title: Bilateral adrenal incidentalomas differ from unilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications.
abstract: OBJECTIVE
  To investigate the possibility of a different prevalence of subclinical Cushing's syndrome (SCS) and potentially related morbidities between patients with unilateral adrenal incidentalomas (UAI) and bilateral adrenal incidentalomas (BAI), as existing data are few and controversial.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Clinical examination, biochemical tests, and hormonal evaluation were performed in 298 consecutive patients with adrenal incidentalomas, unilateral in 224 patients (75.2%), bilateral in 74 patients (24.8%), with apparently benign masses based on imaging characteristics and after exclusion of overt endocrine disease. The diagnosis of SCS was based on a post-dexamethasone suppression test (2 mg dexamethasone/24 h for 48 h), with serum cortisol level ≥1.8 μg/dl combined with at least one abnormal result of the other hormonal measurements.
  
  
  RESULTS
  SCS was diagnosed in 66 out of 298 (22.1%) patients, being more frequent in patients with BAI (35.1 vs 17.9%, P=0.003, for BAI and UAI respectively). Hypertension, type 2 diabetes mellitus, impaired glucose tolerance, and dyslipidemia were of a similar frequency in both groups. SCS patients with UAI and BAI did not differ in age, gender, BMI, waist circumference, and mass size. Factors related to SCS were the presence of BAI (OR, 3.24; 95% CI, 2.31-4.54) and mass size (OR, 2.63; 95% CI, 1.31-5.26).
  
  
  CONCLUSIONS
  BAI patients present more often with SCS when compared with UAI patients; however, morbidities potentially related to subtle cortisol hypersecretion were of a similar frequency in both groups. Further studies are needed to clarify whether this difference in hormonal activity may be related to different pathophysiologies.
authors.affiliation: Endocrine Unit2nd Department of Internal Medicine - Propaedeutic, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Amalia Fleming' General Hospital, Athens, Greece niadas@hol.gr.
authors.forename: Evangeline
authors.initials: E
authors.lastname: Vassilatou
authors.affiliation: Endocrine Unit2nd Department of Internal Medicine - Propaedeutic, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Amalia Fleming' General Hospital, Athens, Greece.
authors.forename: Andromachi
authors.initials: A
authors.lastname: Vryonidou
authors.affiliation: Endocrine Unit2nd Department of Internal Medicine - Propaedeutic, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Amalia Fleming' General Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Ioannidis
authors.affiliation: Endocrine Unit2nd Department of Internal Medicine - Propaedeutic, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Amalia Fleming' General Hospital, Athens, Greece.
authors.forename: Stavroula A
authors.initials: SA
authors.lastname: Paschou
authors.affiliation: Endocrine Unit2nd Department of Internal Medicine - Propaedeutic, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Amalia Fleming' General Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Panagou
authors.affiliation: Endocrine Unit2nd Department of Internal Medicine - Propaedeutic, 'Attikon' University Hospital, 1 Rimini Street, Haidari, Athens 12462, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, GreeceDepartment of EndocrinologyDiabetes and Metabolism, 'Amalia Fleming' General Hospital, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tzavara
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000378:metabolism*; D000368:Aged; D003480:Cushing Syndrome / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D006854:Hydrocortisone