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Bilateral adrenal incidentalomas differ from unilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications.
[adrenal incidentaloma]
To
investigate
the
possibility
of
a
different
prevalence
of
subclinical
Cushing
's
syndrome
(
SCS
)
and
potentially
related
morbidities
between
patients
with
unilateral
adrenal
incidentalomas
(
UAI
)
and
bilateral
adrenal
incidentalomas
(
BAI
)
,
as
existing
data
are
few
and
controversial
.
Prospective
observational
study
.
Clinical
examination
,
biochemical
tests
,
and
hormonal
evaluation
were
performed
in
298
consecutive
patients
with
adrenal
incidentalomas
,
unilateral
in
224
patients
(
75
.
2
%
)
,
bilateral
in
74
patients
(
24
.
8
%
)
,
with
apparently
benign
masses
based
on
imaging
characteristics
and
after
exclusion
of
overt
endocrine
disease
.
The
diagnosis
of
SCS
was
based
on
a
post-dexamethasone
suppression
test
(
2
 
mg
dexamethasone
/
24
 
h
for
48
 
h
)
,
with
serum
cortisol
level
≥
1
.
8
 
μg
/
dl
combined
with
at
least
one
abnormal
result
of
the
other
hormonal
measurements
.
SCS
was
diagnosed
in
66
out
of
298
(
22
.
1
%
)
patients
,
being
more
frequent
in
patients
with
BAI
(
35
.
1
vs
17
.
9
%
,
P
=
0
.
003
,
for
BAI
and
UAI
respectively
)
.
Hypertension
,
type
2
diabetes
mellitus
,
impaired
glucose
tolerance
,
and
dyslipidemia
were
of
a
similar
frequency
in
both
groups
.
SCS
patients
with
UAI
and
BAI
did
not
differ
in
age
,
gender
,
BMI
,
waist
circumference
,
and
mass
size
.
Factors
related
to
SCS
were
the
presence
of
BAI
(
OR
,
3
.
24
;
95
%
CI
,
2
.
31
-
4
.
54
)
and
mass
size
(
OR
,
2
.
63
;
95
%
CI
,
1
.
31
-
5
.
26
)
.
BAI
patients
present
more
often
with
SCS
when
compared
with
UAI
patients
;
however
,
morbidities
potentially
related
to
subtle
cortisol
hypersecretion
were
of
a
similar
frequency
in
both
groups
.
Further
studies
are
needed
to
clarify
whether
this
difference
in
hormonal
activity
may
be
related
to
different
pathophysiologies
.
Diseases
Validation
Diseases presenting
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated