The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection

Midorikawa, Sanae; Sanada, Hironobu; Hashimoto, Shigeatsu; Suzuki, Takayuki; Watanabe, Tsuyoshi

doi:10.1046/j.1365-2265.2001.01274.x

Cited by 125 publications

(100 citation statements)

References 25 publications

(36 reference statements)

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“…Midorikawa and cols. had demonstrated an incidence of insulin resistance, disturbed glucose tolerance and elevated blood pressure in patients with non-functioning adrenal adenoma and subsequent improvement in these metabolic states after removal of the tumors (21). Fernández-Real and cols.…”

Section: Resultsmentioning

confidence: 99%

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The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

Karaköse

Karbek

Şahi̇n

et al. 2015

Arch. Endocrinol. Metab.

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Objective: Patients with incidental nonfunctioning adrenal adenoma are associated with increased risk of obesity, impaired glucose tolerance and dyslipidemia. We aimed to investigate the relationship between thyroid function, serum lipids and insulin resistance in patients with nonfunctioning adrenal incidentaloma. Subjects and methods: Forty patients who had diagnosed as adrenal incidentaloma (AI) in our department were included in the study. Serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroperoxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-Tg Ab), lipid profile, hs-CRP, fasting insulin levels were measured and insulin resistance calculated by HOMA-IR. Thyroid volume (TV) was assessed. Results: None of the patients showed specific signs and symptoms of hormone excess. TV, TSH and fT3 levels in the patient and control groups did not differ significantly (p > 0.05). The serum fT4, anti-TG Ab, anti-TPO Ab levels in the patient group were significantly higher than in the control group (p = 0.013, p < 0.0001, p = 0.016 respectively). The HOMA-IR, hs-CRP and HDL cholesterol levels in the AI patients were significantly higher than the control group (p = 0.034, p = 0.041, p = 0.002, respectively).

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Section: Resultsmentioning

confidence: 99%

“…Many patients with incidental nonfunctioning adrenal adenoma have increased risk of obesity, impaired glucose tolerance and dyslipidemia (11)(12)(13). We aimed to investigate the relationship between thyroid function, serum lipids and insulin resistance in patients with nonfunctioning adrenal incidentaloma.…”

Section: Introductionmentioning

confidence: 99%

The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

Karaköse

Karbek

Şahi̇n

et al. 2015

Arch. Endocrinol. Metab.

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“…Improvement of blood pressure, obesity, metabolic abnomalities, collagen and bone turnover markers was observed after adrenalectomy in patients with subclinical Cushing's syndrome (51,66,67). In particular, Midorikawa et al (89) demonstrated an improvement in systolic blood pressure and insulin resistance after adrenalectomy both in patients with subclinical Cushing's syndrome and in those with non-functioning cortical adenoma, but not in patients with non-cortical tumors (89). Cross-sectional and case-control studies indicate that the degree of metabolic abnormalities in patients with adrenal incidentalomas is directly related to the severity of the hypercortisolism (94, 118, 121 -124).…”

Section: Hormone Productionmentioning

confidence: 98%

“…Whether these features, which are typical of the metabolic syndrome, will have an impact on the long-term morbidity of patients with subclinical Cushing's syndrome remains to be determined. Long-term perspective studies are lacking; however, an amelioration of clinical or biochemical abnormalities in patients with subclinical hypercortisolism after surgery has been reported (42,51,53,66,67,(88)(89)(90). Improvement of blood pressure, obesity, metabolic abnomalities, collagen and bone turnover markers was observed after adrenalectomy in patients with subclinical Cushing's syndrome (51,66,67).…”

Section: Hormone Productionmentioning

confidence: 99%

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

556

414

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Clinically silent adrenal masses discovered by imaging studies performed for unrelated reasons, i.e. adrenal incidentalomas, have become a rather common finding in clinical practice. However, only limited studies of incidence, prevalence, and natural history of adrenal incidentalomas are available. A comprehensive review of the literature shows the prevalence of adrenal incidentalomas to be 2.3% at autopsy and 0.5 -2% at abdominal computed tomography scan. Most lesions are adrenocortical adenomas at histology, whereas the prevalence of adrenocortical carcinomas is relatively low. The risk of malignancy over time for masses defined as benign at diagnosis is estimated at about 1/1000, even though 5-25% of masses increase in size during follow-up. Hyperfunction develops in about 1.7% of cases and the risk is higher in patients with lesions larger than 3 cm. Cortisol hypersecretion is the most likely disorder that may ensue, and it remains subclinical in about two-thirds of cases. The lack of controlled studies precludes making specific management recommendations. Large perspective controlled studies to define the epidemiology, natural history, and possible associated morbidity of adrenal incidentalomas and their impact on the quality of life of patients are needed.

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“…However, so far, no studies specifically investigated the possible association between the pre-surgical biochemical diagnosis of SH and the subsequent presence of post-surgical hypocortisolism. The prevalence of post-surgical hypocortisolism in patients, with and without SH, who underwent unilateral adrenalectomy for AI, varies depending on the criteria used to diagnose SH (12)(13)(14)(15)(16)(17)(18). In addition, most studies considered only post-surgical basal cortisol level or the presence of symptoms suggesting adrenal failure as a diagnostic tool for post-surgical hypocortisolism (12,15,17,18).…”

Section: Introductionmentioning

confidence: 99%

Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

Eller-Vainicher¹,

Morelli²,

Salcuni³

et al. 2010

European Journal of Endocrinology

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Objective: Few data are available regarding the need of steroid substitutive therapy after unilateral adrenalectomy for adrenal incidentaloma (AI). It is unknown whether, before surgery, the hypothalamic-pituitary-adrenal (HPA) axis secretion parameters can predict post-surgical hypocortisolism. Aim: This study aimed to evaluate whether, in AI patients undergoing unilateral adrenalectomy, postsurgical hypocortisolism could be predicted by the parameters of HPA axis function. Design: Prospective, multicenter. Methods: A total of 60 patients underwent surgical removal of AI (surgical indication: 29 subclinical hypercortisolism (SH); 31 AI dimension). Before surgery, SH was diagnosed in patients presenting at least three criteria out of urinary free cortisol (UFC) levelsO60 mg/24 h, cortisol after 1-mg dexamethasone suppression test (1 mg-DST)O3.0 mg/dl, ACTH levels!10 pg/ml, midnight serum cortisol (MSC)O5.4 mg/dl. Two months after surgery, HPA axis function was assessed by low dose ACTH stimulation test or insulin tolerance test when needed: 39 patients were affected (Group B) and 21 were not affected (Group A) with hypocortisolism. The accuracy in predicting hypocortisolism of pre-surgical HPA axis parameters or their combinations was evaluated. Results: The presence of O2 alterations among 1 mg-DSTO5.0 mg/dl, ACTH!10 pg/ml, elevated UFC and MSC has the highest odds ratio (OR) for predicting post-surgical hypocortisolism (OR 10.45, 95% confidence interval, PZ0.001). Post-surgical hypocortisolism was predicted with 100% probability by elevated UFC plus MSC levels, but not ruled out even in the presence of the normality of all HPA axis parameters. Conclusion: Post-surgical hypocortisolism cannot be pre-surgically ruled out. A steroid substitutive therapy is indicated after unilateral adrenalectomy for SH or size of the adenoma.European Journal of Endocrinology 162 91-99

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The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection

Cited by 125 publications

References 25 publications

The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

Prevalence and natural history of adrenal incidentalomas

Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

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