Skip to content
2000
Volume 21, Issue 1
  • ISSN: 1573-4056
  • E-ISSN: 1875-6603

Abstract

Background

Adrenal incidentalomas have increased over the past years. Although there are a lot of studies related to the frequency of adrenal masses and comorbidities, whether patients with functional or nonfunctional adrenal masses have higher risk is still a controversial issue.

Methods

A total of 464 patients (female/male: 309/155) with adrenal incidentalomas were evaluated and followed up for 8 years. The patients were divided into 5 subgroups, including Autonomous Cortisol Secretion (ACS), Cushing Syndrome (CS), Pheochromocytoma (Pheo), Non-functional Adrenal Incidentalomas (NFAI), and Primary Aldosteronism (PA).

Results

While 336 (72.4%) of the patients had NFAI, the others suffered from ACS (10.8%), CS (4.3%), Pheo (4.1%), and PA (8.4%), respectively. When comparing biochemical and demographical data, BMI (p=0.77), Hba1c (p=0.495), FPG (p=0.28), LDL (p=0.66), and HDL (p=0.521) were similar among the patients with functional and nonfunctional adrenal masses. The most common comorbidities were hypertension (n=259, 55.8%), diabetes mellitus (n=158, 34.1%), and dyslipidemia (33.4%), respectively. While 84 (32.4%) patients with hypertension had functional adrenal masses, the others (n=175, 67.6%) had non-functional adrenal incidentalomas. In subgroup analyses, hypertension was more common in patients with PA (87.2% . 72%, p=0.001) and ACS. In multivariable regression analyses, hypertension (p<0.001), cortisol (p=0.003), and aldosterone (p=0.04) levels were significantly correlated with functionality.

Conclusion

Hypertension was the most common comorbidity in patients with adrenal adenomas, especially in functional adrenal adenomas related to serum cortisol and aldosterone levels.

This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode.
Loading

Article metrics loading...

/content/journals/cmir/10.2174/0115734056347340241009102228
2025-08-05
2025-09-13
Loading full text...

Full text loading...

/deliver/fulltext/cmir/21/1/CMIR-21-E15734056347340.html?itemId=/content/journals/cmir/10.2174/0115734056347340241009102228&mimeType=html&fmt=ahah

