Predicting morphological and functional variations of benign adrenal incidentalomas in relation to initial characteristics

Abstract

The follow-up strategy for unresected non-functional adrenal tumors (NFAT) is a major controversial issue in endocrinological clinical practice, as the natural history of adrenal incidentalomas (AI) is partially unknown and a consensus on their adequate management is lacking. In a recent longitudinal study by Ceccato et al., a large cohort of patients with conservatively treated AI were evaluated for possible radiological variations over time and their relationship with autonomous cortisol secretion (ACS). Starting from this paper, we performed a literature review of available longitudinal studies focus on the same issue. Notwithstanding the high variability in the duration of follow-up and in the criteria used to define ACS in the included studies, our findings support the idea that there is a not negligible risk of morphological and functional changes, which may have metabolic implications, especially after 5-10 years of follow-up. Unfortunately, these variations seem to be scarcely predictable. Therefore, it may be risky to interrupt the follow-up in patients with NFAT, in particular in the presence of larger diameter of the adenoma and higher cortisol levels at diagnosis. These results should be considered in defining the optimal management of these patients.

Landscape of Adrenal Tumours in Patients with Congenital Adrenal Hyperplasia

“…Moreover, our 10-year sample-based study included the COVID-19 pandemic period (between March 2020 and the first months of 2023); it is difficult to establish if fewer imaging investigations have been performed in these patients due to the medical and social regulations amid first waves. However, as seen in other medical and surgical domains, the pandemic impact should be noted when referring to the incidence of tumours, including adrenal incidentalomas [115][116][117][118][119][120].…”

Prevalence and Incidence of Fractures in Patients With Nonfunctional Adrenal Tumors

“…Using the most recent European guidelines, which define MACS as a serum cortisol concentration after administration of 1 mg of dexamethasone of greater than 1.8 μg/dL (>50 nmol/L) without clinical signs of overt Cushing syndrome, studies have shown a prevalence of 43% to 45% in adrenal incidentalomas . A previous long-term study found a conversion from NFAT to MACS of 0% to 31% . MACS has been reported to be associated with mainly increased cardiometabolic risk, but increased occurrences of fractures have also been found in studies .…”

“… 6 , 7 , 8 A previous long-term study found a conversion from NFAT to MACS of 0% to 31%. 9 MACS has been reported to be associated with mainly increased cardiometabolic risk, 10 but increased occurrences of fractures have also been found in studies. 11 , 12 Interestingly, in a population-based cohort study conducted in 1 county, patients with NFAT were more likely to have previous fractures when diagnosed with an NFAT and an increased incidence of new fractures during follow-up.…”