Akdeniz University, School of Medicine, Department ofInternal Medicine, Division of Endocrinology andMetabolism, Antalya, Turkey.
Exp Clin Endocrinol Diabetes. 2021 May;129(5):349-356. doi: 10.1055/a-1079-4915. Epub 2020 Jan 20.
It is recommended that adrenal incidentaloma patients should be monitored for radiological changes, increase in size and new functionality that may occur in the future, even if they are benign and nonfunctional at the initial evaluation. Our aim is to evaluate the key clinical characteristics of adrenal incidentaloma patients focusing on changes during follow-up and associated clinical outcomes. A total of 755 patients (median age: 56 years), with an adrenal incidentaloma > 1 cm and underwent functionality tests, were included in the study. Clinical characteristics, functionality status and follow-up durations were recorded. During the course of follow-up, any changes in size and development of new functionality, and clinical consequences thereof were evaluated. In 71.8% of patients, incidentalomas were non-functional. Most frequent functionality (15.8%, n=119) was subclinical hypercortisolemia (SH) [10.9% (n=82) possible autonomous cortisol secretion (PACS) and 4.9% (n=37) autonomous cortisol secretion (ACS)] of all incidentalomas. Frequencies of Cushing's syndrome (CS), pheochromacytoma and primary hyperaldosteronism were 4.9% (n=37), 3.8% (n=29) and 3.7% (n=28), respectively. Adrenocortical carcinoma frequency was 1.5% (n=11). Of 755 patients, 43% (n=325) were followed up regularly more than 6 months. Median follow-up duration was 24 months (6-120). A total of 17 (5.2%) patients, which had non-functional incidentalomas at baseline had developed new functionality during follow-up, of which 15 (4.6%) were SH [13 patients (4%) PACS and 2 patients (0.6%) ACS] and 2 (0.6%) were CS. During follow-up, 24% (n=78) of the patients had an increase in mass size between 5-9 mm, while 11.7% (n=38) of the patients had an increase of ≥10 mm. During follow-up, 4% (n=13) of the patients developed a new lesion with a diameter ≥10 mm on the opposite side. In patients with a follow-up duration of more than 2 years, frequencies of size increase and new lesion emerging at the opposite adrenal gland were higher. 14 patients (4.3% of the patients with regular follow-up) underwent surgery due to increase in size or development of new functionality during follow-up. Our study demonstrated that a necessity for surgery may arise due to increase in size and development of functionality during follow-up period in adrenal incidentaloma patients, and thus continuing patient follow-up, even with wider intervals, will be appropriate.
建议对偶然发现的肾上腺肿瘤患者进行影像学改变、大小增加和未来可能出现的新功能的监测，即使它们在初始评估时是良性和无功能的。我们的目的是评估偶然发现的肾上腺肿瘤患者的关键临床特征，重点是随访期间的变化和相关的临床结局。共纳入 755 例（中位年龄：56 岁）>1cm 偶然发现的肾上腺肿瘤且进行了功能检测的患者。记录了临床特征、功能状态和随访时间。在随访过程中，评估了大小的任何变化和新功能的发展，以及由此产生的临床后果。在 71.8%的患者中，偶然发现的肿瘤是无功能的。最常见的功能（15.8%，n=119）是亚临床皮质醇增多症（SH）[10.9%（n=82）可能的自主皮质醇分泌（PACS）和 4.9%（n=37）自主皮质醇分泌（ACS）]。库欣综合征（CS）、嗜铬细胞瘤和原发性醛固酮增多症的发生率分别为 4.9%（n=37）、3.8%（n=29）和 3.7%（n=28），肾上腺皮质癌的发生率为 1.5%（n=11）。在 755 例患者中，43%（n=325）定期随访时间超过 6 个月。中位随访时间为 24 个月（6-120）。共有 17 例（5.2%）患者在基线时有非功能性偶然发现的肿瘤，在随访期间出现了新的功能，其中 15 例（4.6%）为 SH[13 例（4%）PACS 和 2 例（0.6%）ACS]，2 例（0.6%）为 CS。在随访期间，24%（n=78）的患者肿瘤大小增加了 5-9mm，11.7%（n=38）的患者肿瘤大小增加了≥10mm。在随访期间，4%（n=13）的患者在对侧出现了直径≥10mm 的新病灶。在随访时间超过 2 年的患者中，肿瘤大小增加和对侧肾上腺新病灶出现的频率更高。由于在随访期间肿瘤大小增加或出现新功能，14 例（定期随访患者的 4.3%）患者接受了手术。我们的研究表明，偶然发现的肾上腺肿瘤患者在随访期间可能因大小增加和功能改变而需要手术，因此即使间隔时间更长，继续对患者进行随访也是合适的。