References

  1. TerzoloM. StiglianoA. ChiodiniI. LoliP. FurlaniL. ArnaldiG. ReimondoG. PiaA. ToscanoV. ZiniM. BorrettaG. PapiniE. GarofaloP. AllolioB. DupasB. ManteroF. TabarinA. AME Position Statement on adrenal incidentaloma.Eur. J. Endocrinol.2011164685187010.1530/EJE‑10‑114721471169
    [Google Scholar]
  2. YoungW.F.Jr Clinical practice. The incidentally discovered adrenal mass.N. Engl. J. Med.2007356660161010.1056/NEJMcp06547017287480
    [Google Scholar]
  3. FeeneyT. MadiedoA. KnappP.E. GuptaA. McAnenyD. DrakeF.T. Incidental adrenal masses: Adherence to guidelines and methods to improve initial follow-up: A systematic review.J. Surg. Res.2022269182710.1016/j.jss.2021.07.04134508918
    [Google Scholar]
  4. TabarinA. BardetS. BertheratJ. DupasB. ChabreO. HamoirE. LaurentF. TenenbaumF. CazaldaM. LefebvreH. ValliN. RohmerV. Exploration and management of adrenal incidentalomas.Ann. Endocrinol. (Paris)200869648750010.1016/j.ando.2008.09.00319022420
    [Google Scholar]
  5. PrinzR.A. BrooksM.H. ChurchillR. GranerJ.L. LawrenceA.M. PaloyanE. SparaganaM. Incidental asymptomatic adrenal masses detected by computed tomographic scanning. Is operation required?JAMA1982248670170410.1001/jama.1982.033300600410317097921
    [Google Scholar]
  6. EbbehojA. LiD. KaurR.J. ZhangC. SinghS. LiT. AtkinsonE. AchenbachS. KhoslaS. ArltW. YoungW.F. RoccaW.A. BancosI. Epidemiology of adrenal tumours in Olmsted County, Minnesota, USA: A population-based cohort study.Lancet Diabetes Endocrinol.202081189490210.1016/S2213‑8587(20)30314‑433065059
    [Google Scholar]
  7. SherlockM. ScarsbrookA. AbbasA. FraserS. LimumpornpetchP. DineenR. StewartP.M. Adrenal incidentaloma.Endocr. Rev.202041677582010.1210/endrev/bnaa00832266384
    [Google Scholar]
  8. SongJ.H. ChaudhryF.S. Mayo-SmithW.W. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy.AJR Am. J. Roentgenol.200819051163116810.2214/AJR.07.279918430826
    [Google Scholar]
  9. HammarstedtL. MuthA. WängbergB. BjörneldL. SigurjónsdóttirH.A. GötherströmG. AlmqvistE. WidellH. CarlssonS. AnderS. HellströmM. Adrenal lesion frequency: A prospective, cross-sectional CT study in a defined region, including systematic re-evaluation.Acta Radiol.201051101149115610.3109/02841851.2010.51601620969508
    [Google Scholar]
  10. ManteroF. TerzoloM. ArnaldiG. OsellaG. MasiniA.M. AlìA. GiovagnettiM. OpocherG. AngeliA. A survey on adrenal incidentaloma in Italy.J. Clin. Endocrinol. Metab.200085263764410.1210/jc.85.2.63710690869
    [Google Scholar]
  11. CastroM.A. Predictive model for autonomous cortisol secretion development in non-functioning adrenal incidentalomas.Hormones (Athens)20221515910.1007/s42000‑022‑00406
    [Google Scholar]
  12. BerniniG.P. MorettiA. OriandiniC. BardiniM. TaurinoC. SalvettiA. Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas.Br. J. Cancer20059261104110910.1038/sj.bjc.660245915770213
    [Google Scholar]
  13. SeregM. SzappanosÁ. TőkeJ. KarlingerK. FeldmanK. KaszperÉ. VargaI. GlázE. RáczK. TóthM. Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study.Eur. J. Endocrinol.2009160464765510.1530/EJE‑08‑070719174533
    [Google Scholar]
  14. ConsensusN.I.H. StatementsS. NIH state-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”).NIH Consens. State Sci. Statements200219212514768652
    [Google Scholar]
  15. KumariM. ShipleyM. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II Study.J. Clin. Endocrinol. Metab.2011961478148510.1210/jc.2010‑213721346074
    [Google Scholar]
  16. Kasperlik-ZałuskaA. OttoM. CichockiA. RosłonowskaE. Słowińska-SrzednickaJ. JeskeW. PapierskaL. ZgliczyńskiW. Incidentally discovered adrenal tumors: A lesson from observation of 1,444 patients.Horm. Metab. Res.200840533834110.1055/s‑2008‑107316718491253
    [Google Scholar]
  17. TanabeA. NaruseM. NishikawaT. YoshimotoT. ShimizuT. SekiT. TakagiS. ImakiT. TakanoK. Autonomy of cortisol secretion in clinically silent adrenal incidentaloma.Horm. Metab. Res.200133744445010.1055/s‑2001‑1623411507684
    [Google Scholar]
  18. FassnachtM. ArltW. BancosI. DralleH. Newell-PriceJ. SahdevA. TabarinA. TerzoloM. TsagarakisS. DekkersO.M. Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the european network for the study of adrenal tumors.Eur. J. Endocrinol.20161752G1G3410.1530/EJE‑16‑046727390021
