![]() The two primary predictors of malignancy within an adrenal incidentaloma are the size of the mass and imaging characteristics on computed tomography (CT Figures 2, 3) or magnetic resonance imaging (MRI). ![]() Testing for all adrenal hormones is recommended as the results can be used in postoperative surveillance and monitoring of the disease (Table 1). 7,9,14 Adrenocortical carcinomaĪdrenocortical carcinomas are generally larger than benign incidental adrenal masses and may be heralded by symptoms of mass effect or adrenal hormone excess (Table 1). (40 years and in those with bilateral adrenal masses. Muscle cramps, periodic paralysis, headaches, palpitations Moon face, acne, buffalo hump, supraclavicular fat-pads, central obesity, striae, easy bruising, poor wound-healing, emotional and cognitive changesġ mg overnight dexamethasone suppression test Summary of symptoms, signs and recommended screening tests for functioning adrenal lesionsĬushing’s syndrome or subclinical Cushing’s syndrome ![]() Most patients with primary hyperaldosteronism are normokalaemic. Hallmarks include refractory hypertension, usually requiring more than three antihypertensive agents, and hypokalaemia or severe, diuretic-induced hypokalaemia. Primary hyperaldosteronism (Conn’s syndrome) is usually asymptomatic. 7,9,11 Therefore, as a screening test in low-risk patients, minimising the likelihood of false-positive results with the 24-hour urinary measurement is preferred. Measurement of 24-hour urinary metanephrines and catecholamines yields a sensitivity of 90% and specificity of 98%. Fractionated plasma metanephrines have a high sensitivity of 96–100%, but a specificity of 85–89%. ![]() 7 Medications such as tricyclic antidepressants and decongestants should be ceased to reduce the likelihood of a false-positive result. There is currently no consensus as to the optimal biochemical test for pheochromocytoma. Pheochromocytomas can be associated with familial syndromes such as von Hippel–Lindau disease, multiple endocrine neoplasia type 2, familial paraganglioma syndrome and neurofibromatosis. Severe hypertension is often seen however, up to 15% of patients are normotensive. Patients with pheochromocytoma may be asymptomatic or have episodic symptoms because of catecholamine excess (Table 1). 7,10 With 91% sensitivity, confirmatory testing with a high-dose (8 mg) dexamethasone suppression test, serum adrenocorticotropin (ACTH) and cortisol in response to corticotropin‑releasing hormone, and midnight salivary cortisol should be undertaken to limit the possibility of a false-positive result. Malignant tumours, such as primary adrenocortical carcinomas, account for 50 nmol/L is suggestive of Cushing’s syndrome. Adenomas that produce sex hormones are very rare. Of the tumours that are functional, 5% are pheochromocytomas, 5% cortisol-producing and 1% aldosterone-producing. Overall, benign, non-functioning adrenal adenomas account for about 80% of adrenal incidentalomas. 2 Although most lesions are benign, non-functional adrenal adenomas, further evaluation is necessary to determine whether a lesion may be hormonally active or malignant, as this would affect future management decisions. 1 The widespread use of cross-sectional imaging has highlighted this entity, which can present a management dilemma for the clinician. We show that in many settings this strong notion of protection fromĭiscrimination is both attainable and aligned with the goal of obtainingĪccurate predictions.Adrenal incidentalomas are adrenal lesions ≥1 cm identified serendipitously on imaging performed for unrelated indications. In particular, it can contain many overlapping subgroups of a protected group. We think of the class as being quite rich (calibrated) predictions for every subpopulation that can be identified withinĪ specified class of computations. ![]() Process of learning a predictor from data. That aims to mitigate concerns about discrimination that is introduced in the We develop and study multicalbration - a new measure of algorithmic fairness Maliciously introduce biases that are not borne out in the data. Others (2) the analysis of this training data might inadvertently or The output of an algorithm can beĭiscriminatory for many reasons, most notably: (1) the data used to train theĪlgorithm might be biased (in various ways) to favor certain populations over Individuals, it becomes increasingly important to address concerns that theseĪlgorithms might be discriminatory. Rothblum Download PDF Abstract: As algorithms increasingly inform and influence decisions made about Authors: Úrsula Hébert-Johnson, Michael P. ![]()
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