Clinical and imaging presentations are associated with function in incidental adrenocortical adenomas: a retrospective cohort study.

IF 5.3 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

European Journal of Endocrinology Pub Date : 2024-07-02 DOI:10.1093/ejendo/lvae078

Oksana Hamidi, Muhammad Shah, Catherine D Zhang, Natalia Lazik, Dingfeng Li, Sumitabh Singh, Nicole M Iñiguez-Ariza, Ram Raman, Maria D Hurtado, Lindsay Carafone, Aakanksha Khanna, Qi Yan, Neena Natt, Robert P Hartman, Travis McKenzie, William F Young, Irina Bancos

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Abstract

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.

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临床和影像学表现与偶发肾上腺皮质腺瘤的功能有关--一项回顾性队列研究。

目的评估临床和影像学特征是否能预测偶发肾上腺皮质腺瘤（ACA）的激素亚型、生长和肾上腺切除术：单中心队列研究：方法：2000年至2016年间确诊的偶发性ACA连续成年患者：在1516例偶发性ACA患者（中位年龄59岁，62%为女性）中，699例（46%）为无功能腺瘤（NFA），482例（31%）为轻度自主皮质醇分泌（MACS），62例（4%）为原发性醛固酮增多症（PA），39例（3%）为库欣综合征（CS），18例（1%）为PA和MACS（PA-MACS），226例（15%）检查不完全。年龄、性别、肿瘤大小和肿瘤侧位与激素亚型有关，但与未增强计算机断层扫描Hounsfield单位（HU）无关。在一项多变量分析中，肿瘤生长≥1厘米与年龄较小（每增加5年的几率比，OR=0.8，P=0.0047）和较长的成像随访时间（OR=1.2/年，P5 vs 结论）有关：年龄、性别、肿瘤大小和侧位与 ACA 激素亚型相关，可指导诊断和治疗。年龄越小、随访时间越长，肿瘤生长越常见。未增强 HU 不能预测激素亚型或肿瘤生长。针对MACS和NFA的肾上腺切除术主要针对肿瘤体积较大、生长旺盛、地塞米松后皮质醇升高的年轻患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Endocrinology 医学-内分泌学与代谢

CiteScore

9.80

自引率

3.40%

发文量

354

审稿时长

1 months

期刊介绍： European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.