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Long-Term Follow-Up in Adrenal Incidentalomas: An Italian Multicenter Study
Open accessAbstract
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 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]
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“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]
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“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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Metabolic comorbidities in Cushing's syndrome
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Adrenal Incidentalomas are Tied to Increased Risk of Diabetes: Findings from a Prospective Study
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“The present data provide strong evidence to support the view that patients with adrenal incidentalomas have a worse metabolic profile, which is associated with increased cardiovascular risk (13-16,18).”
Background“Nonfunctional” Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes
Lopez, D., Luque-Fernández, M. Á., Steele, A. E., Adler, G. K., Turchin, A., & Vaidya, A. (2016) · Annals of Internal Medicine · doi:10.7326/m16-0547 · Cited by 149
“In contrast to the studies by Di Dalmazi and Morelli and their respective colleagues, we did not have measures of adrenocorticotropic hormone (ACTH) because our study was observational and ACTH is rarely measured in patients with NFATs and those without adrenal tumors.”
BackgroundInfluentialSteroid Metabolome Analysis in Disorders of Adrenal Steroid Biosynthesis and Metabolism
Storbeck, K.-H., Schiffer, L., Baranowski, E. S., Chortis, V., Prete, A., Barnard, L., Gilligan, L. C., Taylor, A. E., Idkowiak, J., Arlt, W., et al. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00262 · Cited by 141
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“In 5 cohort studies, 11,52,53,55,56 the incidence of cardiovascular events during follow-up was higher in MACS.”
InfluentialSubclinical hypercortisolism: a state, a syndrome, or a disease?
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Mild autonomous cortisol secretion: pathophysiology, comorbidities and management approaches
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“It is tempting to speculate that the molecular mechanisms underlying the subclinical hypercortisolism is different from those of patients with ACTH-independent Cushing’s syndrome, given that recent reports on the natural history of this condition have shown that patients with subclinical hypercortisolism do not develo…”
Debono, M., Harrison, R. F., Chadarevian, R., Gueroult, C., Abitbol, J.-L., & Newell-Price, J. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-00823 · Cited by 100
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“Tumours larger than 3 cm are more frequently hormonally active than smaller lesions [61].”
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“Moreover, patients with ACS treated by adrenalectomy showed a significant improvement in hypertension when compared with those under conservative management [183].”
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Six controversial issues on subclinical Cushing’s syndrome
on behalf of the ABC Group, Chiodini, I., Albani, A., Ambrogio, A. G., Campo, M., Martino, M. C. D., Marcelli, G., Morelli, V., Zampetti, B., Colao, A. A. L., et al. (2016) · Endocrine · doi:10.1007/s12020-016-1017-3 · Cited by 47
Arruda, M., Cavalari, E. M. R., de Paula, M. P., de Morais, F. F. C., Bilro, G. F., Coelho, M. C. A., de Morais, N. A. D. O. E. S., Choeri, D., Moraes, A. B., & Neto, L. V. (2017) · Journal of Human Hypertension · doi:10.1038/s41371-017-0011-4 · Cited by 46
Modern management of mild autonomous cortisol secretion
Delivanis, D. A., Athimulam, S., & Bancos, I. (2019) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.1551 · Cited by 46
“1).(17) Whether patients with MACS and morning cortisol concentrations after overnight DST between 1.”
BackgroundPark, J., De Luca, A., Dutton, H., Malcolm, J. C., & Doyle, M.-A. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2019-00090 · Cited by 46
Cardiovascular and metabolic risk factors in patients with subclinical Cushing
Petramala, L., Olmati, F., Concistrè, A., Russo, R., Mezzadri, M., Soldini, M., Vincentis, G. D., Iannucci, G., Toma, G. D., & Letizia, C. (2020) · Endocrine · doi:10.1007/s12020-020-02297-2 · Cited by 50
Ceccato, F., Antonelli, G., Frigo, A. C., Regazzo, D., Plebani, M., Boscaro, M., & Scaroni, C. (2017) · Journal of Endocrinological Investigation · doi:10.1007/s40618-017-0644-8 · Cited by 44
“In our clinical practice, hypertension, diabetes, or dyslipidemia are intensively treated, as recently suggested [10], and this probably explains the lack of any relationship between traditional cardiovascular risk factors and the incidence of CVE in our cohort, which was similar to that previously reported in a large…”
ResultCastro, M. A., Lázaro, C. R., Ramírez, P. A. P., Hernández, M. C., Núñez, M. A. S., & Marazuela, M. (2019) · Endocrine · doi:10.1007/s12020-019-02066-w · Cited by 44
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cAMP signaling in cortisol-producing adrenal adenoma
Calebiro, D., Dalmazi, G. D., Bathon, K., Ronchi, C. L., & Beuschlein, F. (2015) · European Journal of Endocrinology · doi:10.1530/eje-15-0353 · Cited by 42
The Steroid Profile of Adrenal Incidentalomas: Subtyping Subjects With High Cardiovascular Risk
Dalmazi, G. D., Fanelli, F., Zavatta, G., Bitti, S. R., Mezzullo, M., Repaci, A., Pelusi, C., Gambineri, A., Altieri, P., Mosconi, C., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2019-00365 · Cited by 45
Pathophysiology of Mild Hypercortisolism: From the Bench to the Bedside
Favero, V., Cremaschi, A., Parazzoli, C., Falchetti, A., Gaudio, A., Gennari, L., Scillitani, A., Vescini, F., Morelli, V., Aresta, C., et al. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23020673 · Cited by 44
Glucocorticoid withdrawal syndrome: what to expect and how to manage
Theiler‐Schwetz, V., & Prete, A. (2023) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000804 · Cited by 40
Mortality in Patients With Nonfunctional Adrenal Tumors
Patrova, J., Mannheimer, B., Lindh, J. D., & Falhammar, H. (2023) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2023.2442 · Cited by 40
“Postsecondary (≥3 y) 1956 (11) 18 344 (14.”
