Category: Adrenal Disorders

Monitor: 20

20 - PREVALENCE AND CLINICAL FEATURES OF ADRENAL INCIDENTALOMAS: A PROSPECTIVE CT STUDY IN AN UNSELECTED OUTPATIENTS POPULATION.

Saturday, Apr 27
11:30 AM – 12:00 PM

Objective :

Context. The widespread use of cross-sectional imaging in medical practice has increased detection of adrenal tumors, which are most frequently unexpected prior to their discovery (adrenal incidentalomas). Most adrenal incidentalomas (AI) are benign and frequently cause a low-grade cortisol excess that may portend adverse clinical consequences. However, this association is subject to confounding by indication since more diagnostic tests are done in diseased patients.


Objective. To assess prospectively the prevalence of AI in an unselected adult population performing abdominal CT in our catchment area, and to evaluate the demographic, laboratory and clinical features of AI patients. 


Methods :

Design and setting. Monocentric, prospective study.


Patients. A consecutive series of 601 unselected inpatients undergoing abdominal CT as part of their management. Patients with any known adrenal disorder or malignancy were excluded.


Results :

Results. Of the 601 patients, aged 63.5 ± 14.4 years, 55.4% had hypertension, 15.1% diabetes, 16.8% dyslipidemia and 16% previous CV events. These characteristics are overall comparable to the background general population. We found serendipitously 44 adrenal tumors (7.3%), 43 with radiological features of benign cortical adenoma (density < 10 HU) and 1 with indeterminate features, which was a pheochromocytoma and excluded by further analysis. Mass size ranged between 0.6-5 cm and tumors were bilateral in 29.5%. Patients with AI compared to patients without were more frequently suffering from diabetes (31.8% vs 14.2%; p=0.0038) and showing higher BMI (27.6± 6.2 vs. 25.6 ± 4.8, p=0.009) and larger waist (101.2 ± 13.9 cm vs. 95.3 ± 13.9 cm, p=0.0069). No differences were found for frequency of hypertension, dyslipidemia or history of CV events. Forty patients underwent a 1-mg overnight dexamethasone test (DST) and 20 (50%,) did not suppress cortisol below 1.8 mg/dL (4 had post-DST cortisol >5.0 mg/dL). Post-DST cortisol levels were not different between diabetic and non-diabetic AI patients (3.5 ± 4.0 µg/dL vs. 2.4 ± 2.5 µg/dL). In multivariate analysis, diabetes was significantly associated with AI (p=0.003).  


Discussion : We confirm in a prospective study the high prevalence of previously unsuspected adrenal tumors, most of which are benign adenomas. 


Conclusion :

 In an outpatient unselected population at average risk of metabolic disorders, we found a significant association between adrenal incidentalomas and diabetes.

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Elena Castellano

MD
Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy

Dr. Elena Castellano, was born on 21/11/1985 in Turin.
Her main research interests include the role of Vitamin D nutrition in parathyroid disorders and bone health.
She has authored or co-authored over 30 peer reviewed original papers, abstracts and book chapters.
Dr.Castellano is a fellow of the Associazione Medici Endocrinologi (AME), Società Italiana Endocrinologia (SIE), American Association of Clinical Endocrinologist (AACE).

Giuseppe Reimondo

MD
Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Medical Doctor at
Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Giorgio Borretta

MD
Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy

Director of Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy

Micaela Pellegrino

MD
Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy

Medical Doctor at Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy

Maurizio Grosso

MD
Radiology Department, Santa Croce and Carle Hospital, Cuneo, Italy

Director at Radiology Department, Santa Croce and Carle Hospital, Cuneo, Italy

Anna Pia

MD
Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Medical Doctor at Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Soraya Puglisi

MD
Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Medical Doctor at Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Massimo Terzolo

MD
Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy

Director at Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, AOU San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy