Nonfunctioning adrenal incidentaloma: A novel predictive factor for metabolic syndrome

Cavalari, Emanuela; Paula, Marcela Pessoa de; Arruda, Mariana; Carraro, Nathália; Martins, Arthur; Souza, Kamila de; Coelho, Maria Caroline Alves; Morais, Nathalie de Oliveira e Silva de Anne; Moraes, Aline Barbosa; Neto, Leonardo Vieira

doi:10.1111/cen.13822

Cited by 32 publications

(22 citation statements)

References 47 publications

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“…There is growing evidence suggesting that the presence of AI is often associated with the presence of factors increasing cardio-metabolic risk, such as hypertension, insulin resistance, hyperglycemic states and dyslipidemia [7,13,14]. Similar to our observations, in a cohort of patients described by Ribeiro Cavalari et al, metabolic syndrome was significantly more frequent in patients with non-functional AIs than in control subjects with no adrenal tumor (69.2% vs. 31.0% accordingly) [15]. This may suggest a bidirectional relationship between the presence of AIs and insulin resistance, potentially promoting growth of adrenal masses, but also subclinical hormonal activity of AIs leading to metabolic disturbances.…”

Section: Discussionsupporting

confidence: 89%

Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Single Tertiary Reference Center

Cyrańska-Chyrek

Szczepanek‐Parulska

Olejarz

et al. 2019

IJERPH

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Background: A rise in adrenal incidentalomas (AIs) detection has been observed recently. Even though AIs are detected in asymptomatic patients, thorough assessment may reveal hormonal and metabolic abnormalities or malignant character. Methods: Medical records of 2005 patients (1301 women, 704 men) with 2498 tumors aged 61 ± 11.3 (18–93) years, who had been hospitalized due to AI diagnosis, were reviewed. Patients underwent clinical examination, adrenal CT and hormonal assessment. In patients subjected to adrenalectomy, histopathological character of AI was confirmed. Results: AIs most frequently occurred in patients in their 7th decade of life. Hypertension was present in 76.6%, glucose metabolism disorders in 41.3%, and hypercholesterolemia in 60.1% of patients. Lipid-rich adenomas (83.2%) and hormonally inactive tumors (83.1%) predominated. Autonomous cortisol secretion was present or suspected in 6.6%, pheochromocytoma in 4.7%, hyperandrogenism in 3.1%, and primary hyperaldosteronism in 2.4% of patients. The risk of malignancy increased in patients with tumors >6 cm was 37.7%. The logistic regression analysis revealed that the strongest predictor of hormonal activity of AIs was lipid-poor picture on CT scan (OR 7.072; CI 5.118–9.771), while the most important factor increasing the risk of malignancy was lipid-poor adenoma or non-adenoma on CT scan (OR 4.843; CI 1.697–13.819). Final histopathology was available for 214 tumors; 106 adrenocortical adenomas, 46 pheochromocytomas, and 18 adrenocortical carcinomas were diagnosed. Conclusion: Most AIs are hormonally inactive adenomas. The most frequent hormonal manifestation of AI is subclinical hypercortisolemia. Presence of AI is often accompanied by features of metabolic syndrome. The tumor density on CT scan picture may be predictive of both hormonal activity and the risk of malignancy. Tumors of all sizes may exhibit hormonal activity, while the risk of malignancy significantly increases with the size above 6 cm.

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Section: Discussionsupporting

confidence: 89%

Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Single Tertiary Reference Center

Cyrańska-Chyrek

Szczepanek‐Parulska

Olejarz

et al. 2019

IJERPH

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“…Only less than 10% secrete excess amounts of hormones, most frequently autonomous cortisol secretion (ACS) [ 10 , 11 ]. Although patients with AI, by definition, do not show any signs and symptoms of adrenal hormonal excess [ 12 ], insulin resistance (IR) hypertension, dyslipidemia, glucose intolerance and obesity in ACS are clearly associated with the slight cortisol hypersecretion [ 11 , 13 , 14 ]. Moreover, the increased frequencies of IR, impaired glucose homeostasis and metabolic syndrome were reported also in patients with NFAI when compared to those with normal adrenal imaging [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The prevalence and characteristics of non-functioning and autonomous cortisol secreting adrenal incidentaloma after patients’ stratification by body mass index and age

2020

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Background: The escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population. It is currently unclear whether patients with obesity more likely develop AI and the current rise in the prevalence of AI could be at least partly associated with the respective rise in obesity. We compared the prevalence and characteristics of non-functional (NF) and autonomous cortisol secreting (ACS) adrenal incidentalomas (AIs) after the study population was stratified by different body mass indexes (BMI) and age groups. Methods: Retrospective cross-sectional study comprising of 432 patients (40.6% male, 59.4% female) with NFAI (N = 290) and ACS (N = 142), of median age 63.4 (54.0-71.6) years and median BMI 28.6 (25.5-31.7) kg/m 2. The data collection contained 11.132 points including demographic, anthropometric, radiologic, hormonal and metabolic parameters. Results: We observed 68-87% higher prevalence of AI across different age groups in NFAI and ACS in obese/ overweight compared to normal weight subjects. Patients with ACS were older (P = 0.008), with higher basal cortisol (P < 0.001), lower basal DHEAS (P = 0.001), lower suppression DHEAS (P = 0.027) and higher aldosterone (P = 0.039). AIs with ACS were larger than NFAI (P < 0.001). Interestingly, ACS group had lower body mass (P = 0.023) and did not differ in BMI, blood pressure, heart rate, lipid profile, fasting glucose and presence of diabetes mellitus type 2 when compared to NFAI., By contrast to the similarity of metabolic profiles in ACS and NFAI, some components of adverse metabolic traits were rather associated with higher BMI and older age, in particular in NFAI.

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“…Nonfunctional AI (NFAI) should be considered for surgery if >40 mm due to the risk of malignancy, in particular adrenal cortical carcinoma (ACC) [37,91]. The detection of NFAI is predictive of the presence of diabetes mellitus and metabolic syndrome [93,94]. Smaller NFAIs may be scheduled for repeated imaging after 6 to 12 months to exclude significant growth and, therefore, malignancy [15].…”

Section: Adrenal Incidentalomamentioning

confidence: 99%

WFUMB position paper on the management incidental findings: adrenal incidentaloma

Dietrich

Corréas

et al. 2020

Ultrasonography

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Focal lesions of the adrenal glands are incidentally detected in approximately 5% of cases by modern imaging techniques. Fewer than 5% of these adrenal incidentalomas are malignant and approximately 10% have endocrine activity. Reliable differentiation of malignant versus benign and hormonally active versus nonfunctional adrenal incidentalomas significantly influences therapeutic management and the outcome of affected individuals. Therefore, each adrenal incidentaloma should undergo a standardized diagnostic work-up to exclude malignancy and endocrine activity. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on the management of adrenal incidentaloma and describes efficient management strategies with particular reference to the role of ultrasound techniques.

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Nonfunctioning adrenal incidentaloma: A novel predictive factor for metabolic syndrome

Abstract: Metabolic syndrome is frequently found in patients with NFAI, and this frequency is higher in NFAI patients than in those with normal adrenal imaging.

Cited by 32 publications

References 47 publications

Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Single Tertiary Reference Center

Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Single Tertiary Reference Center

The prevalence and characteristics of non-functioning and autonomous cortisol secreting adrenal incidentaloma after patients’ stratification by body mass index and age

WFUMB position paper on the management incidental findings: adrenal incidentaloma

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