Update on subclinical Cushing's syndrome
Nieman, L. K. (2015) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000159 · Cited by 40
Ortiz, D. I., Findling, J. W., Carroll, T. B., Javorsky, B. R., Carr, A. A., Evans, D. B., Yen, T. W., & Wang, T. S. (2016) · Surgery · doi:10.1016/j.surg.2015.05.034 · Cited by 39
Minnetti, M., Hasenmajer, V., Sbardella, E., Angelini, F., Simeoli, C., Paola, N. D., Cozzolino, A., Pivonello, C., Alcubierre, D. D., Chiloiro, S., et al. (2022) · European Journal of Endocrinology · doi:10.1530/eje-22-0454 · Cited by 41
Adrenal Incidentalomas: Clinical Controversies and Modified Recommendations
Garrett, R. W., Nepute, J., Hayek, M. E., & Albert, S. G. (2016) · American Journal of Roentgenology · doi:10.2214/ajr.15.15475 · Cited by 41
Mifepristone Treatment in Four Cases of Primary Bilateral Macronodular Adrenal Hyperplasia (BMAH)
Cohan, P., East, H. E., Galati, S.-J., Mercado, J. U., Lim, P. J., Lamerson, M., Smith, J. J., Peters, A. L., & Yuen, K. C. J. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-02638 · Cited by 39
“their cardiometabolic profiles could worsen (39, 40).”
Zhang, C. D., Li, D., Kaur, R. J., Ebbehøj, A. L., Singh, S., Atkinson, E. J., Achenbach, S. J., Young, W. F., Arlt, W., Rocca, W. A., et al. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab468 · Cited by 39
Masserini, B., Morelli, V., Palmieri, S., Eller-Vainicher, C., Zhukouskaya, V. V., Cairoli, E., Orsi, E., Beck‐Peccoz, P., Spada, A., & Chiodini, I. (2015) · Journal of Endocrinological Investigation · doi:10.1007/s40618-014-0232-0 · Cited by 38
“On the other hand, our data agree with the findings of an Italian multicenter study that did not find any difference in prevalence of obesity, arterial hypertension and dyslipidemia between SH+ and SH− patients at baseline evaluation [26].”
ResultScreening for Cushing’s syndrome: Is it worthwhile?
Shimon, I. (2015) · Pituitary · doi:10.1007/s11102-015-0634-9 · Cited by 38
“Moreover, subclinical hypercortisolism is present in more than 10 % of subjects with adrenal incidentalomas (AI), and may be associated with insulin resistance, hypertension, hyperlipidemia and increased visceral fat mass [3, 4].”
The relationship between adrenal incidentalomas and mortality risk
Taya, M., Paroder, V., Bellin, E., & Haramati, L. B. (2019) · European Radiology · doi:10.1007/s00330-019-06202-y · Cited by 38
Koh, J., Song, K., Kwak, M. K., Suh, S., Kim, B., Sung, T., Hong, J. H., Jeong, B. C., Kim, J. H., & Lee, S. H. (2023) · Annals of Surgery · doi:10.1097/sla.0000000000006183 · Cited by 37
Subclinical hypercortisolism in adrenal incidentaloma
Debono, M., & Newell-Price, J. D. C. (2015) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000151 · Cited by 37
Clinical Characteristics and Follow-Up Results of Adrenal Incidentaloma
Yılmaz, N., Avşar, E., Tazegül, G., Sarı, R., Altunbaş, H., & Balcı, M. K. (2020) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1079-4915 · Cited by 38
Dalmazi, G. D., Quinkler, M. O., Deutschbein, T., Prehn, C. P., Rayes, N., Kroiß, M., Berr, C., Stalla, G. K., Faßnacht, M., Adamski, J., et al. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0109 · Cited by 39
“Even in patients with milder forms of hypercortisolism, who are not clinically evident as overt CS, metabolic and cardiovascular complications are well recognized (4-6).”
