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Cited by 223Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Long-term follow-up in adrenal incidentalomas: an Italian multicenter study

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Morelli, Valentina, Reimondo, Giuseppe, Giordano, Roberta, Della Casa, Silvia, Policola, Caterina, Palmieri, Serena, Salcuni, Antonio S., Dolci, Alessia +8 more·2014·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2013-3527
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Abstract

CONTEXT: The long-term consequences of subclinical hypercortisolism (SH) in patients with adrenal incidentalomas (AIs) are unknown. SETTING AND PATIENTS: In this retrospective multicentric study, 206 AI patients with a ≥5-year follow-up (median, 72.3 mo; range, 60-186 mo) were enrolled. INTERVENTION AND MAIN OUTCOME MEASURES: 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). RESULTS: 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. CONCLUSION: 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.

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  • A recent systematic review showed that patients with autonomous cortisol secretion had a higher prevalence of cardiovascular events (16.7-26.8%) compared with patients with nonfunctional adrenal incidentaloma (6.7-10.4%).

    “A recent systematic review showed that ACS patients had a higher prevalence of cardiovascular events (16.7-26.8%) compared with patients with nonfunctional AI (6.7-10.4%) (79,244,245,247).”

    From Adrenal incidentaloma (2020) · cites this paper as [244]

  • An Italian group reported increased risk of ACS development if adenoma size >2.4 cm (sensitivity 73.3%, specificity 60.5%, P=.014).

    “An Italian group reported an increased risk of ACS development if the adenoma size was >2.4 cm (sensitivity 73.3% and specificity 60.5%, P = .014) (244).”

    From Adrenal incidentaloma (2020) · cites this paper as [244]

  • The prevalence of impaired glucose tolerance or diabetes has been higher in patients with subclinical Cushing syndrome than in nonfunctioning adenoma or controls, but other studies did not confirm this.

    “Focusing on glucose metabolism, the prevalence of IGT or DM has been higher in patients with SCS than in cases of nonfunctioning adenoma or controls (, , , , , , ), but these data were not confirmed by other studies that found much the same prevalence of these comorbidities in SCS as in the overall series of AI and in the general population (, -).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [220]

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  1. Mauclère-Denost S, Duron-Martinaud S, Nunes M, et al. Surgical excision of subclinical cortisol secreting incidentalomas: impact on blood pressure, BMI and glucose metabolism [in French]. Ann En- docrinol (Paris). 2009;70:211-217.

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Authors
Morelli, V., Reimondo, G., Giordano, R., Della Casa, S., Policola, C., Palmieri, S., Salcuni, A. S., Dolci, A., Mendola, M., Arosio, M., Ambrosi, B., Scillitani, A., Ghigo, E., Beck-Peccoz, P., Terzolo, M., & Chiodini, I.
Affiliations
  • University of Milan (IT)
  • Ospedale San Luigi Gonzaga (IT)
  • University of Turin (IT)
  • Catholic University (S.D.C., C.P.), Unit of Endocrinology and Metabolism, 00168 Rome, Italy
  • Casa Sollievo della Sofferenza (IT)
  • Department of Clinical Sciences and Community Health (V.M., S.P., A.D., M.A., P.B.-P., I.C.), University of Milan, 20122 Milan, Italy
Corresponding author
Morelli, Valentina
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2014-03-01
Volume
99
Issue
3
Pages
827-834
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2013-3527
OpenAlex
W1990214209
Cited by
223
References
44
Citations by year
2026: 9 · 2025: 13 · 2024: 12 · 2023: 16 · 2022: 15 · 2021: 22 · 2020: 23 · 2019: 23 · 2018: 19 · 2017: 18 · 2016: 22 · 2015: 21 · 2014: 9
FWCI
23.12
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
Funders
Regione Piemonte
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
adrenal incidentaloma, subclinical hypercortisolism, adrenocortical function, cardiovascular events, type 2 diabetes, adenoma size, dexamethasone suppression test, metabolic control, long-term follow-up, ACTH, urinary free cortisol, hypertension, dyslipidemia, glycemic control, weight gain
MeSH terms
Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Hydrocortisone, Italy, Male, Middle Aged, Retrospective Studies, Tumor Burden, Pituitary ACTH Hypersecretion

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