Introduction: Adrenal incidentalomas are common occurrence with up to 310% of the general population who have imaging. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to biochemical evidence of excess cortisol, but without the overt cushings syndrome.
Aim: Prevalence of ACS in our cohort of patients with adrenal incidentalomas and review their care.
Method: Retrospective review of 70 patients with adrenal incidentalomas over 2 years (January 2016December 2018)
Results: 70 patients with adrenal adenomas of which 16 patients had bilateral lesions (86 adrenal adenomas) were included. 90% of them had hormone assessment for cortisol and 24% of them had 24 h urinary free cortisol with rest of them underwent 1 mg overnight dexamethasone suppression test. 19% had levels in the range for ACS. None of them had overt cushings syndrome. Only 16% of them had cushings specific symptoms, reported easy bruising. Of the comorbidities, 75% of them hypertension, 33% type 2 diabetes, 33% had bone mineral density in the range of osteopenia/osteoporosis, and 25% had cardiovascular complications. 58% of them had single and 42% of them had bilateral adrenal lesions. Of the 17 lesions individually analysed, most (65%) were in the 24 cm range, followed by lesions less than 2 cm (24%) and least common were lesions more than 4 cm (11%). 58% of them were appropriately being followed up by endocrinology team but 42% of them followed up elsewhere.
Conclusion: The prevalence of ACS in our patient cohort with adrenal incidentalomas was similar to previously published reports i.e. up to one fifth. Nearly one third of the patients who had bilateral adrenal incidentalomas had ACS. This emphasizes the need for careful clinical and biochemical assessment for adrenal hormone excess by endocrinology team in people with adrenal incidentalomas.