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Long-term follow-up in adrenal incidentalomas: an Italian multicenter study.
[adrenal incidentaloma]
The
long
-term
consequences
of
subclinical
hypercortisolism
(
SH
)
in
patients
with
adrenal
incidentalomas
(
AIs
)
are
unknown
.
In
this
retrospective
multicentric
study
,
206
AI
patients
with
a
≥
5
-
year
follow-up
(
median
,
72
.
3
mo
;
range
,
60
-
186
mo
)
were
enrolled
.
Adrenocortical
function
,
adenoma
size
,
metabolic
changes
,
and
incident
cardiovascular
events
(
CVEs
)
were
assessed
.
We
diagnosed
SH
in
11
.
6
%
of
patients
in
the
presence
of
cortisol
after
a
1
mg
-dexamethasone
suppression
test
>
5
μg
/
dL
(
138
nmol
/
L
)
or
at
least
two
of
the
following
:
low
ACTH
,
increased
urinary
free
cortisol
,
and
1
mg
-dexamethasone
suppression
test
>
3
μg
/
dL
(
83
nmol
/
L
)
.
At
baseline
,
age
and
the
prevalence
of
CVEs
and
type
2
diabetes
mellitus
were
higher
in
patients
with
SH
than
in
patients
without
SH
(
62
.
2
±
11
y
vs
58
.
5
±
10
y
;
20
.
5
vs
6
%
;
and
33
.
3
vs
16
.
8
%
,
respectively
;
P
<
.
05
)
.
SH
and
type
2
diabetes
mellitus
were
associated
with
prevalent
CVEs
(
odds
ratio
[
OR
]
,
3
.
1
;
95
%
confidence
interval
[
CI
]
,
1
.
1
-
9
.
0
;
and
OR
,
2
.
0
;
95
%
CI
,
1
.
2
-
3
.
3
,
respectively
)
,
regardless
of
age
.
At
the
end
of
the
follow-up
,
SH
was
diagnosed
in
15
patients
who
were
without
SH
at
baseline
.
An
adenoma
size
>
2
.
4
cm
was
associated
with
the
risk
of
developing
SH
(
sensitivity
,
73
.
3
%
;
specificity
,
60
.
5
%
;
P
=
.
014
)
.
Weight
,
glycemic
,
lipidic
,
and
blood
pressure
control
worsened
in
26
,
25
,
13
,
and
34
%
of
patients
,
respectively
.
A
new
CVE
occurred
in
22
patients
.
SH
was
associated
with
the
worsening
of
at
least
two
metabolic
parameters
(
OR
,
3
.
32
;
95
%
CI
,
1
.
6
-
6
.
9
)
and
with
incident
CVEs
(
OR
,
2
.
7
;
95
%
CI
,
1
.
0
-
7
.
1
)
,
regardless
of
age
and
follow-up
.
SH
is
associated
with
the
risk
of
incident
CVEs
.
Besides
the
clinical
follow-up
,
in
patients
with
an
AI
>
2
.
4
cm
,
a
long
-term
biochemical
follow-up
is
also
required
because
of
the
risk
of
SH
development
.
Diseases
Validation
Diseases presenting
"diabetes mellitus"
symptom
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
allergic bronchopulmonary aspergillosis
alpha-thalassemia
child syndrome
cholangiocarcinoma
cohen syndrome
congenital adrenal hyperplasia
congenital toxoplasmosis
cowden syndrome
cushing syndrome
cystinuria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial hypocalciuric hypercalcemia
malignant atrophic papulosis
neuralgic amyotrophy
pyomyositis
sneddon syndrome
typhoid
werner syndrome
wolf-hirschhorn syndrome
This symptom has already been validated
