under 50s: A Retrospective Study

Angiology ◽  
2021 ◽  
pp. 000331972110421
Author(s):  
Simon Soudet ◽  
Lorène Bultel ◽  
Lamrani Adnane ◽  
Thierry Reix ◽  
Marie Antoinette Sevestre
Keyword(s):  
Medical Treatment ◽  
Peripheral Artery Disease ◽  
Young Patients ◽  
Limb Ischemia ◽  
Major Amputation ◽  
University Hospital ◽  
Acute Limb Ischemia ◽  
Peripheral Artery ◽  
Artery Disease

Peripheral artery disease (PAD) is a common cause of morbidity and mortality; however, data on its etiology and evolution in patients under 50 years old are scarce. Therefore, we performed a retrospective analysis of data from medical records, including cardiovascular risk factors, etiology, medical and surgical treatment, and follow-up. We included all patients with PAD aged between 18 and 50 years attending our university hospital between 2005 and 2015. Of the 87 patients included, 32 (36%) were women. Smoking was acknowledged by 81 patients (93%), and 37 had dyslipidemia (42.5%). Median follow-up was 24 months (10-59). Recurrence occurred in 41 patients (47.1%), all active smokers, with a median delay of 14 months (7-47). Acute limb ischemia at diagnosis was significantly associated with major amputation, odds ratio (OR) 5.95 (95%CI 1.41-40.90, P = .029), which was needed by 11 patients (12.6%). Treatments included antiplatelet therapy (76; 87.4%), statins (67; 77%), and anti-hypertensives (60; 69%), and 29 (32.1%) patients benefited from vascular rehabilitation. This cohort of relatively young patients with PAD showed a high level of symptom recurrence. Atherosclerosis was the most common etiology. Our study revealed that medical treatment is often under-prescribed in this age group and needs to be improved.

scholarly journals SAT-200 Clinical Dilemmas of Adrenal Incidentaloma, Is Change in HU Clinically Significant?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Azra Niaz ◽  
John Jun ◽  
Sophia Y Ali
Keyword(s):  
Adrenal Mass ◽  
Cushing Syndrome ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Adrenal Tumors ◽  
Size Change ◽  
Attenuation Value ◽  
Noncontrast Ct ◽  
Work Up

Abstract Introduction There has been a recent increase in the incidence of adrenal incidentaloma (AI), defined as an adrenal mass that’s unintentionally discovered on imaging obtained for an indication other than suspected adrenal pathology, mainly because of increased availability and improved quality of imaging modalities. Differentiation based on malignant vs benign and secretory vs non secretory becomes the most important question on finding such mass. Another important question is long term follow up of these AI. We present a case that highlights the importance of follow up due to the potential of AI to increase in size and density over 3 year. Case A 58 years old male with a history of ESRD secondary to hypertension, controlled hypertension, CAD s/p CABG was seen for a right 1.9 cm AI (found in 11/2016 on noncontrast CT abdomen) with low attenuation of approximately 10 Hounsfield units (HU). He was asymptomatic, normal vitals, and an unremarkable physical exam. Hormonal work up was negative for hyperaldosteronism and Cushing syndrome. About 1 year later, repeat CT abdomen reported an unchanged right, 2.0 x 1.7 cm adrenal mass, 22 HU. Hormonal work-up was not completed and patient was lost to follow up. Two years later, repeat CT abdomen reported increase size of AI to 2.7 cm and increase in attenuation of 24 HU precontract which increased to 55 HU on the immediate postcontrast exam and 55 HU on 13-minute delayed images. Hormonal work up was negative for Cushing syndrome and hyperaldosteronism. Plasma metanephrine was 0.50 with elevated plasma normetanephrine of 3.85. In light of being a renal transplant patient and due to increase in size, change in HU, and significantly elevated normetanephrine levels patient was referred for right adrenalectomy. Discussion Change in adrenal mass size is known to be a significant predictor of malignant potential. An unenhanced attenuation value &lt;10 HU is characteristic of a lipid-rich adenoma, can predict benign adrenal adenoma with 98% specificity, and has a very low likelihood of a pheochromocytoma. European Society of Endocrinology recommends if the AI is homogenous, &lt; 4 cm, with a density ≤ 10 UH, no imaging follow up is recommended and biochemical testing for ruling out pheochromocytoma is indicated in adrenal tumors with an unenhanced attenuation value &gt;10HU. However, the AACE/AAES guidelines recommends AI ≥ 1cm and less than 4cm, repeat imaging with noncontrast CT should be performed at 3–6 months and annually for 1-2 years and if the mass grows or becomes hormonally active then adrenalectomy should be performed. Conclusion There are no prospective studies of the optimal frequency and duration of follow up for AI. Considering the increasing incidence of AI, further studies on the clinical significance of change in HU, such as risk of developing pheochromocytoma, along with standardized international guidelines would be helpful for clinicians in managing patients with AI.

scholarly journals Spontaneous intra-adrenal massive hematoma: possible extreme evolution of a non-secreting untreated adrenal adenoma

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Mariangela Mancini ◽  
Nicolò Leone ◽  
Massimo Iafrate ◽  
Ambrogio Fassina ◽  
Filiberto Zattoni ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Adrenal Adenoma ◽  
Rare Event ◽  
Adrenal Incidentaloma ◽  
Retroperitoneal Mass ◽  
Long Term Follow Up ◽  
Adrenal Hematoma ◽  
Potential Damage

Abstract The spontaneous adrenal hematoma is a rare event. An 83-year-old male patient presented a 26-cm asymptomatic retroperitoneal mass of doubtful renal–adrenal origin. He had been evaluated 10 years before for an adrenal incidentaloma of 2.3 cm and had refused surgery when it had reached 7 cm. Later, the mass enlarged to 26 cm and was surgically removed through an open anterior approach. The histopathology showed a solid 4 kg mass of fibrinoid–hemorrhagic material, partially necrotic, mixed with adrenal tissue, with a well-vascularized capsule. No relapse is present at 6-month follow-up. This is the largest case described of spontaneous intra-adrenal hematoma in a case with previous non-secreting adrenal adenoma. The hematoma (a 4 kg mass) developed 10 years after the first diagnosis and exposed the patient to potential damage of the surrounding organs and to high-risk abdominal surgery. Long-term follow-up of non-secreting adrenal adenomas should be recommended.

