The association between adrenal adenoma size, autonomous cortisol secretion and metabolic derangements

Abstract

Objective Autonomous cortisol secretion (ACS) is common in patients with adrenal incidentalomas (AI). ACS is associated with increased cardiovascular morbidity and mortality. Data regarding the association between radiological characteristics of adrenal adenomas, their hormonal functionality and metabolic outcomes, are scarce and inconclusive. In this study, we aim to delineate the association between radiological characteristics of AI, ACS and metabolic status. Methods A cross‐sectional study of 77 patients with AI who underwent a comprehensive hormonal evaluation. Radiological assessments were performed by an independent radiologist blinded to the clinical and hormonal phenotype of each case. Linear regression models were used to evaluate the association between post dexamethasone suppression test (DST) cortisol levels, metabolic indices and radiological measurements. Results Mean maximal adenoma diameter was greater in patients with versus without ACS (20.35 ± 6 vs. 27.09 ± 9.3 mm, respectively, p < .01). Maximal adenoma diameter was found to be positively and linearly correlated with post‐DST morning cortisol levels across their entire range (R = .474, p < .01). Linear correlations between maximal adenoma diameter and indices of glycemic control showed a correlation coefficient (R) of .481 and .463 for fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c), respectively, p < .01. When analysis included only patients with ACS, an R = .584 and R = .565 was observed for FPG and HbA1c, respectively (p < .01 for both). The association between maximal adenoma diameter and both FPG and post‐DST morning cortisol intensified in patients with metabolic syndrome. Conclusion There is a quantitative positive mild correlation between AI size and both cortisol autonomy and metabolic parameters.

Predictive Factors of Functioning Adrenal Incidentaloma: A 15-Year Retrospective Study

“…A prior cross-sectional study reported that a plain HU of ≥18.5 on non-contrast CT scans was a significant radiological parameter that could help detect functioning AI [ 8 ], while our study determined that patients with HU < 10 on plain CT scans have a probability of the mass being functioning 2.47 times that of patients with HU ≥ 10. Similar to our study, a previous report on 77 patients stated that a greater mass size of AI was significantly related to functioning AI, particularly the ACS subtype [ 11 ]. That study, however, did not specify the cut-off nodule size associated with a significantly increased risk of a functioning AI.…”

“…In categorizing mass size, we used a standard cut-off of 4 cm because that value is widely used in the evaluation of the malignancy of a mass, and hence to determine the appropriate management for AI patients. Most previous reports have stated that there is a correlation between functioning AI and larger mass size [ 11 , 12 ]. For example, Barzon et al stated that masses of >3 cm are linked to functioning AI [ 12 ].…”

Adrenal limb thickness is associated with metabolism profiles in patients with diabetes: A cross‐sectional study

“…The adrenal glands control a variety of vital physiological processes with endocrine secretory function 4 . Adrenal adenomas with abnormal adrenal hormone production, such as primary aldosteronism and hypercortisolism, are closely relevant to dysregulated blood pressure, blood lipids, and blood glucose 5–8 . Adrenal morphological abnormity without aberrant adrenal functions, for example adrenal incidentaloma or adrenal hypertrophy, was regarded as lacking clinical significance for a long time.…”

“… 4 Adrenal adenomas with abnormal adrenal hormone production, such as primary aldosteronism and hypercortisolism, are closely relevant to dysregulated blood pressure, blood lipids, and blood glucose. 5 , 6 , 7 , 8 Adrenal morphological abnormity without aberrant adrenal functions, for example adrenal incidentaloma or adrenal hypertrophy, was regarded as lacking clinical significance for a long time. The significance of adrenal morphology to metabolic profiles has been unrecognized to some extent, until the last decades, evidence is accumulating on the association between adrenal size and metabolic disorders.…”