Adrenal Incidentalomas and Other Endocrine-Related Adenomas: How Much Does Cortisol Secretion Matter?

Abstract

Background: Adrenal incidentalomas (AI) are frequent findings in clinical practice. About 40% of AIs are associated with hypercortisolism of variable severity. Although mild autonomous cortisol secretion (MACS) has been associated with the impaired clinical outcome of several diseases, its effect on the development of benign neoplasms is unknown. Aim: To compare the prevalence of adenomas (thyroid, parathyroid, pituitary and other locations) in patients with nonfunctioning AIs (NFAIs) and MACS. Methods: A multicenter, retrospective study of patients with AIs evaluated in four tertiary hospitals was performed. Results: A total of 923 patients were included. Most patients were male (53.6%), with a mean age at diagnosis of 62.4 ± 11.13 years; 21.7% presented with bilateral AIs. MACS was observed in 29.9% (n = 276) of patients, while 69.9% (n = 647) were NFAIs. Adenomas in locations other than the adrenal gland were observed in 36% of the studied population, with a similar distribution in patients with MACS and NFAIs (33% vs. 32%; p > 0.05). There were no statistically significant differences in the prevalence of pituitary, thyroid, parathyroid or other endocrine-related adenomas between both groups, but the prevalence of metabolic comorbidities and mortality was increased in patients with MACS, specifically in patients with thyroid and other endocrine-related adenomas (p < 0.05). Conclusions: Adenomas in locations other than the adrenal glands occur in one third of patients with AIs. Mild autonomous hypercortisolism does not affect the prevalence of other endocrine-related adenomas but is associated with increased metabolic comorbidities and mortality, especially in patients with thyroid adenomas and adenomas in other locations.

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

“…Hormonal evaluation of all incidentalomas can be very costly, so they are suggested only "if there are evident clinical signs or symptoms", which is contrary to the endocrine literature where "adrenal secretion excess may be present also without clinical symptoms". In fact, in up to 30% of patients, a mild increase in cortisol secretion was detected without any clinical signs [2][3][4][5][6]16]. The increasing knowledge that these patients may be at high risk for hypertension, obesity, diabetes, osteoporosis, cardiovascular events, and mortality still presents a source of uncertainties, leading to misclassification of these patients mainly because of the lack of standardized procedures [5,6,16].…”

“…Benign or malignant primary adrenal tumors (AT) are a heterogeneous group of neoplasms characterized by a marked diversity of the clinical presentation, which results from the functional, structural, embryological, and evolutionary heterogeneity of normal endocrine cells and it is associated with high rates of morbidity and mortality [1]. While the majority of morphological disorders are benign tumors (adenomas), some of them behave like truly malignant tumors with the capacity for metastatic spread and the possibility of fatal evolution [1,2]. Adrenal incidentalomas (AI) are often asymptomatic masses that are usually detected using imaging diagnostic techniques performed for other purposes [2,3].…”

“…While the majority of morphological disorders are benign tumors (adenomas), some of them behave like truly malignant tumors with the capacity for metastatic spread and the possibility of fatal evolution [1,2]. Adrenal incidentalomas (AI) are often asymptomatic masses that are usually detected using imaging diagnostic techniques performed for other purposes [2,3]. Clinical manifestations of functionally active tumors depend on specific hormone secretion, although plurihormonal secretion is the most common [2][3][4].…”

“…Adrenal incidentalomas (AI) are often asymptomatic masses that are usually detected using imaging diagnostic techniques performed for other purposes [2,3]. Clinical manifestations of functionally active tumors depend on specific hormone secretion, although plurihormonal secretion is the most common [2][3][4]. Although most AI are benign, non-functional tumors, 10% of these masses are related to abnormal hormone secretion and are rarely found to be malignant [4][5][6].…”