BackgroundMorelli, V., Scillitani, A., Arosio, M., & Chiodini, I. (2016) · Journal of Endocrinological Investigation · doi:10.1007/s40618-016-0558-x · Cited by 35
“3 %) for predicting the cardiovascular events in AI patients [9].”
BackgroundDalmazi, G. D., Vicennati, V., Pizzi, C., Mosconi, C., Tucci, L., Balacchi, C., Cosentino, E. R., Paolisso, P., Fanelli, F., Gambineri, A., et al. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa270 · Cited by 35
Subclinical Cushing’s syndrome: Current concepts and trends
Zografos, G. N., Perysinakis, I., & Vassilatou, E. (2014) · HORMONES · doi:10.14310/horm.2002.1506 · Cited by 33
Prediction of Vertebral Fractures in Patients With Monolateral Adrenal Incidentalomas
Morelli, V., Eller-Vainicher, C., Palmieri, S., Cairoli, E., Salcuni, A. S., Scillitani, A., Carnevale, V., Corbetta, S., Arosio, M., Casa, S. D., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1423 · Cited by 34
Frequently asked questions and answers (if any) in patients with adrenal incidentaloma
Ceccato, F., Barbot, M., Scaroni, C. M., & Boscaro, M. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01615-3 · Cited by 35
Management of adrenal incidentaloma: the role of adrenalectomy may be underestimated
Ye, Y., Yuan, X., Chen, M., Dai, Y., Qin, Z., & Zheng, F. (2016) · BMC Surgery · doi:10.1186/s12893-016-0154-1 · Cited by 35
“4 cm was associated with patients developing subclinical hypercortisolism [22].”
BackgroundHidden hypercortisolism: a too frequently neglected clinical condition
Giovanelli, L., Aresta, C., Favero, V., Bonomi, M., Cangiano, B., Eller-Vainicher, C., Grassi, G., Morelli, V., Pugliese, F., Falchetti, A., et al. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01484-2 · Cited by 32
Assessment of mild autonomous cortisol secretion among incidentally discovered adrenal masses
Yozamp, N., & Vaidya, A. (2021) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2021.101491 · Cited by 33
Schalin‐Jäntti, C., Raade, M., Hämäläinen, E. K., & Sane, T. (2015) · Endocrinology and Metabolism · doi:10.3803/enm.2015.30.4.481 · Cited by 31
Adrenal adenomas, subclinical hypercortisolism, and cardiovascular outcomes
Dalmazi, G. D., & Pasquali, R. (2015) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000153 · Cited by 31
Cardiovascular mortality in patients with subclinical Cushing
Morelli, V., Arosio, M., & Chiodini, I. (2018) · Annales d Endocrinologie · doi:10.1016/j.ando.2018.03.005 · Cited by 31
Mifepristone Treatment for Mild Autonomous Cortisol Secretion Due to Adrenal Adenomas: A Pilot Study
Belokovskaya, R., Ravikumar, A., Arumugam, D., Izadmehr, S., Goddard, G. M., Geer, E. B., & Levine, A. C. (2019) · Endocrine Practice · doi:10.4158/ep-2019-0047 · Cited by 30
Castro, M. A., Ojeda, C. M., Ramírez, M. N. S., Santos, V. G. D., Corrales, E. P., & Fernández-Argüeso, M. (2022) · Endocrine · doi:10.1007/s12020-022-03120-w · Cited by 30
Subclinical Hypercortisolism: How to Deal with It?
Chiodini, I., & Morelli, V. (2016) · Frontiers of hormone research · doi:10.1159/000443862 · Cited by 30
Morelli, V., Minelli, L., Eller-Vainicher, C., Palmieri, S., Cairoli, E., Spada, A., Arosio, M., & Chiodini, I. (2017) · Journal of Endocrinological Investigation · doi:10.1007/s40618-017-0788-6 · Cited by 29
Possible, probable, and certain hypercortisolism: A continuum in the risk of comorbidity
Castro, M. A., Corrales, E. P., & Lamas, C. (2023) · Annales d Endocrinologie · doi:10.1016/j.ando.2023.01.005 · Cited by 36
Mosconi, C., Vicennati, V., Papadopoulos, D., Dalmazi, G. D., Morselli‐Labate, A. M., Golfieri, R., & Pasquali, R. (2017) · American Journal of Roentgenology · doi:10.2214/ajr.16.16965 · Cited by 30
Kaštelan, D., Kraljević, I., Dušek, T., Knežević, N., Solak, M., Gardijan, B., Kralik, M., Poljičanin, T., Skoric‐Polovina, T., & Kaštelan, Ž. (2015) · European Journal of Endocrinology · doi:10.1530/eje-15-0199 · Cited by 28
Ioachimescu, A. G., Remer, E. M., & Hamrahian, A. H. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2015.02.005 · Cited by 28
Nonfunctioning Adrenal Incidentalomas are not Clinically Silent: A Longitudinal Cohort Study
Kim, J. H., Kim, M. J., Lee, J. H., Yoon, J. W., & Shin, C. S. (2020) · Endocrine Practice · doi:10.4158/ep-2020-0182 · Cited by 27
Chiodini, I., Ramos-Rivera, A., Marcus, A. O., & Yau, H. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2018-00382 · Cited by 25
Self-citationFalcetta, P., Orsolini, F., Benelli, E., Agretti, P., Vitti, P., Cosmo, C. D., & Tonacchera, M. (2020) · Endocrine · doi:10.1007/s12020-020-02476-1 · Cited by 25
Hypercoagulability in Cushing’s syndrome: From arterial to venous disease
St‐Jean, M., Lim, D. S. T., & Langlois, F. (2021) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2021.101496 · Cited by 25
Emerging diagnostic methods and imaging modalities in cushing’s syndrome
Wright, K. E., van Rossum, E. F. C., Zan, E., Werner, N. L., Harris, A. G., Feelders, R. A., & Agrawal, N. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1230447 · Cited by 27
Castro, M. A., Reincke, M., & Lamas, C. (2023) · Biomedicines · doi:10.3390/biomedicines11123115 · Cited by 24
The impact of an adrenal incidentaloma algorithm on the evaluation of adrenal nodules
Eldeiry, L. S., Alfisher, M. M., Callahan, C. F., Hanna, N. N., & Garber, J. R. (2018) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2018.07.001 · Cited by 26
Goddard, G. M., Ravikumar, A., & Levine, A. C. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2015.02.009 · Cited by 24
Moraes, A. B., Cavalari, E. M. R., de Paula, M. P., Arruda, M., Curi, D., Leitão, R., de Mendonça, L. M. C., Farias, M. L. F., Madeira, M., & Neto, L. V. (2018) · Journal of Endocrinological Investigation · doi:10.1007/s40618-018-0985-y · Cited by 26
Is Follow-up of Adrenal Incidentalomas Always Mandatory?
Reimondo, G., Muller, A., Ingargiola, E., Puglisi, S., & Terzolo, M. (2020) · Endocrinology and Metabolism · doi:10.3803/enm.2020.35.1.26 · Cited by 23
Araujo-Castro, M., García Cano, A., Jiménez Mendiguchía, L., Escobar-Morreale, H. F., & Valderrábano, P. (2021) · Scientific Reports · doi:10.1038/s41598-021-00011-4 · Cited by 24
WFUMB position paper on the management incidental findings: adrenal incidentaloma
Dietrich, C. F., Correas, J. M., Dong, Y., Nolsøe, C., Westerway, S. C., & Jenssen, C. (2019) · ULTRASONOGRAPHY · doi:10.14366/usg.19029 · Cited by 21
“Recurrent vertebral fractures [80] and less specifically, arterial hypertension, impaired glucose tolerance, or type 2 diabetes mellitus are typical [81-83].”
BackgroundManagement of adrenal incidentalomas: Working through uncertainty
Cambos, S., & Tabarin, A. (2020) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2020.101427 · Cited by 22
Castro, M. A., Guevara, M. I., Gutiérrez, M. C., Ramírez, P. A. P., Gimeno, P. G., Hanzu, F. A., & Lamas, C. (2020) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2020.08.010 · Cited by 22
Favero, V., Aresta, C., Parazzoli, C., Cairoli, E., Eller-Vainicher, C., Palmieri, S., Salcuni, A. S., Arosio, M., Persani, L., Scillitani, A., et al. (2023) · Cardiovascular Diabetology · doi:10.1186/s12933-023-01836-1 · Cited by 22
“4 μg/dL (39 nmol/L) has the highest accuracy in predicting cardiovascular risk [16, 22] or the incidence of diabetes mellitus [17] in AI patients.”
BackgroundCosta, D., Conceição, F. L., Leite, N. C., Ferreira, M. T., Salles, G. F., & Cardoso, C. R. L. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.05.006 · Cited by 22
Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study
Ceccato, F., Tizianel, I., Voltan, G., Maggetto, G., Boschin, I. M., Quaia, E., Crimì, F., & Scaroni, C. M. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.794197 · Cited by 21
“Several studies reported a progression from a nonfunctioning adrenal incidentaloma (NFAI) to ACS in up to 11% of cases (8–10), especially in larger adenomas (11, 12).”
Background
Metadata
- 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
- 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
- bronze
- doi.org
- 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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