Faruk KILINÇ, Sezgin BARUTÇU, Zafer PEKKOLAY, Alpaslan Kemal TUZCU, Mazhar Müslüm TUNA, Hikmet SOYLU

Nonfonksiyonel adrenal insidentaloma insülin direnci ile ilişkili olabilir

Amaç: Adrenal insidentalomalar; adrenal bezle ilişkili herhangi bir hastalık kuşkusu yokken görüntüleme yöntemleri veya abdominal laparotomide tesadüfen saptanan kitlelerdir. Abdominal görüntüleme yöntemlerinin kullanımının artması ile adrenal insidentalomaların tespit edilme sıklığı da artmıştır. Bu çalışmada nonfonksiyonel adrenal insidentalomalı (NFAI) hastaların demografik özellikleri ve insülin direncini araştırmayı amaçladık.Yöntemler: Çalışmaya 2007-2013 yılları arasında Dicle Üniversitesi Tıp Fakültesi Endokrinoloji Anabilim Dalı'nda NFAI nedeniyle takip edilen 30 hasta (20 kadın, 10 erkek) ve 66 sağlıklı birey (44 kadın, 22 erkek) dahil edildi. Hasta dosyalarından hastalara ait fizik muayene, ultrason, bilgisayarlı tomografi sonuçları kaydedildi. Tüm hastalara 1 mg deksametazon testi, idrar metanefrin ve normetanefrin, serum aldosteron ve renin düzeyi bakılmıştı. Açlık kan şekeri (AKŞ) ve insülin değerleri mevcut olan hastaların homeostatic model assessment- insulin resistance (HOMA-IR) formülüne göre insülin direnci hesaplandı, yaş ve beden kitle indeksi (BKİ) farklı olmayan kontrol grubundaki sağlıklı bireylerle karşılaştırıldı.Bulgular: Hastaların yaş ortalaması 45,9±10,9, BKİ 28,5±5,8 kg/m2 idi. Gruplar arasında yaş, cinsiyet ve BKİ açısından fark yoktu. AKŞ ve HOMA IR, NFAI grubunda kontrol grubuna göre anlamlı olarak yüksekti (sırasıyla, p= 0,022 ve p=0,005). LDL, HDL kolesterol ve trigliserid düzeyleri bakımında gruplar arasında farklılık gözlenmedi (p>0,05). Sonuç: Nonfonksiyonel adrenal insidentalomalı hastalar insulin direnci ve metabolik parametreler açısından riskli olduklarından bu açıdan değerlendirilmelidir.

Non functioning adrenal incidentalomas may be associated with insulin resistance

Objective: Adrenal incidentaloma are bulks which are stated incidentally by imagining methods or in abdominal laparotomy when there is no suspicion of any disease in adrenal gland. With increase in using abdominal ultrasonography and BT, the frequency of determining adrenal incidentaloma also increases. In this study, we aimed to examine demographical features and insulin resistance in patients with non functioning adrenal incidentaloma (NFAI). Methods: 30 (20 female-10 male) patients, who followed due to NFAI at Dicle University Medical Faculty Department of Endocrinology between years of 2007-2013, and age, BMI matched 66 healthy subjects were included in the study. Results of physical examination, USG and BT were recorded from patients' files. All patients were underwent following analyses for excluding a functioning adrenal mass, overnight dexamethasone suppression test, 24 hour urinary metanephrine and normetanephrine, plasma aldosterone/ renin activity ratio. Insulin resistance was calculated in accordance with homeostatic model assessmentinsulin resistance formula. Results: The average of age was 45.9 ± 10.9 years and body mass ındex (BMI) 28.5 ± 5.8. There were no significantly difference in terms of age, gender and BMI between groups. Fasting blood glucose and insulin resistance were significantly higher in patients with non-functional adrenal incidentaloma than control group (p=0.022, p=0.005i respectively). No significant difference was found between groups, in terms of LDL, HDL and triglyceride levels. Conclusion: patients with NFAI are more prone to have insulin resistance and hyperglycemia. Thus, clinicians should evaluate those patients with NFAI, in terms of metabolic parameters.

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