Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy.
J Clin Endocrinol Metab. 2023 Jun 16;108(7):1813-1823. doi: 10.1210/clinem/dgad044.
Adrenal hyperfunction is associated with an increased risk of cardiometabolic complications in subjects with adrenal incidentaloma (AI). Reliable prevalence estimates of functioning AIs are important to direct resources allocations.
To assess the prevalence of autonomous/possible autonomous cortisol secretion (ACS), primary aldosteronism (PA), pheochromocytoma (PHEO), and Cushing syndrome (CS) in patients with AI.
We performed a comprehensive search of multiple databases (PubMed, Ovid MEDLINE, Web of Science) for potentially relevant studies without language restriction, up to February 2022. Of the 1661 publications evaluated at title and abstract levels, 161 were examined as full text and 36 were included. Study level clinical data were extracted by 3 independent reviewers.
The overall prevalence of functioning AIs was 27.5% (95% CI 23.0, 32.5). ACS/possible ACS, with a prevalence of 11.7% (95% CI 8.6, 15.7), was the most frequent hormonal alteration, while PA occurred in 4.4% of the patients (95% CI 3.1, 6.2). Subgroup analysis showed that PA was more prevalent in patients from Asia than in patients from Europe/America; in contrast, ACS/possible ACS had a lower prevalence in Asian countries. At meta-regression analysis, the prevalence of ACS/possible ACS was influenced by the proportion of female patients, while the prevalence of PA was positively associated with the proportion of patients with hypertension and the publication year. Finally, PHEO and CS prevalence were 3.8% (95% CI 2.8, 5.0) and 3.1% (95% CI 2.3, 4.3) respectively.
This meta-analysis provides extensive data on the prevalence of functioning AIs and the factors affecting heterogeneity in prevalence estimates.
肾上腺意外瘤（AI）患者的肾上腺功能亢进与心血管代谢并发症的风险增加相关。可靠的功能性 AI 患病率估计对于指导资源分配很重要。
评估 AI 患者自主/可能自主皮质醇分泌（ACS）、原发性醛固酮增多症（PA）、嗜铬细胞瘤（PHEO）和库欣综合征（CS）的患病率。
我们对多个数据库（PubMed、Ovid MEDLINE、Web of Science）进行了全面检索，检索时间截至 2022 年 2 月，没有语言限制，以评估可能相关的研究。在对标题和摘要进行评估的 1661 篇出版物中，有 161 篇作为全文进行了检查，其中 36 篇被纳入。3 名独立审查员提取了研究水平的临床数据。
功能性 AI 的总体患病率为 27.5%（95%CI 23.0，32.5）。ACS/可能 ACS 的患病率为 11.7%（95%CI 8.6，15.7），是最常见的激素改变，而 PA 发生在 4.4%的患者中（95%CI 3.1，6.2）。亚组分析表明，PA 在亚洲患者中的患病率高于欧洲/美洲患者；相反，ACS/可能 ACS 在亚洲国家的患病率较低。在荟萃回归分析中，ACS/可能 ACS 的患病率受女性患者比例的影响，而 PA 的患病率与高血压患者比例和发表年份呈正相关。最后，PHEO 和 CS 的患病率分别为 3.8%（95%CI 2.8，5.0）和 3.1%（95%CI 2.3，4.3）。
这项荟萃分析提供了关于功能性 AI 患病率以及影响患病率估计异质性的因素的广泛数据。
