Endocrinol Metab.  2014 Dec;29(4):457-463. 10.3803/EnM.2014.29.4.457.

Clinical Characteristics and Metabolic Features of Patients with Adrenal Incidentalomas with or without Subclinical Cushing's Syndrome

• Kim BY
• Chun AR
• Kim KJ
• Jung CH
• Kang SK
• Mok JO
• Kim CH

• KMID: 2384242
• DOI: http://doi.org/10.3803/EnM.2014.29.4.457

Abstract

BACKGROUND
The aim of this study was to examine the clinical characteristics of adrenal incidentalomas discovered by computed tomography (CT) and to investigate metabolic features of subclinical Cushing's syndrome (SCS) in patients with adrenal incidentalomas in a tertiary hospital in Korea.
METHODS
This retrospective study examined the clinical aspects of 268 patients with adrenal incidentalomas discovered by CT at Soonchunhyang University Bucheon Hospital. Clinical data and endocrine function of the patients as well as histological findings were obtained from medical records, while anatomic characteristics were analyzed by reviewing imaging studies. Hormonal tests for pheochromocytoma, Cushing's syndrome, and aldosterone-secreting adenoma were performed.
RESULTS
Most (n=218, 81.3%) cases were nonfunctioning tumors. Of the 50 patients with functioning tumors (18.7%), 19 (7.1%) were diagnosed with SCS, nine (3.4%) with overt Cushing's syndrome, 12 (4.5%) with primary aldosteronism, and 10 (3.7%) with pheochromocytoma. Malignant tumors (both primary and metastatic) were rare (n=2, 0.7%). Body mass index, fasting glucose, hemoglobin A1c, and total cholesterol were significantly higher in patients with SCS in comparison with those with nonfunctioning tumors. The prevalence of type 2 diabetes mellitus and hypertension were significantly higher in patients with SCS compared with those with nonfunctioning tumors.
CONCLUSION
Functioning tumors, especially those with subclinical cortisol excess, are commonly found in patients with adrenal incidentalomas, although malignancy is rare. In addition, patients with SCS in adrenal incidentalomas have adverse metabolic and cardiovascular profiles.

Keyword

Adrenal incidentalomas; Metabolic features; Subclinical Cushing's syndrome

MeSH Terms

Adenoma
Body Mass Index
Cholesterol
Cushing Syndrome*
Diabetes Mellitus, Type 2
Fasting
Glucose
Gyeonggi-do
Humans
Hydrocortisone
Hyperaldosteronism
Hypertension
Korea
Medical Records
Pheochromocytoma
Prevalence
Retrospective Studies
Tertiary Care Centers
Cholesterol
Glucose
Hydrocortisone

Reference

1. Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004; 25:309–340.

2. Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, Borasio P, Fava C, Dogliotti L, Scagliotti GV, Angeli A, Terzolo M. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006; 29:298–302.

3. Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, Harris EL, Lee JK, Oertel YC, Posner MC, Schlechte JA, Wieand HS. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003; 138:424–429.

4. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003; 149:273–285.

5. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, Giovagnetti M, Opocher G, Angeli A. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000; 85:637–644.

6. Tsagarakis S, Vassiliadi D, Thalassinos N. Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications. J Endocrinol Invest. 2006; 29:471–482.

7. Nawar R, Aron D. Adrenal incidentalomas: a continuing management dilemma. Endocr Relat Cancer. 2005; 12:585–598.

8. Terzolo M, Bovio S, Reimondo G, Pia A, Osella G, Borretta G, Angeli A. Subclinical Cushing's syndrome in adrenal incidentalomas. Endocrinol Metab Clin North Am. 2005; 34:423–439.

9. Terzolo M, Reimondo G, Bovio S, Angeli A. Subclinical Cushing's syndrome. Pituitary. 2004; 7:217–223.

10. Garrapa GG, Pantanetti P, Arnaldi G, Mantero F, Faloia E. Body composition and metabolic features in women with adrenal incidentaloma or Cushing's syndrome. J Clin Endocrinol Metab. 2001; 86:5301–5306.

11. Tauchmanovà L, Rossi R, Biondi B, Pulcrano M, Nuzzo V, Palmieri EA, Fazio S, Lombardi G. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab. 2002; 87:4872–4878.

