Ludwig, Daniel R.

Abstract Context Evidence on the etiology and function of adrenal masses in younger adults is scarce. Objective This work aimed to characterize the clinical, imaging, and biochemical presentation of adrenal masses in 18- to 40-year-olds. Methods A retrospective cohort study was conducted January 2016 to December 2021 at a tertiary academic medical center. Participants included young adults (age 18-40 years) with adrenal masses identified through radiologic registry. Exclusion criteria included preexisting adrenal masses before 2016, hyperplasia, or masses smaller than 1 cm. Outcomes included adrenal mass diagnosis, as determined by reference standard of histopathology, radiologic surveillance, and biochemical evaluation. Results A total of 255 patients (women 142 [56%]; White 156 [61%]; median age 35 years [interquartile range 30-39 years]) were included. Comorbidities included genetic predisposition syndromes (16, 6.3%), preexisting malignancy (70, 27%), obesity (100, 48%), hypertension (89, 35%), and diabetes (25, 10%). The majority of adrenal masses were incidentally found (184, 72%) and median size was 1.9 cm (IQR 1.4-2.7 cm) on detection. Among adrenal masses in young adults, prevalence of malignancy and pheochromocytoma was 16% and 4%, respectively; among adrenal incidentalomas, 5% were malignant. Factors associated with malignancy or pheochromocytoma in multivariable analysis included nonincidental mechanism of discovery (odds ratio [OR] 15.5; 95% CI, 7.2-35.7; P < .001), and larger size (OR 1.5; 95% CI, 1.2-2.0; P < .001). Hormonal evaluation was performed in only 57 (22%) patients and was positive for hormone hypersecretion in 16 (28%) of tested individuals. Conclusion We demonstrated a high prevalence of malignancy and pheochromocytoma in our cohort of young adults with adrenal masses. Completion of appropriate hormonal work-up was infrequent, potentially missing patients with functioning adrenal adenomas.

Understanding the imaging appearance of autoimmune disorders of the liver and biliary tract is important to guide further workup, suggest a particular diagnosis, monitor for disease progression or response to treatment, and evaluate for complications.

Abstract Background and Aims Perianal fistuliing Crohn’s disease [PFCD] is an aggressive phenotype of Crohn’s disease defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by the TOpCLASS consortium, which seeks to unify disease severity with patient-centred goals but has not yet been validated. We aimed to apply this to a real-world cohort and to identify factors that predict transition between classes over time. Methods We identified all patients with PFCD and at least one baseline and one follow-up pelvic MRI [pMRI]. TOpCLASS classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs. Results We identified 100 patients with PFCD, of whom 96 were assigned TOpCLASS Classes 1–2c at baseline. Most patients [78.1%] started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex [72.0%, 46.6%, 40.0%, p = 0.03] and prior perianal surgery [52.0% vs 44.6% vs 40.0%, p = 0.02] were more frequently observed in those with improved class compared to unchanged and worsened class. Baseline pMRI indices were not associated with changes in classification; however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modelling identified only male sex [-0.31, 95% CI -0.60 to -0.02] with improvement in class. Conclusion The TOpCLASS classification highlights the dynamic nature of PFCD over time. However, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower TOpCLASS classification.

Abstract Disclosure: S.A. Jacob: None. M. Itani: None. M.J. Hoegger: None. D. Ludwig: None. T. Pandian: None. T.C. Brown: None. L.M. Brunt: None. I. Bancos: None. N. Genere: None. Introduction: Adrenal mass incidence has increased tenfold over the last two decades, with most masses detected in individuals over 40 years of age. The majority of these adrenal masses are benign (>80%), and few are malignant (8%) or hormonally active (4%); most are incidentally detected. Studies suggest higher rates of hormonally active and malignant adrenal masses in younger patients, however, evidence for this age group is scarce. In two recent large cohort studies of adrenal masses, young adults (18-40 years) represented only 0.2-7.1% of individuals studied. This study aimed to characterize clinical, imaging, and biochemical presentation of young adults diagnosed with adrenal masses. Methods: This is a retrospective cohort study of young adults (18-40 years) with adrenal masses detected based on a radiology report text database search between January 2015 and December 2021 at a tertiary medical center. Exclusion criteria included pre-existing adrenal masses before 2015, hyperplasia, or masses <1cm. Images were reviewed by abdominal radiologists, and clinical data were obtained through review of electronic medical records. Results: A total of 255 young adults (56% women, 61% white) were diagnosed with adrenal masses with median age 35 (IQR 30-39) years. Genetic predisposition syndrome was present in 6%. Comorbidities included: BMI >30 kg/m2 in 48%, hypertension in 35%, and diabetes in 10%. Adrenal masses were detected incidentally in 72% and during cancer staging in 16%. Median mass size was 1.9cm (IQR 1.4-2.7cm) and 49% (39/79) were lipid poor (Hounsfield units >10). Only 22% of patients underwent hormonal evaluation. Final diagnoses included 16% malignancy, 9% benign adenoma with overt hormone excess, 40% benign adenoma with incomplete hormonal evaluation and 24% radiographically indeterminate masses. Subgroup analysis showed that adrenal masses in those <30 years old compared to 31-40 year-olds were more frequently associated with tumor predisposition syndrome (15% vs 3%, p<0.01) and more often lipid poor (76% vs 40%, p<0.01); but, no differences in frequency of malignancy or overt hormone excess were identified. Discussion: We found a higher frequency of malignancy and overt hormonal excess in our cohort of young adults compared to previously published studies, though direct comparisons are limited by differences in methodology. These findings, in addition to high frequencies of metabolic disease in our cohort, would suggest the need for hormonal assessment in young adults; yet, this was completed in only a minority of patients. Additional areas of research may include studying hormonal status of adrenal masses in young adults in a multi-center cohort to overcome issues of selection bias and increase the rates of those with complete hormonal evaluation. Presentation: Thursday, June 15, 2023

Abstract In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.