Adrenal incidentaloma: evaluation and management

2008 ◽  
Vol 61 (11) ◽  
pp. 1168-1173 ◽  
Author(s):  
P K Singh ◽  
H N Buch
Keyword(s):  
Surgical Intervention ◽  
Adrenal Incidentaloma ◽  
Adrenal Incidentalomas ◽  
Imaging Studies ◽  
Imaging Characteristics ◽  
Risk Of Malignancy ◽  
Life Threatening ◽  
History Of ◽  
Adrenal Masses

Adrenal incidentalomas are adrenal masses discovered incidental to imaging studies performed for reasons unrelated to adrenal pathology. Although most adrenal incidentalomas are non-functioning benign adenomas, their increasing prevalence presents diagnostic and therapeutic challenges. The assessment of adrenal incidentalomas is aimed at deciding whether or not the tumour should be surgically removed. Adrenalectomy is indicated for phaeochromocytoma, other symptomatic hormone-secreting tumours and those with a high risk of malignancy. Biochemical screening for tumour hypersecretion is mandatory in all adrenal incidentalomas, since hormone secreting tumours may be clinically silent. The diagnosis of phaeochromocytoma is of paramount importance because of its life-threatening complications. Non-functioning adrenal incidentalomas need assessment for risk of malignancy, and this is based on the size of the tumour and its imaging characteristics. An observational policy with periodic radiological and biochemical reassessment is pursued in patients with non-functioning incidentalomas with low malignancy risk. The duration and frequency of reassessment remains unclear, as the natural history of adrenal incidentalomas has yet to be clearly defined, and there is a lack of controlled studies comparing surgical intervention with observation. However, the possibility of acquiring autonomous hypersecretion or conversion to malignancy in an incidentaloma diagnosed to be a benign non-functioning lesion is very low, and most patients may be safely discharged after an initial follow-up period of 2 years.

scholarly journals Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Filippo Ceccato ◽  
Irene Tizianel ◽  
Giacomo Voltan ◽  
Gianmarco Maggetto ◽  
Isabella Merante Boschin ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Lipid Content ◽  
Univariate Analysis ◽  
Adrenal Incidentaloma ◽  
University Hospital ◽  
Endocrine Function ◽  
Adrenal Incidentalomas ◽  
Attenuation Value ◽  
Mean Diameter

ContextA tendency to grow has been reported in adrenal incidentalomas. However, long-term data regarding attenuation value, a measure of lipid content, are not available.AimThis study aims to collect radiological data (diameter in mm and attenuation value in Hounsfield units, HU) with computed tomography (CT) in adrenal incidentalomas, in order to compare baseline characteristics with the last follow-up imaging.DesignThis is a longitudinal study which included patients with a new diagnosis of adrenal incidentaloma, evaluated from January 2002 to June 2020.SettingReferral University-Hospital center.PatientsTwo hundred seventy-seven patients with 355 different cortical adenomas (baseline group) were evaluated at the first outpatient visit; the follow-up cohort consists of 181 patients with 234 adenomas (12–175 months after baseline). Inclusion criteria were conservative management and radiological features able to minimize malignancy or risk of progression.Main Outcome MeasureCT modification according to endocrine function: autonomous cortisol secretion (ACS) if cortisol &gt;50 nmol/L after 1-mg dexamethasone test (DST).ResultsAt baseline CT, mean diameter was 18.7 mm and attenuation value was 0.8 HU (higher in ACS, 66 cases &gt;10 HU), without modification in early imaging (12–36 months). The size increased over time (r = 0.289), achieving the largest differences after at least 60 months of follow-up (mean diameter, +2 mm; attenuation value, −4 HU), combined with a reduction in the attenuation value (r = −0.195, especially in patients with ACS). Lipid-poor adenomas (&gt;10 HU) presented a reduced cortisol suppression after 1-mg DST, an increase in size and the largest decrease in attenuation value during follow-up. Univariate analysis confirmed that larger adenomas presented reduced suppression after DST and increase in size during follow-up.ConclusionsGrowth is clinically modest in adrenal incidentaloma: the first follow-up CT 5 years after baseline is a reasonable choice, especially in ACS. Mean density is increased in patients with ACS and overt hypercortisolism. Mean density reduces during follow-up in all adrenal adenomas, suggesting an increase in lipid content, especially in those with ACS.

Rezidivrisiko nach thyreostatischer Behandlung immunogener und nicht-immunogener Hyperthyreosen

1990 ◽  
Vol 29 (01) ◽  
pp. 1-6 ◽  
Author(s):  
E. Voth ◽  
N. Dickmann ◽  
H. Schicha ◽  
D. Emrich
Keyword(s):  
Relapse Rate ◽  
Urinary Iodine ◽  
Young Patients ◽  
Antithyroid Drugs ◽  
Urinary Iodine Excretion ◽  
Old Patients ◽  
Primary Disease ◽  
Iodine Excretion ◽  
Immunogenic Hyperthyroidism

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogeriic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p <0.001 and 83%, p <0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

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