title: Long-term follow-up in adrenal incidentalomas: an Italian multicenter study.
abstract: BACKGROUND
  The long-term consequences of subclinical hypercortisolism (SH) in patients with adrenal incidentalomas (AIs) are unknown.
  
  
  METHODS
  In this retrospective multicentric study, 206 AI patients with a ≥5-year follow-up (median, 72.3 mo; range, 60-186 mo) were enrolled.
  
  
  METHODS
  Adrenocortical function, adenoma size, metabolic changes, and incident cardiovascular events (CVEs) were assessed. We diagnosed SH in 11.6% of patients in the presence of cortisol after a 1 mg-dexamethasone suppression test >5 μg/dL (138 nmol/L) or at least two of the following: low ACTH, increased urinary free cortisol, and 1 mg-dexamethasone suppression test >3 μg/dL (83 nmol/L).
  
  
  RESULTS
  At baseline, age and the prevalence of CVEs and type 2 diabetes mellitus were higher in patients with SH than in patients without SH (62.2 ± 11 y vs 58.5 ± 10 y; 20.5 vs 6%; and 33.3 vs 16.8%, respectively; P < .05). SH and type 2 diabetes mellitus were associated with prevalent CVEs (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1-9.0; and OR, 2.0; 95% CI, 1.2-3.3, respectively), regardless of age. At the end of the follow-up, SH was diagnosed in 15 patients who were without SH at baseline. An adenoma size >2.4 cm was associated with the risk of developing SH (sensitivity, 73.3%; specificity, 60.5%; P = .014). Weight, glycemic, lipidic, and blood pressure control worsened in 26, 25, 13, and 34% of patients, respectively. A new CVE occurred in 22 patients. SH was associated with the worsening of at least two metabolic parameters (OR, 3.32; 95% CI, 1.6-6.9) and with incident CVEs (OR, 2.7; 95% CI, 1.0-7.1), regardless of age and follow-up.
  
  
  CONCLUSIONS
  SH is associated with the risk of incident CVEs. Besides the clinical follow-up, in patients with an AI >2.4 cm, a long-term biochemical follow-up is also required because of the risk of SH development.
authors.affiliation: Department of Clinical Sciences and Community Health (V.M., S.P., A.D., M.A., P.B.-P., I.C.), University of Milan, 20122 Milan, Italy; Unit of Endocrinology and Diabetology (V.M., S.P., P.B.-P., I.C.), Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Division of Internal Medicine I (G.R., M.T.), Ospedale San Luigi, 10043 Orbassano, Italy; Department of Biological and Clinical Sciences (G.R., R.G., M.T.), University of Turin, 10124 Turin, Italy; Catholic University (S.D.C., C.P.), Unit of Endocrinology and Metabolism, 00168 Rome, Italy; Unit of Endocrinology (A.S.S., A.S.), Ospedale "Casa Sollievo della Sofferenza," IRCCS, 71013 San Giovanni Rotondo, Foggia, Italy; Unit of Endocrine Diseases and Diabetology (A.D., M.A.), Ospedale San Giuseppe, Gruppo Multimedica, 20123 Milan, Italy; Department of Biomedical Sciences for Health (M.M., B.A.), University of Milan, Unit of Endocrinology and Diabetology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy; and Division of Endocrinology, Diabetology, and Metabolism (E.G.), Department of Medical Sciences, University of Turin, 10124 Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Reimondo
authors.forename: Roberta
authors.initials: R
authors.lastname: Giordano
authors.forename: Silvia
authors.initials: S
authors.lastname: Della Casa
authors.forename: Caterina
authors.initials: C
authors.lastname: Policola
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.forename: Antonio S
authors.initials: AS
authors.lastname: Salcuni
authors.forename: Alessia
authors.initials: A
authors.lastname: Dolci
authors.forename: Marco
authors.initials: M
authors.lastname: Mendola
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Ezio
authors.initials: E
authors.lastname: Ghigo
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Massimo
authors.initials: M
authors.lastname: Terzolo
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000453:epidemiology*; D012189:Retrospective Studies; D047368:Tumor Burden
chemical_list: D006854:Hydrocortisone