Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice

Hong, A Ram; Kim, Jung Hee; Park, Kyeong Seon; Kim, Kyong Young; Lee, Ji Hyun; Kong, Sung Hye; Lee, Seo Young; Shin, Chan Soo; Kim, Sang Wan; Kim, Seong Yeon

doi:10.1530/eje-17-0372

Cited by 51 publications

(45 citation statements)

References 31 publications

(50 reference statements)

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“… 2 7 However, the best cutoff value for mass size in the COAR cohort for predicting ACC was 3.25 cm and was lower than that in the SIE cohort. 8 Although the reason is currently uncertain, except for the advance in CT technology detecting smaller AIs, a recent retrospective study investigating Korean AIs also suggested an optimal cutoff value for mass size as 3.4 cm for differentiating malignant from benign lesions, 40 similar with the cutoff value in the COAR cohort. Given the high mortality rate associated with ACCs, we suggest excision of lesions ≥3 cm.…”

Section: Discussionmentioning

confidence: 90%

Characteristics of Adrenal Incidentalomas in a Large, Prospective Computed Tomography-Based Multicenter Study: The COAR Study in Korea

et al. 2018

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PurposePrevious studies on adrenal incidentalomas (AIs) are limited by their retrospective design, small numbers of patients, Western populations, or use of an outdated imaging technique. We investigated the characteristics of AIs in Korean patients and compared them with those reported in the largest retrospective study in Italy to discover the effects of improved imaging techniques and ethnicity differences.Materials and MethodsThis was a prospective, multicenter, cross-sectional observational study including 1005 Korean patients. Levels of plasma adrenocorticotrophic hormone, 24-h urinary free cortisol (UFC), serum cortisol after a 1 mg-dexamethasone suppression test, 24-h urinary fractionated metanephrine, and plasma aldosterone and plasma renin activity were measured. All AIs were characterized using computed tomography (CT).ResultsCompared with the results of the Italian study, AIs in Korean patients were observed more frequently in men and predominantly on the left side. Korean patients with AIs were slightly younger, and fewer patients underwent surgery. Most AIs were nonfunctional in both studies, while fewer subclinical hypercortisolism and more primary aldosteronism (PA) cases were detected in Korean patients. In our study, high UFC levels showed very low sensitivity, compared to those in the Italian study. In pheochromocytoma or PA cases, there were no hormonal differences between the studies. AIs in Korean patients were smaller, such that a lower cutoff size for detecting adrenocortical carcinoma (ACC) could be warranted.ConclusionRecent advances in CT technology were leveraged to provide accurate characteristics of AIs and to detect smaller ACCs.

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Section: Discussionmentioning

confidence: 90%

Characteristics of Adrenal Incidentalomas in a Large, Prospective Computed Tomography-Based Multicenter Study: The COAR Study in Korea

et al. 2018

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“…The reported frequency of ACC is derived from highly selected patient populations and may not reflect the prevalence rates observed in population-based studies. Combining the studies reported from 1982 to 2008, the ACC etiology of adrenal incidentaloma ranged from 0 to 14% (3,4,5,6,7). Further, studies including patients…”

Section: Introductionmentioning

confidence: 99%

Characteristics of adrenocortical carcinoma in South Korea: a registry-based nationwide survey

Lim

Lee

Kim

et al. 2020

Endocrine Connections

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Purpose To evaluate the clinical characteristics and prognostic factors in patients with adrenocortical carcinoma (ACC) in South Korea. Methods A nationwide, registry-based survey was conducted to identify pathologically proven ACC at 25 tertiary care centers in South Korea between 2000 and 2014. Cox proportional hazard model and log-rank test were adopted for survival analysis. Results Two hundred four patients with ACC were identified, with a median follow-up duration of 20 months (IQR 5–52 months). The median age at diagnosis was 51.5 years (IQR 40–65.8 years), and ACC was prevalent in women (n = 110, 53.9%). Abdominal pain was the most common clinical symptom (n = 70, 40.2%), and ENSAT stage 2 was most common (n = 62, 30.4%) at the time of diagnosis. One hundred sixty-nine patients underwent operation, while 17 were treated with other modalities. The remission rate was 48%, and median recurrence-free survival time was 46 months. Estimated 5-year recurrence-free rate was 44.7%. There were more women, large tumor, atypical mitosis, venous invasion, and higher mitotic count in cancer recurrence group. Estimated 5-year overall survival and disease-specific survival rates were 64.5 and 70.6%, respectively. Higher ENSAT stage and advanced pathologic characteristics were risk factors for all-cause mortality of ACC. Large tumor size and cortisol-secreting tumor were additional risk factors for ACC-specific death. Conclusions We report the first epidemiologic study regarding ACC in an Asian population. ENSAT stage 4; lymph node involvement; non-operative group; and invasion of vein, sinusoid, or capsule were associated with an increased risk for all-cause mortality.

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“…The best known causes of bilateral adrenal masses are related to macronodular adrenal hyperplasia, potentially regulated by aberrant G proteincoupled receptors (21), familial pheochromocytoma, primary hyperaldosteronism (22), ARMC5 gene mutation (23,24), 21-hydroxylase deficiency, multiple endocrine neoplasia type 1 (MEN-1), infectious diseases, nonfunctioning tumor or metastatic diseases (18). However, a direct relationship between adrenal incidentalomas and altered GR signaling has never been investigated thus far nor evoked in recent published guidelines (25,26).…”

Section: Introductionmentioning

confidence: 99%

Significant prevalence of NR3C1 mutations in incidentally discovered bilateral adrenal hyperplasia: results of the French MUTA-GR Study

Vitellius

Trabado

Hoeffel

et al. 2018

European Journal of Endocrinology

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Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice

Abstract: We advocate that no follow-up imaging is required if the detected adrenal mass is <4 cm and has clear benign features. However, prospective studies with longer follow-up are needed to confirm the appropriate follow-up strategies.

Cited by 51 publications

References 31 publications

Characteristics of Adrenal Incidentalomas in a Large, Prospective Computed Tomography-Based Multicenter Study: The COAR Study in Korea

Characteristics of Adrenal Incidentalomas in a Large, Prospective Computed Tomography-Based Multicenter Study: The COAR Study in Korea

Characteristics of adrenocortical carcinoma in South Korea: a registry-based nationwide survey

Significant prevalence of NR3C1 mutations in incidentally discovered bilateral adrenal hyperplasia: results of the French MUTA-GR Study

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