![]() The most common sites of metastases are the lung, liver, peritoneum, and less commonly, the bones and major veins. The detection of metastatic lesions may allow effective palliation of both functioning and nonfunctioning lesions. Although the use of positron emission tomography may be effective in identifying unsuspected sites of metastases, its role as a staging tool is unclear. In addition, a CT of the chest is necessary to assess potential lung metastasis. ![]() Staging should include imaging of the primary site by computed tomography (CT) and/or magnetic resonance imaging of the abdomen. Initial evaluation should include careful endocrine studies to reveal any excessive hormone production by the tumor, which can serve as a tumor marker during therapy. A small percentage of ACCs are incidentally discovered when imaging studies are conducted for reasons other than potential adrenal disease. The second most common symptoms at time of initial presentation are unspecific abdominal symptoms, such as abdominal pain or fullness. Biochemical hormone testing reveals that up to 80% of tumors are functioning. In approximately 60% of patients, symptoms related to excessive hormone secretion are the main reason for seeking medical attention. ![]() The role of other prognostic indicators is controversial. Patients who have low-grade tumors without evidence of invasion into local tissues or spread to lymph nodes have an improved prognosis.
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