title: Follow-up of patients with adrenal incidentaloma, in accordance with the European society of endocrinology guidelines: Could we be safe?
abstract: Recently, the European Society of Endocrinology (ESE) published new guidelines on the management of adrenal incidentalomas. At the same time Lopez and coworkers published on the Annals of Internal Medicine an important study showing that even patients with non-functioning adrenal tumors have an increased risk of incident diabetes. In consideration of previous data and of the results of the study of Lopez and coworkers, some points emerge from the ESE Guidelines that deserve attention. Firstly, it must be observed that the term "autonomous cortisol secretion," introduced by the ESE Panel in the place of the commonly used "subclinical hypercortisolism," seems questionable, since the guidelines do not suggest determining the adrenocorticotroph hormone levels that could give the certain proof of a truly autonomous cortisol secretion. Secondly, the ESE Guidelines suggest against repeated hormonal workup in AI patients with a normal hormonal secretion at initial evaluation, but also in those with a "possible autonomous cortisol secretion," if in the absence of comorbidities potentially related to hypercortisolism. Thirdly, the ESE Guidelines suggest against further imaging during follow-up in patients with an adrenal mass below 4 cm in size with clear benign features on imaging studies. Considering the available literature data that are briefly summarized in this comment, we believe that no sufficient evidence is available to date for giving sharp-cutting recommendations about the uselessness of a biochemical and morphological follow-up in AI patients, even in those with initially benign and not hypersecreting adrenal adenomas. However, if a recommendation has to be given on the basis of the present evidences, we should suggest to biochemically and morphologically follow-up AI patients for at least 5 years.
authors.affiliation: Unit of Endocrinology and Metabolic Diseases, Padiglione Granelli, Fondazione IRCCS Cà-Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.|Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Morelli
authors.affiliation: Unit of Endocrinology, "Casa Sollievo della Sofferenza", Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Scillitani
authors.affiliation: Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.|Unit of Endocrine Diseases and Diabetology, Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Arosio
authors.affiliation: Unit of Endocrinology and Metabolic Diseases, Padiglione Granelli, Fondazione IRCCS Cà-Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. iacopo.chiodini@policlinico.mi.it.
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology* / Q000628:therapy; D004704:Endocrinology / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: Adrenal incidentalomas; ESE Guidelines; Subclinical hypercortisolism