Yonsei Med J.  2018 Jun;59(4):501-510. 10.3349/ymj.2018.59.4.501.

Characteristics of Adrenal Incidentalomas in a Large, Prospective Computed Tomography-Based Multicenter Study: The COAR Study in Korea

• Ahn SH
• Kim JH
• Baek SH
• Kim H
• Cho YY
• Suh S
• Kim BJ
• Hong S
• Koh JM
• Lee SH
• Song KH

• KMID: 2410905
• DOI: http://doi.org/10.3349/ymj.2018.59.4.501

Abstract

PURPOSE
Previous studies on adrenal incidentalomas (AIs) are limited by their retrospective design, small numbers of patients, Western populations, or use of an outdated imaging technique. We investigated the characteristics of AIs in Korean patients and compared them with those reported in the largest retrospective study in Italy to discover the effects of improved imaging techniques and ethnicity differences.
MATERIALS AND METHODS
This was a prospective, multicenter, cross-sectional observational study including 1005 Korean patients. Levels of plasma adrenocorticotrophic hormone, 24-h urinary free cortisol (UFC), serum cortisol after a 1 mg-dexamethasone suppression test, 24-h urinary fractionated metanephrine, and plasma aldosterone and plasma renin activity were measured. All AIs were characterized using computed tomography (CT).
RESULTS
Compared with the results of the Italian study, AIs in Korean patients were observed more frequently in men and predominantly on the left side. Korean patients with AIs were slightly younger, and fewer patients underwent surgery. Most AIs were nonfunctional in both studies, while fewer subclinical hypercortisolism and more primary aldosteronism (PA) cases were detected in Korean patients. In our study, high UFC levels showed very low sensitivity, compared to those in the Italian study. In pheochromocytoma or PA cases, there were no hormonal differences between the studies. AIs in Korean patients were smaller, such that a lower cutoff size for detecting adrenocortical carcinoma (ACC) could be warranted.
CONCLUSION
Recent advances in CT technology were leveraged to provide accurate characteristics of AIs and to detect smaller ACCs.

Keyword

Adrenal incidentaloma; characteristics; Italy; Korea

MeSH Terms

Adrenocortical Carcinoma
Adrenocorticotropic Hormone
Aldosterone
Cushing Syndrome
Humans
Hydrocortisone
Hyperaldosteronism
Italy
Korea*
Male
Metanephrine
Observational Study
Pheochromocytoma
Plasma
Prospective Studies*
Renin
Retrospective Studies
Adrenocorticotropic Hormone
Aldosterone
Hydrocortisone
Metanephrine
Renin

Figure

• 

  Fig. 1 Comparison of mass sizes of histologically proven adrenal cortical adenomas and carcinomas in the COAR cohort. Median values with ranges are shown. The cutoff value of 3.25 cm was determined according to the best cutoff values in receiver operating characteristics curves, corresponding to Youden's index.25 COAR, Co-work of Adrenal Research; CT, computed tomography.

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