Arac Yasin, Yaylali Guzin F, Topsakal Senay, Onder Canay
Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, GBR.
Diabetes and Endocrinology, Pamukkale University, Denizli, TUR.
Cureus. 2024 Oct 23;16(10):e72221. doi: 10.7759/cureus.72221. eCollection 2024 Oct.
In this retrospective study, we aimed to investigate the clinical, hormonal, and radiological characteristics of patients with adrenal incidentalomas (AIs), to assess the prevalence of metabolic syndrome components in patients with AIs, and to determine whether changes in tumor size or hormonal activity occur during long-term follow-up in patients with AIs.
We retrospectively analyzed data from 384 patients diagnosed with AI between 2010 and 2020. Data regarding radiological, hormonal, and metabolic investigations in diagnosis and also during follow-ups were collected.
A total of 384 patients (248 female, 64%) enrolled in this study. Of them, 348 (90.6%) of the masses were classified as adenomas, 31 (8.07%) as non-adenomas, and four (1.04%) were non-specified. The mean adenoma diameter was approximately 2 cm. Adenomas were found to be mostly on the left side (48.9%). Overall, 13.81% (n = 53) of the tumors were functioning, and among functional adenomas, nine patients (2.34%) had autonomous cortisol secretion, seven subjects (1.82%) had primary hyperaldosteronism, four subjects (1.04%) had pheochromocytomas, and 39 subjects (10.1%) had possible autonomous cortisol secretion. In patients with bilateral incidentalomas, the mean diameter of adenomas was higher than unilateral incidentalomas with a diameter of 24.22 mm in comparison to 20.36 mm (p > 0.05). Similarly, in patients with bilateral incidentalomas, systolic and diastolic blood pressure was higher than in unilateral incidentalomas (135.83 ± 20.27, 130.02 ± 18.84 and 79.25 ± 11.56, 78.52 ± 10.11, respectively, p > 0.05). Moreover, our study revealed that the frequency of diabetes, hypertension, and hyperlipidemia in patients with possible autonomous cortisol secretion was 37%, 63%, and 22.2%, respectively. Of 384 patients, 9.11% (n = 35) underwent surgery. The most common pathological finding was adrenocortical adenoma (n = 19, 54%). The median follow-up duration of patients was 48.91 months. Of 384 patients, 44.7% (n = 172) were followed up regularly with CT/MRI. During the follow-ups, the diameter of adenomas (11.6%) increased by more than 10 mm. Of 384 subjects, 56.7% (n = 218) of patients were followed with hormonal evaluation, six patients had developed possible autonomous cortisol secretion, and three patients had developed autonomous cortisol secretion. Moreover, one subject developed primary hyperaldosteronism.
In this retrospective study, we examined the clinical, radiological, and hormonal profiles of patients with AIs, finding results consistent with existing literature. The conversion to subclinical or clinical hypercortisolism was low, and no new cases of pheochromocytoma were observed, with only one case of primary hyperaldosteronism. Most of the adenomas showed minor growth in size over time, and a small percentage developed hormonal hyperfunctionality. Our study also identified an increased risk of diabetes, hypertension, hyperlipidemia, and metabolic syndrome in AI patients. Additionally, patients with unilateral adenomas had higher triglyceride levels and insulin resistance than those with bilateral adenomas.
在这项回顾性研究中，我们旨在调查肾上腺偶发瘤（AI）患者的临床、激素和放射学特征，评估AI患者代谢综合征各组分的患病率，并确定AI患者在长期随访期间肿瘤大小或激素活性是否发生变化。
我们回顾性分析了2010年至2020年间诊断为AI的384例患者的数据。收集了诊断时以及随访期间有关放射学、激素和代谢检查的数据。
本研究共纳入384例患者（248例女性，占64%）。其中，348例（90.6%）肿块被分类为腺瘤，31例（8.07%）为非腺瘤，4例（1.04%）未明确分类。腺瘤的平均直径约为2 cm。腺瘤大多位于左侧（48.9%）。总体而言，13.81%（n = 53）的肿瘤具有功能，在功能性腺瘤中，9例患者（2.34%）有自主性皮质醇分泌，7例患者（1.82%）有原发性醛固酮增多症，4例患者（1.04%）有嗜铬细胞瘤，39例患者（10.1%）可能有自主性皮质醇分泌。双侧偶发瘤患者腺瘤的平均直径高于单侧偶发瘤患者，分别为24.22 mm和20.36 mm（p > 0.05）。同样，双侧偶发瘤患者的收缩压和舒张压高于单侧偶发瘤患者（分别为135.83±20.27、130.02±18.84和79.25±11.56、78.52±10.11，p > 0.05）。此外，我们的研究显示，可能有自主性皮质醇分泌的患者中糖尿病、高血压和高脂血症的发生率分别为37%、63%和22.2%。384例患者中，9.11%（n = 35）接受了手术。最常见的病理发现是肾上腺皮质腺瘤（n = 19，占54%）。患者的中位随访时间为48.91个月。384例患者中，44.7%（n = 172）接受了CT/MRI定期随访。在随访期间，11.6%的腺瘤直径增加超过10 mm。384例患者中，56.7%（n = 218）接受了激素评估，6例患者出现了可能的自主性皮质醇分泌，3例患者出现了自主性皮质醇分泌。此外，1例患者出现了原发性醛固酮增多症。
在这项回顾性研究中，我们检查了AI患者的临床、放射学和激素特征，发现结果与现有文献一致。向亚临床或临床皮质醇增多症的转变率较低，未观察到嗜铬细胞瘤新病例，仅1例原发性醛固酮增多症。大多数腺瘤随时间推移大小增长较小，一小部分出现激素功能亢进。我们的研究还发现AI患者患糖尿病、高血压、高脂血症和代谢综合征的风险增加。此外，单侧腺瘤患者的甘油三酯水平和胰岛素抵抗高于双侧腺瘤患者。