    [Google Scholar]
  19. TerzoloM. PiaA. AlìA. OsellaG. ReimondoG. BovioS. DaffaraF. ProcopioM. PaccottiP. BorrettaG. AngeliA. Adrenal incidentaloma: A new cause of the metabolic syndrome?J. Clin. Endocrinol. Metab.2002873998100310.1210/jcem.87.3.827711889151
    [Google Scholar]
  20. MidorikawaS. SanadaH. HashimotoS. SuzukiT. WatanabeT. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection.Clin. Endocrinol. (Oxf.)200154679780410.1046/j.1365‑2265.2001.01274.x11422115
    [Google Scholar]
  21. ZeigerM.A. ThompsonG.B. DuhQ.Y. HamrahianA.H. AngelosP. ElarajD. FishmanE. KharlipJ. ZeigerM.A. ThompsonG.B. DuhQ-Y. HamrahianA.H. ZeigerM.A. ThompsonG.B. DuhQ-Y. AngelosP. ElarajD. FishmanE. HamrahianA.H. KharlipJ. GarberJ.R. MechanickJ.I. DemeureM.J. InabnetW.B. The american association of clinical endocrinologists and american association of endocrine surgeons medical guidelines for the management of adrenal incidentalomas.Endocr. Pract.2009151Suppl. 112010.4158/EP.15.S1.119632967
    [Google Scholar]
  22. PatrovaJ. JarockaI. WahrenbergH. FalhammarH. Clinical outcomes in adrenal incidentaloma: experience from one center.Endocr. Pract.201521887087710.4158/EP15618.OR26121453
    [Google Scholar]
  23. LibèR. Dall’AstaC. BarbettaL. BaccarelliA. Beck-PeccozP. AmbrosiB. Long-term follow-up study of patients with adrenal incidentalomas.Eur. J. Endocrinol.2002147448949410.1530/eje.0.147048912370111
    [Google Scholar]
  24. KochC.A. PacakK. ChrousosG.P. The molecular pathogenesis of hereditary and sporadic adrenocortical and adrenomedullary tumors.J. Clin. Endocrinol. Metab.200287125367538410.1210/jc.2002‑02106912466322
    [Google Scholar]
  25. TerzoloM. OsellaG. AlìA. BorrettaG. CesarioF. PaccottiP. AngeliA. Subclinical Cushing’s syndrome in adrenal incidentaloma.Clin. Endocrinol. (Oxf.)1998481899710.1046/j.1365‑2265.1998.00357.x9509073
    [Google Scholar]
  26. SydneyG.I. IoakimK.J. PaschouS.A. Insulin resistance and adrenal incidentalomas: A bidirectional relationship.Maturitas20191211610.1016/j.maturitas.2018.12.00230704559
    [Google Scholar]
  27. ElhassanY.S. AlahdabF. PreteA. DelivanisD.A. KhannaA. ProkopL. MuradM.H. O’ReillyM.W. ArltW. BancosI. Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess. A systematic review and meta-analysis.Ann. Intern. Med.2019171210711610.7326/M18‑363031234202
    [Google Scholar]
  28. GarrapaG.G. PantanettiP. ArnaldiG. ManteroF. FaloiaE. Body composition and metabolic features in women with adrenal incidentaloma or Cushing’s syndrome.J. Clin. Endocrinol. Metab.200186115301530611701696
    [Google Scholar]
  29. LopezD. Luque-FernandezM.A. SteeleA. AdlerG.K. TurchinA. VaidyaA. “Nonfunctional” adrenal tumors and the risk for incident diabetes and cardiovascular outcomes.Ann. Intern. Med.2016165853354210.7326/M16‑054727479926
    [Google Scholar]
  30. Ribeiro CavalariE.M. de PaulaM.P. ArrudaM. CarraroN. MartinsA. de SouzaK. CoelhoM.C. de Oliveira e Silva de MoraisN.A. MoraesA.B. Vieira NetoL. Nonfunctioning adrenal incidentaloma: A novel predictive factor for metabolic syndrome.Clin. Endocrinol. (Oxf.)201889558659510.1111/cen.1382230044007
    [Google Scholar]
  31. DebonoM. BradburnM. BullM. HarrisonB. RossR.J. Newell-PriceJ. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas.J. Clin. Endocrinol. Metab.201499124462447010.1210/jc.2014‑300725238207
    [Google Scholar]
  32. PatrovaJ. KjellmanM. WahrenbergH. FalhammarH. Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center.Endocrine201758226727510.1007/s12020‑017‑1400‑828887710
    [Google Scholar]
  33. NiemanL.K. BillerB.M.K. FindlingJ.W. Newell-PriceJ. SavageM.O. StewartP.M. MontoriV.M. The diagnosis of cushing’s syndrome: An endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab.20089351526154010.1210/jc.2008‑012518334580
    [Google Scholar]
  34. Di DalmaziG. VicennatiV. GarelliS. CasadioE. RinaldiE. GiampalmaE. MosconiC. GolfieriR. PaccapeloA. PagottoU. PasqualiR. Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study.Lancet Diabetes Endocrinol.20142539640510.1016/S2213‑8587(13)70211‑024795253
    [Google Scholar]
/content/journals/cmir/10.2174/0115734056347340241009102228
Loading
/content/journals/cmir/10.2174/0115734056347340241009102228
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test