Endocrine Abstracts

JOINT3331

Objective: There is an increased interest in the incidence of malignancy among patients with endogenous Cushing’s syndrome (CS). Although immunosuppression in patients with overt CS is a well-established knowledge favoring a cancerous state, the presence of a mild autonomous cortisol secretion (MACS) or a nonfunctional adrenal incidentaloma (NFAI) has not been studied adequately.

Design: This is a matched monocentric cohort analysis investigating the prevalence of an adrenal incidentaloma among oncological patients diagnosed either before the diagnosis of malignancy or at the staging of the malignancy before any therapeutic regimen. The medical files of a total of 370 patients followed at the Units of Oncology and Endocrinology of the First Department of Internal Medicine at Laikon General Hospital were analysed from 2016 to 2024.

Methods: Patients with adrenal metastatic lesions were excluded based on routine imaging criteria (MRI or CT), functional imaging (18FDG-PET) or biopsies. A complete hormonal profile was performed including the baseline plasma and urine measurements as well as hormonal functional tests. All measurements were performed before any oncological therapeutic regimen. Forty subjects with no active malignancy or history of cancer and no adrenal lesion were included as controls. All controls were age, sex, and body mass index-matched with the oncological patients.

Results: A total of 48 (12.9%) oncological patients with a median age of 66 (25-75%: 59-72) years old out of a total of 370 oncological patients (41,7% with melanoma, 18,8% with breast cancer and the remaining with renal, lung, colon, and bladder cancer) had a diagnosis of a benign adrenal tumor found either incidentally at staging or based on their medical history. The 56.3% of them presented a left unilateral adenoma whereas the 27.5% had bilateral lesions. The median size of the adrenal lesion was 16.5mm (25-75%: 11-28) and based on the endocrine functional tests (1 mg overnight dexamethasone secretion test), 66.7% had NFAI and 33.3% MACS. The 29% of these patients presented with diabetes mellitus, 25% with osteoporosis and 32.5% with hypertension compared with 23%, 17% and 23% respectively among controls. The mean time between diagnosis of cancer and AI diagnosis was 1.93 years.

Conclusion: Benign AI were diagnosed in 13% out of patients with a history of cancer. The vast majority included NFAI. However relevant comorbidities were more frequent in those patients compared to age and sex-matched controls. These findings underscore the need for further research to establish recommendations for cancer screening in patients with AI.