Department of Clinical and Biological Sciences, Division of Endocrinology, University of Turin, Azienda Ospedaliero-Universitaria San Giovanni Battista, Corso Dogliotti 14, 10126 Turin, Italy.
Eur J Endocrinol. 2010 Apr;162(4):779-85. doi: 10.1530/EJE-09-0957. Epub 2010 Jan 26.
To evaluate long-term morphological, functional, and clinical outcome in adrenal incidentalomas.
A total of 118 patients (77 F and 47 M; age 62.3+/-1.0 years) with adrenal incidentalomas were evaluated at baseline and followed-up for median 3 years (range 1-10 years) by clinical, biochemical, hormonal, and morphological evaluation. Among them, six patients with diagnosis of subclinical Cushing's syndrome (SCS) underwent surgery.
At entry, 86% (n=102) of tumors were nonfunctioning (NF) and 14% (n=16) showed SCS. Comparing NF with SCS patients, a significantly higher percentage of dyslipidemia was found in the group of SCS patients (50 vs 23%, P=0.033). During follow-up, adrenal function remained normal in all NF patients, none of them developed subclinical or overt endocrine disease. The cumulative risk of mass enlargement was globally low (25%), but progressive up to 8 years. SCS was confirmed in all patients, and none of them shifted to overt Cushing's syndrome. The cumulative risk of developing metabolic-cardiovascular abnormalities was globally low (22%), but progressive up to 8 years and new diseases were recorded in the group of NF patients only (three patients with dyslipidemia, four with impaired fasting glucose/impaired glucose tolerance, and three with diabetes mellitus). SCS patients who underwent surgery did not show any significant clinical improvement.
The risk of mass enlargement, hormonal, and metabolic impairment over time is globally low. Conservative management seems to be appropriate, but further prospective studies are needed to establish the long-term outcome of such patients, especially for metabolic status, cardiovascular risk profile and their relationship with endocrine function.
评估意外肾上腺瘤的长期形态学、功能和临床结果。
共评估了 118 例（77 例女性，47 例男性；年龄 62.3+/-1.0 岁）患有意外肾上腺瘤的患者，通过临床、生化、激素和形态学评估，中位随访 3 年（范围 1-10 年）。其中，6 例亚临床库欣综合征（SCS）患者接受了手术。
在入组时，86%（n=102）的肿瘤为无功能（NF），14%（n=16）表现为 SCS。与 NF 患者相比，SCS 患者的血脂异常发生率明显更高（50%比 23%，P=0.033）。在随访期间，所有 NF 患者的肾上腺功能均保持正常，无一人出现亚临床或显性内分泌疾病。肿块增大的累积风险总体较低（25%），但可进展至 8 年。SCS 在所有患者中均得到证实，无一例转变为显性库欣综合征。发生代谢-心血管异常的累积风险总体较低（22%），但可进展至 8 年，并且仅在 NF 患者中记录到新的疾病（三例血脂异常，四例空腹血糖受损/糖耐量受损，三例糖尿病）。接受手术的 SCS 患者未显示出任何明显的临床改善。
随着时间的推移，肿块增大、激素和代谢损害的风险总体较低。保守治疗似乎是合适的，但需要进一步的前瞻性研究来确定此类患者的长期结果，特别是代谢状态、心血管风险状况及其与内分泌功能的关系。
