Adrenal Incidentaloma: Picking out the High-Risk Patients

Dalmazi, Guido Di

doi:10.1055/a-0713-0598

Cited by 9 publications

(5 citation statements)

References 47 publications

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“…Our analysis also included patients with adrenal incidentalomas and MACS [21]. Between 30% and 50% of patients with adrenal incidentalomas have biochemical evidence of possible, low-grade autonomous cortisol release [20], associated with a worsened cardiovascular risk (hypertension, diabetes and obesity), a higher prevalence of cardiovascular events, greater bone loss, and a higher mortality rate [21,24,[48][49][50]. However, very little attention has been paid to the infection risk in patients with MACS.…”

Section: Discussionmentioning

confidence: 99%

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: the ICARO tool

Minnetti

Hasenmajer

Sbardella

et al. 2022

European Journal of Endocrinology

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Objective: Registry data show that Cushing’s syndrome (CS) and adrenal insufficiency (AI) increase mortality rates associated with infectious diseases. Little information is available on susceptibility to milder forms of infections, especially those not requiring hospitalization. This study aimed to investigate infectious diseases in patients with glucocorticoid disorders through the development of a specific tool. Methods: We developed and administered the ICARO (InfeCtions in pAtients with endocRinOpathies) questionnaire, addressing infectious events over a 12-month observation period, to 1017 outpatients referred to four University Hospitals. The ICARO questionnaire showed good test-retest reliability. The odds of infection (OR[95% confidence interval]) were estimated after adjustment for confounders and collated into the ICARO score, reflecting frequency and duration of infections. Results: 780 patients met the inclusion criteria: 43 with CS, 32 with adrenal incidentaloma and mild autonomous cortisol secretion (MACS), and 135 with AI, plus 570 controls. Compared to controls, CS was associated with higher odds of urinary tract infections (UTIs) (5.1[2.3-9.9]), mycoses (4.4[2.1-8.8]), and flu (2.9[1.4-5.8]). Patients with adrenal incidentaloma and MACS also showed an increased risk of UTIs (3.7[1.7-8.0]) and flu (3.2 [1.5-6.9]). Post-dexamethasone cortisol levels correlated with the ICARO score in patients with CS. AI was associated with higher odds of UTIs (2.5[1.6-3.9]), mycoses (2.3[1.4-3.8]), and gastrointestinal infections (2.2[1.5-3.3]), independently of any glucocorticoid replacement dose. Conclusions: The ICARO tool revealed a high prevalence of self-reported infections in patients with glucocorticoid disorders. ICARO is the first of its kind questionnaire, which could be a valuable tool for monitoring infections in various clinical settings.

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Section: Discussionmentioning

confidence: 99%

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: the ICARO tool

Minnetti

Hasenmajer

Sbardella

et al. 2022

European Journal of Endocrinology

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“…Our group of patients with hypercortisolism also included patients with adrenal incidentalomas and pACS [47]. Between 30% and 50% of patients with adrenal incidentalomas have biochemical evidence of low-grade autonomous cortisol release [20], associated with a worsened cardiovascular risk (hypertension, diabetes and obesity), a higher prevalence of cardiovascular events, greater bone loss, and a higher mortality rate [22,[47][48][49]. However, very little attention has been paid to the infection risk in patients with pACS.…”

Section: Discussionmentioning

confidence: 99%

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: The ICARO tool

Minnetti

Hasenmajer

Sbardella

et al. 2022

Preprint

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ObjectiveRegistry data show that Cushing’s syndrome (CS) and adrenal insufficiency (AI) increase mortality rates associated with infectious diseases. Little information is available on susceptibility to infections, especially milder forms that do not require hospitalization or prescription drugs. This study aimed to investigate infectious diseases in patients with glucocorticoid disorders through the development of a specific tool.MethodsWe developed and administered the ICARO questionnaire addressing infectious events over a 12-month observation period to 1017 outpatients referred to four University Hospitals between 2018 and 2019. The ICARO questionnaire showed good test-retest reliability. The odds of infection were estimated after adjustment for potential confounders and collated into the ICARO score, reflecting the frequency and duration of infections.Results75 patients were diagnosed with hypercortisolism and 135 with hypocortisolism; 237 were excluded for uncontrolled disease. The remaining 570 served as controls. Compared to controls, hypercortisolism was associated with higher odds of respiratory (2.3) and urinary tract infections (4.1), mycoses (3.3) and flu (2.1). Subgroup analysis confirmed an increased risk of UTI (3.7) and flu (3.2) in mild hypercortisolism. Post-dexamethasone cortisol levels correlated with the ICARO score. Hypocortisolism also exhibited higher odds of mycoses (2.3), gastrointestinal (2.2) and urinary tract infections (2.5), independently of any glucocorticoid replacement dose.ConclusionsICARO is the first of its kind questionnaire developed to address susceptibility to infections in patients with glucocorticoid disorders and revealed the high prevalence and features of self-reported infections. ICARO could be a valuable tool for monitoring infections in various clinical settings.

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“…When defining adrenal incidentalomas, it is also worth defining the meaning of the concept of autonomic cortisol secretion (ACS). ACS designates a cortisol concentration after a 1 mg dexamethasone suppression test (DST) >1.8 µg/dl (possible) or >5 µg/dl (confirmed) in patients with adrenal incidentalomas without catabolic symptoms of Cushing's syndrome [9]. The term ACS is considered more appropriate in the context of the adrenal tumor lesions in question than the once used term subclinical Cushing's syndrome [6].…”

Section: Description Of the State Of Knowledge 21 Definition And Etio...mentioning

confidence: 99%

Adrenal incidentaloma (AI) - a puzzle not only for endocrinologists

Dubaj

Dembowska

Bigosiński

2022

J Educ Health Sport

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An adrenal incidentaloma (AI) is any lesion ≥ 1 cm in diameter detected during radiological diagnostics unrelated to suspected adrenal pathology. Each case of an AI requires extended hormonal and imaging assessments to accurately determine the nature of the tumor and its hormonal activity. The frequency of this tumor’s diagnostics has increased exponentially due to the continuous progress in the development of imaging methods, especially computed tomography and magnetic resonance imaging. The most common etiology of AIs are hormonally inactive adenomas of the adrenal cortex, but there are also adrenal cortex carAIcinomas, phaeochromocytoma, metastatic or infectious lesions. In the case of confirmation of the type of lesion, the management involves adrenalectomy or a sufficiently long clinical observation. In recent years, new markers of the malignancy of AI tumors have been discovered, both in imaging and biochemical diagnostics, which is associated with improvements in the accuracy of diagnosis and patient management. The aim of this study was to describe the definition, etiology and epidemiology of AIs and to draw attention to the complexity of diagnostics and therapy of accidentally diagnosed adrenal tumors. Current publications and guidelines from scientific societies around the world were reviewed, using keywords that were compatible with MeSH.

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Adrenal Incidentaloma: Picking out the High-Risk Patients

Cited by 9 publications

References 47 publications

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: the ICARO tool

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: the ICARO tool

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: The ICARO tool

Adrenal incidentaloma (AI) - a puzzle not only for endocrinologists

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