12. Rossi R, Tauchmanova L, Luciano A, Di Martino M, Battista C, Del Viscovo L, Nuzzo V, Lombardi G. Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab. 2000; 85:1440–1448.

13. Masserini B, Morelli V, Bergamaschi S, Ermetici F, Eller-Vainicher C, Barbieri AM, Maffini MA, Scillitani A, Ambrosi B, Beck-Peccoz P, Chiodini I. The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma. Eur J Endocrinol. 2009; 160:87–92.

14. Chiodini I, Guglielmi G, Battista C, Carnevale V, Torlontano M, Cammisa M, Trischitta V, Scillitani A. Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effects of subclinical hypercortisolism and gonadal status. J Clin Endocrinol Metab. 2004; 89:2237–2241.

15. Chiodini I. Clinical review: diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab. 2011; 96:1223–1236.

16. Kim HY, Kim SG, Lee KW, Seo JA, Kim NH, Choi KM, Baik SH, Choi DS. Clinical study of adrenal incidentaloma in Korea. Korean J Intern Med. 2005; 20:303–309.

17. Cho YY, Suh S, Joung JY, Jeong H, Je D, Yoo H, Park TK, Min YK, Kim KW, Kim JH. Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas. Korean J Intern Med. 2013; 28:557–564.

18. Kim J, Bae KH, Choi YK, Jeong JY, Park KG, Kim JG, Lee IK. Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinol Metab (Seoul). 2013; 28:20–25.

19. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev. 1995; 16:460–484.

20. Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery. 1991; 110:1014–1021.

21. Barzon L, Fallo F, Sonino N, Boscaro M. Development of overt Cushing's syndrome in patients with adrenal incidentaloma. Eur J Endocrinol. 2002; 146:61–66.

22. Bulow B, Ahren B. Swedish Research Council Study Group of Endocrine Abdominal Tumours. Adrenal incidentaloma: experience of a standardized diagnostic programme in the Swedish prospective study. J Intern Med. 2002; 252:239–246.

23. Kasperlik-Zeluska AA, Rosłonowska E, Slowinska-Srzednicka J, Migdalska B, Jeske W, Makowska A, Snochowska H. Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients. Clin Endocrinol (Oxf). 1997; 46:29–37.

24. Comlekci A, Yener S, Ertilav S, Secil M, Akinci B, Demir T, Kebapcilar L, Bayraktar F, Yesil S, Eraslan S. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine. 2010; 37:40–46.

25. Reincke M. Subclinical Cushing's syndrome. Endocrinol Metab Clin North Am. 2000; 29:43–56.

26. Terzolo M, Bovio S, Pia A, Conton PA, Reimondo G, Dall'Asta C, Bemporad D, Angeli A, Opocher G, Mannelli M, Ambrosi B, Mantero F. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma. Eur J Endocrinol. 2005; 153:307–315.

27. Di Dalmazi G, Vicennati V, Rinaldi E, Morselli-Labate AM, Giampalma E, Mosconi C, Pagotto U, Pasquali R. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur J Endocrinol. 2012; 166:669–677.

28. Terzolo M, Pia A, Ali A, Osella G, Reimondo G, Bovio S, Daffara F, Procopio M, Paccotti P, Borretta G, Angeli A. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab. 2002; 87:998–1003.

29. Chiodini I, Morelli V, Salcuni AS, Eller-Vainicher C, Torlontano M, Coletti F, Iorio L, Cuttitta A, Ambrosio A, Vicentini L, Pellegrini F, Copetti M, Beck-Peccoz P, Arosio M, Ambrosi B, Trischitta V, Scillitani A. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism. J Clin Endocrinol Metab. 2010; 95:2736–2745.

30. Erbil Y, Ademoglu E, Ozbey N, Barbaros U, Yanik BT, Salmaslioglu A, Bozbora A, Ozarmagan S. Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery. World J Surg. 2006; 30:1665–1671.

31. Mitchell IC, Auchus RJ, Juneja K, Chang AY, Holt SA, Snyder WH 3rd, Nwariaku FE. "Subclinical Cushing's syndrome" is not subclinical: improvement after adrenalectomy in 9 patients. Surgery. 2007; 142:900–905.

32. Iacobone M, Citton M, Viel G, Boetto R, Bonadio I, Mondi I, Tropea S, Nitti D, Favia G. Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing's syndrome. Surgery. 2012; 152:991–997.