Adrenal Incidentalomas are Tied to Increased Risk of Diabetes: Findings from a Prospective Study

Abstract

Context The frequency of adrenal incidentalomas and their association with comorbid conditions have been assessed mostly in retrospective studies that may be prone to ascertainment bias. Objective The objective of this work is to evaluate the frequency of adrenal incidentalomas and their associated comorbid conditions. Design A prospective cohort study was conducted. Setting This study took place at a radiology department at a public hospital. Participants Unselected outpatients who underwent an abdominal computed tomography (CT) from January 2017 to June 2018. Patients with known or suspected adrenal disease or malignancy were excluded. Exposure All abdominal CT scans were evaluated by an experienced radiologist. Hormonal workup including a 1-mg dexamethasone suppression test was performed in patients bearing adrenal incidentalomas. Main Outcome and Measure Frequency of adrenal incidentalomas in abdominal CT of unselected patients; frequency of comorbid conditions, and hormonal workup in patients bearing adrenal incidentalomas. Results We recruited 601 patients, and in 7.3% of them an adrenal tumor was found serendipitously. The patients bearing an adrenal incidentaloma had higher body mass index (P = .009) and waist circumference (P = .004) and were more frequently diabetic (P = .0038). At multivariable regression analysis, diabetes was significantly associated with the presence of adrenal incidentalomas (P = .003). Autonomous cortisol secretion was observed in 50% of patients who did not suppress cortisol less than 50 nmol/L after 1 mg dexamethasone. Conclusions The frequency of adrenal incidentalomas is higher than previously reported. Moreover, adrenal incidentalomas are tied to increased risk of type 2 diabetes. This finding is free from ascertainment bias because patients with adrenal incidentalomas were drawn from a prospective cohort with the same risk of diabetes as the background population.

Clinical features, risk of mass enlargement, and development of endocrine hyperfunction in patients with adrenal incidentalomas: a long-term follow-up study

“…Adrenal incidentalomas (AIs), which define clinically unapparent adrenal masses discovered by abdominal imaging procedures for unrelated reasons, have become a common finding in clinical practice, ranging between 1 and 7% in different series [1][2][3][4][5][6]. Whereas most AIs are benign nonfunctioning AIs (NFAIs), about 5-30% are associated with some degree of hormone production [7][8][9][10].…”

The national Targeted Lung Health Checks programme: Focusing on the lungs does not mean missing adrenal lesions

“…The study did not have ascertainment bias as the prospectively drawn adrenal incidentalomas cohort had the same risk of diabetes similar to the general population. 6 While less common, hyperaldosteronism and particularly phaeochromocytoma have serious morbidity and mortality implications, so cannot be ignored. They could be associated with lesions <4 cm.…”

Presentation, disease progression and outcomes of adrenal gland metastases

“…Adrenal tumours are reported in 4.4%‐7.3% of adults, where most represent benign adenomas 1‐3 . Adrenal malignancies represent only 2.8%‐6.7% of all adrenal tumours, with the prevalence of adrenal cortical carcinomas around 0.6%‐3.7% and the prevalence of adrenal gland metastases around 0.5%‐3.8% 4‐6 .…”