title: Long-term follow-up study of patients with adrenal incidentalomas.
abstract: BACKGROUND
  The incidence of adrenal incidentalomas has sharply increased in recent decades and concurrent subtle endocrine abnormalities, or even subclinical conditions, have been identified. Nonetheless, data concerning possible changes in adrenal size and/or hormonal pattern during follow-up are still inadequate.
  
  
  OBJECTIVE
  To evaluate long-term morphological and functional evolution of adrenal incidentalomas after initial diagnosis and to identify possible risk factors for hormonal hyperactivity and mass enlargement.
  
  
  METHODS
  Sixty-four patients (34-79 years) were followed-up for 12-120 months (median 25.5 months). Initial computerized tomography scan showed a unilateral mass in 51 patients and bilateral lesions in 13 patients. Average mass diameter at diagnosis was 2.5+/-0.1 cm (range 1.0-4.0). Twelve patients had subclinical Cushing's syndrome, 41 had mild hormonal alterations, and 11 had normal adrenal function at baseline. All patients were investigated by morphological and functional evaluation 6 and 12 months after diagnosis, and then at 1-year intervals.
  
  
  RESULTS
  During follow-up, a mass size increase >/=1 cm was observed in 13 patients, and 18 developed further subtle endocrine alterations. Cumulative risk of developing endocrine abnormalities was 17% at 1 year, 29% at 2 years, and 47% at 5 years. The risk was higher in the first 2 years of follow-up if the initial tumor diameter was >or=3 cm. Overall, cumulative risk of mass enlargement was 6% at 1 year, 14% at 2 years, and 29% at 5 years, and it was greater in patients with normal adrenal function than in those with subtle hormonal abnormalities (P<0.05). One female subject showed a mass enlargement after 6 months of follow-up and was eventually diagnosed with non-Hodgkin's lymphoma.
  
  
  CONCLUSIONS
  Patients with an adrenal incidentaloma are at risk for tumor growth and development of hormonal alterations. The risk of adrenal malignancy, although not elevated, also indicates the need for long-term follow-up.
authors.affiliation: Institute of Endocrine Sciences, University of Milan, Ospedale Maggiore IRCCS, Milan, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Libè
authors.forename: Chiara
authors.initials: C
authors.lastname: Dall'Asta
authors.forename: Laura
authors.initials: L
authors.lastname: Barbetta
authors.forename: Andrea
authors.initials: A
authors.lastname: Baccarelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D003907:Dexamethasone; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone