Subclinical Cushing’s syndrome in patients with bilateral compared to unilateral adrenal incidentalomas: a systematic review and meta-analysis

Abstract

The purpose of this study was to systematically review the literature for studies that have investigated possible differences in the prevalence of subclinical Cushing's syndrome (SCS) and related clinical implications between patients with unilateral (UAI) and bilateral adrenal incidentalomas (BAI) and to meta-analyze the best evidence available. Electronic databases PubMed and EMBASE were systematically searched. Main study outcome was the prevalence of SCS in patients with UAI and BAI. Secondary outcomes were the prevalence of obesity, diabetes, glucose intolerance, hypertension, dyslipidemia, and osteoporosis in patients with UAI and BAI. Risk differences (RD) or mean differences (MD) and 95 % confidence intervals (CIs) were calculated. Meta-analysis was conducted using Review Manager (RevMan 5.3). Six studies were included in the meta-analysis involving in total 1239 patients, 968 with UAI, and 271 with BAI. Patients with UAI had lower prevalence of SCS compared with those with BAI [RD (95 % CI) -0.13 (-0.22 to -0.05), I (2) = 42 %]. The mass diameter of UAI did not differ from BAI (the size of the largest lesion) [MD (95 % CI) -0.45 (-1.09 to 0.19), I (2) = 91 %]. The prevalence of obesity [MD (95 % CI) 0.42 (-0.53 to 1.37), I (2) = 4 %], diabetes [RD (95 % CI) -0.04 (-0.11 to 0.04), I (2) = 0 %], hypertension [RD (95 % CI) 0.00 (-0.18 to 0.18), I (2) = 75 %], and dyslipidemia [RD (95 % CI) -0.02 (-0.16 to 0.13), I (2) = 50 %] did not differ between UAI and BAI. The present meta-analysis provided evidence that patients with BAI present a higher prevalence of SCS compared to patients with UAI.

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

“…Bilateral adrenal incidentalomas represent 15-20% of adrenal incidentalomas (18,19,20). This prevalence drastically increases with aging.…”

Luteinizing hormone and insulin resistance in menopausal patients with adrenal incidentalomas: The cause‐effect relationship?

“…Furthermore, there is a direct correlation between IR and ATS in patients with (P)ACS as well. Our findings are also in accordance with the recent meta‐analysis by Paschou et al which show that patients with bilateral adrenal incidentalomas have a higher prevalence of SH when compared to patients with unilateral adrenal incidentalomas . There was no association of HOMA index and LH in patients with bilateral tumours.…”

Osteoporosis and adrenal incidentaloma: To be or not to be?

“…Another study on 152 subjects with adrenal incidentaloma (2/3 had unilateral lesions and 1/3 had bilateral lesions) showed that among them 20% had subclinical Cushing's syndrome (more frequent in bilateral tumours) but the bone mineral density based on DXA at central sites (lumbar spine and femoral neck) was similar between the subgroups (21). Another meta-analysis based on 6 studies including 1239 patients with adrenal incidentaloma showed that metabolic complications as well as osteoporosis do not differ if the incidentaloma is uni or bilateral (22). On the other hand, the presence of subliclinical hypercortisolism is positively correlated with a higher risk of osteoporosis and fragility fractures versus patients with negative secretor profile and adrenal incidentaloma (23).…”