Nazlı KIRNAP, Sanem OZTEKIN, Neslihan TÜTÜNCÜ

Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort

Amaç: Başka endikasyonlar ile yapılan görüntülemelerde tespit edilen adrenal insidentaloma (Aİ) vakalarının çoğunonfonksiyone benign kitlelerdir. Otonom kortizol sekresyonu (OKS) genellikle Aİ’lerin değerlendirilmesi sırasındatanımlanmış bir klinik antitedir. OKS’de Otonom kortizol sekresyonunda artmış kardiyovasküler hastalık (KVH) riskibilinmektedir. Bu çalışmada amacımız; merkezimizde takip edilen Aİ ve özellikle OKS hastalarının uzun dönem klinik,radyolojik ve KVH risk parametrelerini değerlendirmektir.Yöntemler: Toplam 279 Aİ vakasının klinik, radyolojik, hormonal ve labaratuvar takiplerini retrospektif değerlendirdik.Bulgular: Aİ’lerin %76,7 ’si nonfonsiyone Aİ (NFAİ), %13,3’i OKS, %3,9’u Cushing sendromu, %1,8’i feokromositoma,%3,6 ’sı primer aldosteronizm, %0,7’si adrenokortikal karsinom (AKK) idi. Ortalama takip süresi 3,5±2,3 (1-14) yıl idi.Feokromositoma ve AKK vakaları diğer adrenal adenomlara göre anlamlı büyüktü (sırası ile 48±16,04, 71,5±16,23 veortalama 25,8±12,9 mm p

Follow-up of Adrenal Incidentaloma and Autonomous Cortisol Secretion: 14-Year Single Center Study- Retrospective Cohort

Objective: Most cases of adrenal incidentaloma (AI) detected by imaging with other indications are nonfunctioning benign masses. Autonomous cortisol secretion (OCS) is usually a defined clinical entity during the evaluation of AIs. The increased risk of cardiovascular disease (CVD) is known in OCS. The aim of this study is to evaluate the long-term clinical, radiological and CVD risk parameters of AI and especially OCS patients followed in our center. Methods: We retrospectively evaluated clinical, radiological, hormonal and laboratory follow-up of 279 AI cases. Results: 76.7% of the AIs were nonfunctioning AI (NFAI), 13.3% were OCS, 3.9% were Cushing syndrome, 1.8% were pheochromocytoma, 3.6% were primary aldosteronism, 0.7% were adrenocortical carcinoma (ACC).The mean follow-up was3.5 ± 2.3 (1-14) years. Pheochromocytoma and ACC cases were significantly larger than other adrenal adenomas (48 ± 16.04,71.5 ± 16.23 and mean size 25.8 ± 12.9 p

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1. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol. 2016; 175: 1-36. PMID: 27390021.
2. S.A. Paschou, A. Vryonidou, D.G. Goulis. Adrenal incidentalomas: a guide to assessment, treatment and follow-up. Maturitas. 2016; 92: 79–85. PMID: 27621243.
3. Di Dalmazi G, Pasquali R, Beuschlein F, Reincke M. Subclinical hypercortisolism: a state, a syndrome, or a disease? Eur J Endocrinol. 2015; 173: 61-71. PMID: 26282599.
4. ChiodiniI.Clinical review: diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab. 2011; 96: 1223–36. PMID: 21367932.
5. Chiodini I, Vainicher CE, Morelli V, et al. Mechanisms in endocrinology: endogenous subclinical hypercortisolism and bone: a clinical review. Eur J Endocrinol. 2016; 175: 265–82. PMID: 27412441.
6. Rossi R, Tauchmanova L, Luciano A, et al. Subclinical Cushing’ssyndrome in patientswith adrenal incidentaloma: clinical and biochemical features. JCEM 2000; 85: 1440–8. PMID: 10770179.
7. Terzolo M, Pia A, Ali A, et al. Adrenal incidentaloma: a newcause of the metabolic syndrome? JCEM 2002; 87: 998–1003. PMID: 11889151.
8. Debono M, Bradburn M, Bull M, et al. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. JCEM 2014; 99: 4462–70. PMID: 25238207.
9. Zeiger MA, Thompson GB, Duh Q-Y, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons (AACE/AAES) Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009; 15: 450–3. PMID: 19632968.
10. Nieman LK, Biller BM, Findling JW, et al.The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008; 93: 1526‐40. PMID: 18334580.
11. Morelli V, Scillitani A, Arosio M, Chiodini I. Follow-up of patientswith adrenal incidentaloma, in ordance with the Europeansociety of endocrinology guidelines: Couldwe be safe? J Endocrinol Invest. 2017; 40: 331-3. PMID: 27744612.
12. Koschker AC, Fassnacht M, Hahner S, Weismann D, Allolio B. Adrenocortical carcinoma–improving patient care by establishing new structures. Exp Clin Endocrinol Diabetes. 2006 ; 114: 45-51. Review. PMID: 16570232.
13. Bülow B, Jansson S, Juhlin C, et al. Adrenal incidentaloma - follow-up resultsfrom a Swedish prospective study. Eur J Endocrinol. 2006; 154: 419-23. PMID: 16498055.
14. Kim J, Bae KH, Choi YK, et al. Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinol Metab (Seoul) 2013; 28: 20-5.PMID: 24396646.
15. Russell RP, Masi AT, Richter ED. Adrenal cortical adenomas and hypertension A clinical pathologic analysis of 690 cases with matched controls and a review of the literature. Medicine (Baltimore) 1972; 51: 211–25.PMID: 5021770.
16. Grumbach MM, Biller BM, Braunstein GD, et al. Management of theclinically in apparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003; 138: 424–29. PMID: 12614096.
17. Olsen H, Nordenström E, Bergenfelz A, et al. Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden. Endocrine 2012; 42: 164–73.PMID: 22350586.
18. Vassilatou E, Vryonidou A, Ioannidis D, et al. Bilateral adrenal incidentalomasdifferfromunilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications. Eur J Endocrinol Eur Fed Endocr Soc. 2014; 171: 37–45. PMID: 24743396.
19. Satman I, Omer B, Tutuncu Y, et al. TURDEPII Study Group. Twelve-yearrends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80. PMID: 23407904.
20. Di Dalmazi G, Vicennati V, Garelli S, et al. Cardiovascular events and mortality in patients with adrenal incidentalomas that are eithernonsecretingor associated within termediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes & Endocrinology. 2014; 2: 396–405. PMID: 24795253.
21. Morelli V, Reimondo G, Giordano R, et al. Long-termfollow-up in adrenal incidentalomas: an Italian multicenter study. JCEM 2014; 99: 827–34. PMID: 24423350.
22. Sbardella E, Minnetti M, D'Aluisio D, et al. Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas. Eur J Endocrinol. 2018; 178: 501-11. PMID: 29510982.
23. Patrova J, Kjellman M, Wahrenberg H, Falhammar H. Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center. Endocrine. 2017; 58: 267-75. PMID: 28887710.
24. Giordano R, Marinazzo E, Berardelli R, et al. Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas. Eur J Endocrinol 2010; 162: 779–85. PMID: 20103607.