Hormonal activity in clinically silent adrenal incidentalomas

Abstract

IntroductionThe rapid development of modern imaging techniques, has led to an increase in accidentally discovered adrenal masses without clinically apparent hormonal abnormalities. Such tumours have been termed “incidentalomas”. The diagnostic work-up in patients with adrenal incidentalomas is aimed at the determination of hormonal activity of the tumour and identification of patients with potentially malignant tumours. The aim of our study was a retrospective analysis of selected clinical characteristics and hormonal studies in accidentally discovered adrenal tumours.Material and methodsFourty hundred sixty-three patients with serendipitously discovered adrenal masses, diagnosed and treated in the Department of Endocrinology and Internal Diseases, Medical University of Gdansk as well as in the affiliated Endocrinology Clinic between 1993 and October of 2009 were included in the analysis. Out of all patients, 245 were referred for adrenalectomy.ResultsWe found that clinically “silent” tumours often demonstrate subclinical hormonal activity. In our report, increased 24-h urinary excretion of cortisol correlated positively with tumour size (p < 0.001). Moreover, a statistical relationship was demonstrated between tumour size and serum cortisol concentration assessed in the 1 mg dexamethasone suppression test (p < 0.001). Increased values of dehydroepiandrosterone/dehydroepiandrosterone sulphate were more often found in malignant than in benign tumours (p < 0.01). Urinary concentrations of 17-ketosteroids correlate positively with diagnosis of adrenocortical cancer (p = 0.02).ConclusionsWe found that clinically “silent” tumours often demonstrate subclinical hormonal activity (subclinical Cushing syndrome, subclinical pheochromocytoma, low-symptomatic adrenocortical cancer).

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

“…Incydentaloma nadnercza jest nieprawidłową masą tkankową o średnicy ≥ 1 cm wykrytą przypadkowo w badaniu obrazowym klatki piersiowej lub jamy brzusznej [1][2][3][4]. Każda zmiana ogniskowa w rzucie nadnerczy stwierdzona w badaniu ultrasonograficznym (USG) wymaga potwierdzenia w badaniu tomografii komputerowej (CT, computed tompography) lub rezonansu magnetycznego (MR, magnetic resonance).…”

“…An adrenal incidentaloma is a previously unsuspected adrenal mass with a diameter ≥ 1 cm discovered on chest or abdomen imaging examination [1][2][3][4]. Every suspicion of an adrenal lesion observed during ultrasound (US) must be confirmed by computed tomography (CT) or magnetic resonance imaging (MRI).…”

Adipokine and cytokine levels in non-functioning adrenal incidentalomas (NFAI)

“…Adrenal incidentalomas considered hormonally inactive in the past have often been found to exhibit subclinical hormonal activity of the cortex or medulla [6][7][8][9][10].…”

“…Even subclinical hormonal activity, results in coexistence of metabolic diseases: Cushing Syndrome-(CS) and Subclinical Cushing Syndrome (SCS), pheochromocytoma (PHEO) [10][11][12] and coagulation disorders: CS, SCS [13][14][15]. In fact, patients with adrenal incidentalomas have a high prevalence of obesity, hypertension (HT) and diabetes mellitus (DM) [11,12,16,17].…”

Report on 5 Cases of Adrenal Ganglioneuromas

“…The prevalence of incidental adrenal tumors detected in radiological studies is estimated at 2-4%, however, according to some authors, it may be as high as 10% (7)(8)(9). Most of the tumors are hormonally inactive adenomas, which derive from the adrenal gland cortex (71.2 %); less frequent are tumors of the adrenal medulla, i.e.…”