Morphological, functional and metabolic features in a series of 63 patients with adrenal incidentalomas
Charalampos Tsentidis, Athanasios Antoniou-Tsigos, Vasiliki Skarpa, Vasilios Dimarakis, Ioannis Prokovas & Argyris Argyropoulos
Background: The prevalence of incidentally discovered adrenal masses has increased during last decades, due to longer life expectancy and to the extended use of new imaging techniques like high definition C/T and MRI. Diagnostic approach and possible therapeutic management are considered nowadays fascinating challenges for clinical practice, not only for the probability of hormonal hypersecretion but also for the risc of malignancy.
Methods: We investigated 63 patients with adrenal masses, incidentally discovered in imaging techniques performed for non-adrenal disorders (21 male, 42 female, mean 57±13 years, median 60 years), according to NIH criteria of 2002.
Results: Of 47.6% (30/63) of incidentalomas, sized from 10 to 140 mm in max diameter (mean 35.5±20 mm), were located to the right, 39.7% (25/63) to the left and 12.7% (8/63) to both adrenals. Out of the total number of incidentalomas 19% (12/63) found to be functional and 81% (53/63) non-functional. Subclinical hypercortisolism accounted for 6.4% (4/63), pheochromocytoma for 6.4% (4/63) and hyperaldosteronism for 4.8% (3/63) of cases. Non-functioning adenomas were 72.8% (45/63), non-malignant cysts were 4.8% (3/63) and the remaining 4.8% included one myelolipoma, one metastasis and one bilateral teratoma. The prevalence of metabolic syndrome, as defined with IDF criteria of 2005, was also evaluated among these patients. Most patients (59/63) 93.7% where obese, (21/63) 33.3% of patients had diabetes mellitus while (20/63) 31.8% had prediabetes (IFG or IGT). 60.3% (38/63) had hyperlipidemia and 68.3% (43/63) had hypertension. Metabolic syndrome was present in 66.7% (42/63) of patients with adrenal incidentaloma (AI). There was no difference between patients with functional and non functional tumors.
Conclusions: The prevalence of metabolic syndrome parameters was quite high in patients with AI, thus associated with an increased risk for CVD. The prevalence of metabolic syndrome in patients with AI (66.7%) was much higher compared with the overall prevalence of metabolic syndrome in general population (2530%), suggesting there might be a common pathophysiologic pathway, need to be elucidated with further prospective studies.