Hormonal and metabolic evaluation of adrenal incidentalomas

Abstract

The biochemical and hormonal data in patients with adrenal incidentalomas were evaluated to compare the differences between adrenal adenomas and other benign lesions and to find the relationship between metabolic parameters and adrenal hormones. Ninety two patients (29men, age 20-90 years) with incidentally discovered unilateral or bilateral adrenal masses detected on CT were included in this study for the reasons others than adrenal pathology. Glycemia, cholesterolemia, triglyceridemia, hormonal evaluation including plasma ACTH, plasma aldosterone, plasma renin acitivity, overnight dexametasone test, ACTH test, free plasma metanephrines, urinary catecholamines were determined. In the group of patients with adrenal masses the prevalence of arterial hypertension was three fold higher, the prevalence of DM was approximately five fold higher and the prevalence of the overweight and obesity two fold higher than is reported in the general population. The most frequent adrenal masses were nonfunctional masses, the occurence of functional lesions was as follows: steroid enzymopathies (an exaggerated response of 17-OHP indicating a possible 21-hydroxylase deficiency), subclinical Cushing syndrome, primary aldosteronism and pheochromocytoma (5%, 2%, 2% and 1% respectively). There were no significant differences in evaluated data between patients with adenomas and hyperplasia and also no significant difference in evaluated data between lesions smaller than 3 cm and lesions greater than 3 cm. We did not find any correlations between plasma cortisol and lipid values. In this study we confirmed a higher prevalence of symptoms characteristic for different metabolic syndromes in these patients with adrenal incidentalomas, which indicate systematic screening for the metabolic syndrome including evaluation of the insuline resistance in this patients.

High prevalence of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas: a challenge to management

“… 10 did not find any differences in ACTH, midnight cortisol and postdexamethasone cortisol levels between unilateral and bilateral adenomas. Two other studies 27,28 compared diffuse adrenal hyperplasia without distinct adenomas to unilateral adenomas and found no differences in ACTH levels or the overnight dexamethasone suppression test. However, the incidence of SH was not specifically addressed in any of these studies.…”

Adrenal incidentalomas and cardiometabolic morbidity: an emerging association with serious clinical implications

“…Increasing evidence supports the association between NFAIs and several parameters of cardiometabolic risk, such as IR, obesity, hypertension, hyperglycaemia and dyslipidaemia [13–17]. This has led to speculation about the possible underlying mechanisms as well as clinical dilemmas concerning the optimal management of patients.…”

Carotid Intima-Media Thickness as the Cardiometabolic Risk Indicator in Patients with Nonfunctional Adrenal Mass and Metabolic Syndrome Screening

“…Another important subject discussed nowadays is that NFAMs are a risk indicator of increased cardiometabolic risk [ 5 ]. In recent studies it was determined that the frequency of Type 2 diabetes mellitus (DM), obesity, hypertension (HT), impaired glucose tolerance (IGT) and dyslipidemia increase in patients with non functional adrenal incidentaloma (NFAI) [ 6 ]. Additionally, observation of many components (especially increased thrombogenic ambient, insulin resistance, hepatosteatosis and abdominal obesity) of the metabolic syndrome (MS) in the patients with NFAM makes us think that different metabolic pathways are impaired [ 7 ].…”