Clinical Evaluation of Adrenal Incidentaloma: The Experience of a Referral Center

Abstract

The number of adrenal incidentaloma (AI) cases has increased in the last few years due to the widespread use of imaging diagnostics. Management requires evaluation of the malignant nature and hormonal activity. The aim of the present study is to assess possible clinical abnormalities in 132 AI patients both at baseline and during follow-up (mean 48.6 ± 12.5 months). In all patients, demographic, anthropometric data, biochemical, metabolic and hormonal data, and 24-h ambulatory blood pressure monitoring were assessed. Mild autonomous cortisol secretions (MACS) were diagnosed in patients without signs and symptoms of overt Cushing's syndrome and post dexamethasone (DXM) plasma cortisol concentration > 50 nmol/L (>1.8 μg/dL). Patients with overnight DXM-1 mg test positive showed higher values of diastolic blood pressure, glycemia and uric acid levels compared to patients with negative DXM test at baseline. During follow-up, the potential development of MACS in patients with nonfunctional AI showed a prevalence of 29%, though the cardiovascular and metabolic alterations were less pronounced compared to those diagnosed with MACS at baseline. Therefore, follow-ups with AI patients are useful for observing changes in clinical features.

Keywords: adrenal incidentaloma; dexamethasone test; hypertension; metabolic disorders.

Figure 1

Prevalence of non-functional adrenal incidentaloma (NFAI) and mild autonomous cortisol secretions (MACS) at baseline and follow-up.

Figure 2

Prevalence of de novo appearance of an autonomous secretion of cortisol in patients with non-functional adrenal incidentaloma (NFAI) during follow-up. Morelli 2014 [11], Dalmazi 2014 [13], Hong 2017 [15], Papanastiou 2017 [16], Comlecki 2010 [18], Ceccato 2021 [19], Falcetta 2020 [20], Bernini 2005 [21], Vassilatou 2009 [22], Araujo-Castro 2021 [23], Giordano 2005 [24], Barzon 1999 [25], Goh 2020 [26], Anagnostis 2010 [27], Fagour 2009 [28], Patrova 2017 [29], Araujo-Castro 2017 [17]. DXM +: MACS diagnosis after positive DXM test plus one abnormal hormonal test of hypothalamic-pituitary-adrenal axis [urinary free cortisol (UFC) level > 100 mcg/24 h; morning plasma ACTH levels <  pg/mL); altered salivary cortisol]; DXM -: MACS diagnosis after positive DXM test alone.