Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas.
OBJECTIVE
To evaluate long-term morphological, functional, and clinical outcome in adrenal incidentalomas.


METHODS
A total of 118 patients (77 F and 47 M; age 62.3+/-1.0 years) with adrenal incidentalomas were evaluated at baseline and followed-up for median 3 years (range 1-10 years) by clinical, biochemical, hormonal, and morphological evaluation. Among them, six patients with diagnosis of subclinical Cushing's syndrome (SCS) underwent surgery.


RESULTS
At entry, 86% (n=102) of tumors were nonfunctioning (NF) and 14% (n=16) showed SCS. Comparing NF with SCS patients, a significantly higher percentage of dyslipidemia was found in the group of SCS patients (50 vs 23%, P=0.033). During follow-up, adrenal function remained normal in all NF patients, none of them developed subclinical or overt endocrine disease. The cumulative risk of mass enlargement was globally low (25%), but progressive up to 8 years. SCS was confirmed in all patients, and none of them shifted to overt Cushing's syndrome. The cumulative risk of developing metabolic-cardiovascular abnormalities was globally low (22%), but progressive up to 8 years and new diseases were recorded in the group of NF patients only (three patients with dyslipidemia, four with impaired fasting glucose/impaired glucose tolerance, and three with diabetes mellitus). SCS patients who underwent surgery did not show any significant clinical improvement.


CONCLUSIONS
The risk of mass enlargement, hormonal, and metabolic impairment over time is globally low. Conservative management seems to be appropriate, but further prospective studies are needed to establish the long-term outcome of such patients, especially for metabolic status, cardiovascular risk profile and their relationship with endocrine function.
Giordano
R
R
Department of Clinical and Biological Sciences, Division of Endocrinology, University of Turin, Azienda Ospedaliero-Universitaria San Giovanni Battista, Corso Dogliotti 14, 10126 Turin, Italy.
Marinazzo
E
E
Berardelli
R
R
Picu
A
A
Maccario
M
M
Ghigo
E
E
Arvat
E
E
D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000473:pathology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood; D001774:Blood Chemical Analysis; D016009:Chi-Square Distribution; D003480:Cushing Syndrome / Q000097:blood / Q000473:pathology*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D050171:Dyslipidemias / Q000097:blood / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D008676:Metanephrine / Q000652:urine; D008875:Middle Aged; D011446:Prospective Studies; D012083:Renin / Q000097:blood
D000450:Aldosterone; D008676:Metanephrine; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D012083:Renin; D006854:Hydrocortisone