Clinically silent adrenal masses discovered by abdominal imaging procedures performed for non-adrenal disorders, i.e. adrenal incidentalomas, have become a common finding in clinical practice and they represent a clinical concern because of the risk not only of malignancy but also of subclinical hormonal hypersecretion (SCS) that represents a new risk factor for cardiovascular diseases and/or osteoporosis. We studied 73 patients (39F, 34M; mean±S.E.M.: 61.6±1.3 year) with incidentalomas. In all patients the following measures were performed: urinary metanephrines, aldosterone/PRA ratio, UFC, cortisol, ACTH, DHEAS, 17OHP levels, Nugent and Liddle I tests. BMI, blood pressure, OGTT, serum lipids and DEXA were also measured. In 4 pts a biochemical diagnosis of pheocromocytoma was made. No case of primary hyperaldosteronism was demonstrated. In the others 69 pts, ACTH was inhibited in 8 pts, while UFC, cortisol, DHEAS and 17OHP levels were in the normal range in all pts. In 39 pts (57%) cortisol levels after Nugent test were<1.8 μg/dl and no further hormonal evaluation was performed. In 7 pts (10%) post-Nugent cortisol levels were>5.0 μg/dl and in 5 cases Liddle I test confirmed the existence of SCS. In 23 pts (33%) post-Nugent cortisol levels were between 1.8 and 5.0 μg/dl and Liddle I test in 13 cases confirmed the existence of SCS. The hormonal work-up demonstrated that 70% (51/73) of the masses were non-hypersecretory, 5% (4/73) were pheocromocytoma, 25% (18/73) were SCS. No significant difference was found in mass size, while a slight higher percentage of patients in the SCS group showed impairment in blood pressure, glucose tolerance, lipid profile and bone metabolism. Four SCS pts were operated, without a significant clinical improvement, while, in the other SCS pts, no significant progression of the disease was observed. Further studies on large populations are needed to clarify the clinical impact of SCS as well as the effects of adrenal mass removal.
03 - 07 May 2008
European Society of Endocrinology