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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
"urinary free cortisol"
symptom
adrenal incidentaloma
cushing syndrome
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