Long-term follow-up study of patients with adrenal incidentalomas

Abstract

Background: The incidence of adrenal incidentalomas has sharply increased in recent decades and concurrent subtle endocrine abnormalities, or even subclinical conditions, have been identified. Nonetheless, data concerning possible changes in adrenal size and/or hormonal pattern during follow-up are still inadequate. Objective: To evaluate long-term morphological and functional evolution of adrenal incidentalomas after initial diagnosis and to identify possible risk factors for hormonal hyperactivity and mass enlargement. Patients: Sixty-four patients (34 -79 years) were followed-up for 12-120 months (median 25.5 months). Initial computerized tomography scan showed a unilateral mass in 51 patients and bilateral lesions in 13 patients. Average mass diameter at diagnosis was 2:5^0:1 cm (range 1.0 -4.0). Twelve patients had subclinical Cushing's syndrome, 41 had mild hormonal alterations, and 11 had normal adrenal function at baseline. All patients were investigated by morphological and functional evaluation 6 and 12 months after diagnosis, and then at 1-year intervals. Results: During follow-up, a mass size increase $1 cm was observed in 13 patients, and 18 developed further subtle endocrine alterations. Cumulative risk of developing endocrine abnormalities was 17% at 1 year, 29% at 2 years, and 47% at 5 years. The risk was higher in the first 2 years of follow-up if the initial tumor diameter was $ 3 cm. Overall, cumulative risk of mass enlargement was 6% at 1 year, 14% at 2 years, and 29% at 5 years, and it was greater in patients with normal adrenal function than in those with subtle hormonal abnormalities ðP , 0:05Þ: One female subject showed a mass enlargement after 6 months of follow-up and was eventually diagnosed with non-Hodgkin's lymphoma. Conclusions: Patients with an adrenal incidentaloma are at risk for tumor growth and development of hormonal alterations. The risk of adrenal malignancy, although not elevated, also indicates the need for long-term follow-up.

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

“…To test the effectiveness of the different proposed cortisol cut-off after the 1-mg DST by using Bayesan analysis we had to define a priori the probability of autonomous cortisol secretion based on observed alterations in the tests used to assess the function of the HPA axis. We acknowledge that such a definition is arbitrary, but the presence of at least two alterations of the HPA axis has been widely used in previous work (14,22,23,24). Our data confirm that only a cut-point at 138 nmol/l achieves an incremental diagnostic effectiveness to detect functional adrenal autonomy.…”

Effects of sex steroids on bone in women with subclinical or overt endogenous hypercortisolism

“…Ohmori et al did not find a direct correlation between BMD, cortisol, and androgens; however, they suggested a possible role of DHEAS increase in counterbalancing the negative bone effects of endogenous hypercortisolism (33). Greater bone loss was also found in women on replacement therapy for 21-hydroxylase deficit and lower androgen levels (34), supporting the hypothesis on the importance of cortisol-to-androgen ratio in BMD maintenance (8,32,35). Finally, a strong correlation was observed between DHEAS and lumbar/femoral BMD values in healthy women (36).…”

“…Women with overt hypercortisolism had typical clinical symptoms of cortisol excess and more severe biochemical hypercortisolism; women with subclinical hypercortisolism had no typical symptoms of cortisol excess and milder biochemical abnormalities. Subclinical hypercortisolism is much more frequent in adrenal lesions than the overt one and the progression toward the overt form is very rare (34).…”

Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

“…In the literature changes in size have been reported in adrenal incidentalomas (Bastounis et al, 1997;Barry et al, 1998;Terzolo et al, 1998;Barzon et al, 1999;Siren et al, 2000;Libe et al, 2002;Grumbach et al, 2003), with such variations sometimes believed to reflect a more aggressive growth rate (Mansmann et al, 2004). Barzon et al (1999) reported that incidentalomas tend to undergo a period of increase in mass size but thereafter remain unchanged, suggesting the possible existence of a programmed end point of growth of adrenal masses.…”