Keywords
Subclinical Cushing’s syndrome
Non-functional adrenal adenoma
Diagnosis
Treatment
Submitted : 2023-12-30
Accepted : 2024-01-14
Published : 2024-01-29
Abstract
Objective: To evaluate the epidemiological, demographic, clinical features, treatment approaches, and survival of patients followed up for adrenal incidentaloma. Methods: Data from 46 patients who were treated and followed up due to adrenal incidentaloma in the Endocrinology Department of Mersin University Health Research and Application Hospital between 2010 and 2014 were retrospectively analyzed. Results: Of the cases included in the study, 13 were male, 33 were female, and the mean age was 54.09 ± 10.7 years. The most common reason for admission was abdominal pain in 34.78% of the patients, the most commonly diagnosed radiological method was dynamic adrenal CT in 60.87%, and the most common location was the left adrenal gland. The mean lesion diameter was between 26.8 ± 16.5 mm. The frequency of hypertension was 50%, obesity 47.8%, type 2 diabetes 21.7%, osteoporosis 42.8%, and metabolic syndrome 41.3%. According to hormonal evaluation results, non-functional adrenal adenoma (NFAA) was found in 82.61%, subclinical Cushing’s syndrome (SCS) in 15.21%, and aldosteronoma in 2.1%. Myelolipoma, pheochromocytoma, and adrenocortical adenoma were diagnosed in 8 cases undergoing adrenalectomy. One patient died due to liver failure. No hormonal activation or growth in lesion size was detected during the follow-up of the patients. Conclusion: Due to the very different pathological and radiological appearances of adrenal incidentaloma, it is important to evaluate demographic, etiological, clinical, laboratory, and radiological data as a whole in the treatment and follow-up.
References
Hsieh LB, Mackinney E, Wang TS, 2019, When to Intervene for Subclinical Cushing’s Syndrome. Surg Clin North Am, 99(4): 747–758. https://doi.org/10.1016/j.suc.2019.04.011
Jason DS, Oltmann SC, 2019, Evaluation of an Adrenal Incidentaloma. Surg Clin North Am, 99(4): 721–729. https://doi.org/10.1016/j.suc2019.04.009
Cyranska-Chyrek E, Szczepanek-Parulska E, Olejarz M, et al., 2019, Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Singer Tertiary Reference Center. Int J Environ Res Public Health, 16(10): 1872. https://doi.org/10.3390/ijerph16101872.
Taya M, Paroder V, Bellin E, et al., 2019, The Relationship Between Adrenal Incidentalomas and Mortality Risk. Eur Radiol, 29(11): 6245–6255. https://doi.org/10.1007/s00330-019-06202-y
Maher DI, Williams E, Grodski S, et al., 2018, Adrenal Incidentaloma Follow-Up is Influenced by Patient, Radiologic, and Medical Provider Factors: A Review of 804 Cases. Surgery, 164(6): 1360–1365. https://doi.org/10.1016/j.surg.2018.07.011
Celejewski K, Pogorzelski R, Toutounchi S, et al., Adrenal Incidentaloma – Diagnostic and Treating Problem – Own Experience. Open Med (Wars), 13: 281–284. https://doi.org/10.1515/med-2018-0043
Morelli V, Palmieri S, 2019, Adrenal Incidentaloma: Differential Diagnosis and Management Strategies. Minerva Endocrinol, 44(1): 4–18. https://doi.org/10.23736/S0391-1977.18.02868-7
Kerkhofs TM, Roumen RM, Demeyere TB, et al., 2015, Adrenal Tumors with Unexpected Outcome: A Review of the Literature. Int J Endocrinol, 2015: 71054. https://doi.org/10.1155/2015/710514
Kloos RT, Gross MD, Francis IR, et al., 1995, Incidentally Discovered Adrenal Masses. Endocr Rev, 16(4): 460–484. https://doi.org/10.1210/edrv-16-4-460
Mantero F, Terzolo M, Arnaldi G, et al., 2000, A Survey on Adrenal Incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab, 85(2): 637–644. https://doi.org/10.1210/jcem.85.2.6372
Barzon L, Scaroni C, Sonino N, et al., 1998, Incidentally Discovered Adrenal Tumors: Endocrine and Scintigraphic Correlates. J Clin Endocrinol Metab, 83(1): 55–62. https://doi.org/10.1210/jcem.83.1.4501
