Clinical and imaging presentations are associated with function in incidental adrenocortical adenomas: a retrospective cohort study. Eur J Endocrinol 2024 Jul 02;191(1):47-54
Date
06/28/2024Pubmed ID
38941271Pubmed Central ID
PMC11234193DOI
10.1093/ejendo/lvae078Scopus ID
2-s2.0-85198363672 (requires institutional sign-in at Scopus site) 1 CitationAbstract
OBJECTIVE: The aim of this study is to assess whether clinical and imaging characteristics are associated with the hormonal subtype, growth, and adrenalectomy for incidental adrenal cortical adenomas (ACAs).
DESIGN: This is a single-center cohort study.
METHODS: Consecutive adult patients with incidental ACA were diagnosed between 2000 and 2016.
RESULTS: Of the 1516 patients with incidental ACA (median age 59 years, 62% women), 699 (46%) had nonfunctioning adenomas (NFAs), 482 (31%) had mild autonomous cortisol secretion (MACS), 62 (4%) had primary aldosteronism (PA), 39 (3%) had Cushing syndrome, 18 (1%) had PA and MACS, and 226 (15%) had incomplete work-up. Age, sex, tumor size, and tumor laterality, but not unenhanced computed tomography Hounsfield units (HU), were associated with hormonal subtypes. In a multivariable analysis, ≥1 cm growth was associated with younger age (odds ratio [OR] = 0.8 per 5-year increase, P = .0047) and longer imaging follow-up (OR = 1.2 per year, P < .0001). Adrenalectomy was performed in 355 (23%) patients, including 38% of MACS and 15% of NFA. Adrenalectomy for NFA and MACS was more common in younger patients (OR = 0.79 per 5-year increase, P = .002), larger initial tumor size (OR = 2.3 per 1 cm increase, P < .0001), ≥1 cm growth (OR = 15.3, P < .0001), and higher postdexamethasone cortisol (OR = 6.6 for >5 vs <1.8 μg/dL, P = .002).
CONCLUSIONS: Age, sex, tumor size, and laterality were associated with ACA hormonal subtype and can guide diagnosis and management. Tumor growth was more common with younger age and longer follow-up. Unenhanced HU did not predict hormonal subtype or growth. Adrenalectomy for MACS and NFA was mainly performed in younger patients with larger tumor size, growth, and elevated postdexamethasone cortisol.
Author List
Hamidi O, Shah M, Zhang CD, Lazik N, Li D, Singh S, Iñiguez-Ariza NM, Raman R, Hurtado MD, Carafone L, Khanna A, Yan Q, Natt N, Hartman RP, McKenzie T, Young WF, Bancos IAuthor
Catherine Zhang MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Adrenal Cortex NeoplasmsAdrenalectomy
Adrenocortical Adenoma
Adult
Aged
Cohort Studies
Cushing Syndrome
Female
Humans
Hydrocortisone
Hyperaldosteronism
Incidental Findings
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
