title: Concomitant alterations of metabolic parameters, cardiovascular risk factors and altered cortisol secretion in patients with adrenal incidentalomas during prolonged follow-up.
abstract: Adrenal incidentalomas (AI) are associated with metabolic and hormonal abnormalities, most commonly autonomous cortisol secretion (ACS). Data regarding alterations of insulin resistance (IR) and ACS after prolonged follow-up are limited. We investigated the evolution of IR, cortisol secretion and ACS development in patients with AI during prolonged follow-up.
  
  
  
  Prospective study in a tertiary hospital.
  
  
  
  Seventy-one patients with AI [51 nonfunctioning (NFAI) and 20 ACS] and 5·54 ± 1·7 years follow-up underwent testing for ACS and oral glucose tolerance test to determine IR indices and adrenal imaging.
  
  
  
  At follow-up, 16/51 (31%) NFAI patients converted to ACS, while two with previous ACS reverted to NFAI; 21% (7/33) of patients who did not covert to ACS exhibited high urinary-free cortisol (H-UFC) levels. All AI patients developed deterioration of IR irrespective of their cortisol secretory status. Eight patients developed newly diagnosed type 2 diabetes (9·8% NFAI and 15% ACS, respectively) and 14 IR (17·6% NFAI and 25% ACS, respectively). Adenoma size increased from 2·1 ± 0·8 to 2·3 ± 0·8 cm, whereas IR correlated with postdexamethasone cortisol level and adenoma size increase. IR showed an incremental continuum trend from normal UFC (Ν-UFC), to H-UFC, C-ACS and ACS patients.
  
  
  
  New-onset ACS developed in 31% patients with NFAI, whereas 21% of NFAI patients had H-UFC levels. All AI patients as a group and the subgroups of N-UFC, H-UFC, C-ACS and ACS patients developed deterioration of metabolic parameters during follow-up that was more prominent in ACS patients.
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Labrini
authors.initials: L
authors.lastname: Papanastasiou
authors.affiliation: Department of Pathophysiology, Laikon Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Krystallenia I
authors.initials: KI
authors.lastname: Alexandraki
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Ioannis I
authors.initials: II
authors.lastname: Androulakis
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Stelios
authors.initials: S
authors.lastname: Fountoulakis
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Kounadi
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Vaios
authors.initials: V
authors.lastname: Tsiavos
authors.affiliation: Department of Radiology, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: Christianna
authors.initials: C
authors.lastname: Samara
authors.affiliation: 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Theodoros G
authors.initials: TG
authors.lastname: Papaioannou
authors.affiliation: Department of Endocrinology and Diabetes Center, 'G Gennimatas' General Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Piaditis
authors.affiliation: Department of Pathophysiology, Laikon Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism*; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D006854:Hydrocortisone