Chidiac RM, Aron DC, Incidentalomas. A Disease of Modern Technology. Endocrinol Metab Clin North Am, 26(1): 233–253. https://doi.org/10.1016/s0889-8529(05)70242-5
Reincke M, Nieke J, Krestin GP, et al., 1992, Preclinical Cushing’s Syndrome in Adrenal “Incidentalomas”: Comparison with Adrenal Cushing’s Syndrome. J Clin Endocrinol Metab, 75(3): 826–832. https://doi.org/10.1210/jcem.75.3.1517373
Morioko M, Fujii T, Matsuki T, et al., 2000, Preclinical Cushing’s Syndrome: Report of Seven Cases and a Review of the Literature. Int J Urol, 7(4): 126–132. https://doi.org/10.1046/j.1442-2042.2000.00154.x
Rossi R, Tauchmanova L, Luciano A, et al., 2000, Subclinical Cushing’s Syndrome in Patients with Adrenal Incidentaloma: Clinical and Biochemical Features. J Clin Endocrinol Metab, 85(4): 1440–1448. https://doi.org/10.1210/jcem.85.4.6515
Libè R, Dall’Asta C, Barbetta L, et al., 2002, Long-Term Follow-Up Study of Patients with Adrenal Incidentalomas. Eur J Endocrinol, 147(4): 489–494. https://doi.org/10.1530/eje.0.1470489
Kasperlik-Zeluska AA, Ros?onowska E, S?owinska-Srzednicka J, et al., 1997, Incidentally Discovered Adrenal Mass (Incidentaloma): Investigation and Management of 208 Patients. Clin Endocrinol (Oxf), 46(1): 29–37. https://doi.org/10.1046/j.1365-2265.1997.d01-1751.x
Reincke M, 2000, Subclinical Cushing’s Syndrome. Endocrinol Metab Clin North Am, 29(1): 43–56. https://doi.org/10.1016/s0889-8529(05)70115-8
Tsagarakis S, Roboti C, Kokkoris P, et al., 1998, Elevated Post-Dexamethasone Suppression Cortisol Concentrations Correlate with Hormonal Alterations of the Hypothalamo-Pituitary Adrenal Axie in Patients with Adrenal Incidentalomas. Clin Endocrinol (Oxf), 49(2): 165–171. https://doi.org/10.1046/j.1365-2265.1998.00509.x
Bardet S, Rochmer V, Murat A, et al., 1996, 131I-6 Beta-Iodomethylnorcholesterol Scintigraphy: An Assessment of Its Role in the Investigation of Adrenocortical Incidentalomas. Clin Endocrinol, 44(5): 587–596. https://doi.org/10.1046/j.1365-2265.1996.720541.x
Ambrosi B, Passini E, Re T, et al., 1997, The Clinical Evaluation of Silent Adrenal Masses. J Endocrinol Invest, 20: 90–107. https://doi.org/10.1007/BF03347983
Comlekci A, Yener S, Ertilav S, et al., 2010, Adrenal Incidentaloma, Clinical, Metabolic, Follow-Up Aspects: Single Centre Experience. Endocrine, 37(1): 40–46. https://doi.org/10.1007/s12020-009-9260-5
Angeli A, Terzolo M, 2002, Adrenal Incidentaloma – A Modern Disease with Old Complications. J Clin Endocrinol Metab, 87(11): 4869–4871. https://doi.org/10.1210/jc.2002-021436
Angeli A, Osella G, Ali A, et al., 1997, Adrenal Incidentaloma: An Overview of Clinical and Epidemiological Data from the National Italian Study Group. Hormone Res, 47(4–6): 279–283. https://doi.org/10.1159/000185477
Yener S, Ertilav S, Secil M, et al., 2012, Increased Risk of Unfavorable Metabolic Outcome During Short-Term Follow-Up in Subjects with Nonfunctioning Adrenal Adenomas. Med Princ Pract, 21(5): 429–434. https://doi.org/10.1159/000336589
Arnaldi G, Angeli A, Atkinson AB, et al., 2003, Diagnosis and Complications of Cushing’s Syndrome: A Consensus Statement. J Clin Endocrinol Metab, 88(12): 5593–5602. https://doi.org/10.1210/jc.2003-030871
Chiodini I, Torlantano M, Carnevale V, et al., 2001, Bone Loss Rate in Adrenal Incidentalomas: A Longitudinal Study. J Clin Endocrinol Metab, 86(11): 5337–5341. https://doi.org/10.1210/jcem.86.11.8022
Chiodini I, Tauchmanova L, Torlantano M, et al., 2002, Bone Involvement in Eugonadal Male Patients with Adrenal Incidentaloma and Subclinical Hypercortisolism. J Clin Endocrinol Metab, 87(12): 5491–5494. https://doi.org/10.1210/jc.2002-020399
Tauchmanova L, Rossi R, Nuzzo V, et al., 2001, Bone Loss Determined by Quantitative Ultrasonometry Correlates Inversely with Disease Activity in Patients with Endogenous Glucocorticoid Excess Due to Adrenal Mass. Eur J Endocrinol, 145(3): 241–247, https://doi.org/10.1530/eje.0.1450241