Maximum Adenoma Diameter, Regardless of Uni- or Bilaterality, is a Risk Factor for Autonomous Cortisol Secretion in Adrenal Incidentalomas

Overview

Journal J Endocrinol Invest

Publisher Springer

Specialty Endocrinology

Date 2021 Mar 8

PMID 33683661

Citations 11

Authors

M Araujo-Castro

C Robles Lazaro

P Parra Ramirez

R Garcia Centeno

P Gracia Gimeno

M T Fernandez-Ladreda

M A Sampedro Nunez

M Marazuela

H F Escobar-Morreale

P Valderrabano

Affiliations

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Abstract

Purpose: To evaluate differences between patients with unilateral and bilateral adrenal incidentalomas (AIs) in the prevalence of autonomous cortisol secretion (ACS) and related comorbidities.

Methods: In this multicentre retrospective study, AIs ≥ 1 cm without overt hormonal excess were included in the study. ACS was defined by a post-dexamethasone suppression test (DST) serum cortisol ≥ 5.0 µg/dl, in the absence of signs of hypercortisolism. For the association of ACS with the prevalence of comorbidities, post-DST serum cortisol was also analysed as a continuous variable.

Results: Inclusion criteria were met by 823 patients, 66.3% had unilateral and 33.7% bilateral AIs. ACS was demonstrated in 5.7% of patients. No differences in the prevalence of ACS and related comorbidities were found between bilateral and unilateral AIs (P > 0.05). However, we found that tumour size was a good predictor of ACS (OR = 1.1 for each mm, P < 0.001), and the cut-off of 25 mm presented a good diagnostic accuracy to predict ACS (sensitivity of 69.4%, specificity of 74.1%). During a median follow-up time of 31.2 (IQR = 14.4-56.5) months, the risk of developing dyslipidaemia was increased in bilateral compared with unilateral AIs (HR = 1.8, 95% CI = 1.1-3.0 but, this association depended on the tumour size observed at the end of follow-up (HR adjusted by last visit-tumour size = 0.9, 95% CI = 0.1-16.2).

Conclusions: Tumour size, not bilaterality, is associated with a higher prevalence of ACS. During follow-up, neither tumour size nor bilaterality were associated with the development of new comorbidities, yet a larger tumour size after follow-up explained the association of bilateral AIs with the risk of dyslipidaemia.

Citing Articles

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Clinical Evaluation of Adrenal Incidentaloma: The Experience of a Referral Center.

Petramala L, Circosta F, Marino L, Palombi E, Costanzo M, Servello A Biomedicines. 2024; 12(8).

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Hamidi O, Shah M, Zhang C, Lazik N, Li D, Singh S Eur J Endocrinol. 2024; 191(1):47-54.

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Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes.

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