Characteristics of adrenal incidentalomas in a large, prospective computed tomography-based multicenter study: the COAR study in Korea
Open accessAbstract
PURPOSE: Previous studies on adrenal incidentalomas (AIs) are limited by their retrospective design, small numbers of patients, Western populations, or use of an outdated imaging technique. We investigated the characteristics of AIs in Korean patients and compared them with those reported in the largest retrospective study in Italy to discover the effects of improved imaging techniques and ethnicity differences. MATERIALS AND METHODS: This was a prospective, multicenter, cross-sectional observational study including 1005 Korean patients. Levels of plasma adrenocorticotrophic hormone, 24-h urinary free cortisol (UFC), serum cortisol after a 1 mg-dexamethasone suppression test, 24-h urinary fractionated metanephrine, and plasma aldosterone and plasma renin activity were measured. All AIs were characterized using computed tomography (CT). RESULTS: Compared with the results of the Italian study, AIs in Korean patients were observed more frequently in men and predominantly on the left side. Korean patients with AIs were slightly younger, and fewer patients underwent surgery. Most AIs were nonfunctional in both studies, while fewer subclinical hypercortisolism and more primary aldosteronism (PA) cases were detected in Korean patients. In our study, high UFC levels showed very low sensitivity, compared to those in the Italian study. In pheochromocytoma or PA cases, there were no hormonal differences between the studies. AIs in Korean patients were smaller, such that a lower cutoff size for detecting adrenocortical carcinoma (ACC) could be warranted. CONCLUSION: Recent advances in CT technology were leveraged to provide accurate characteristics of AIs and to detect smaller ACCs.
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In the COAR study of 1005 Korean patients with AIs, AIs were more frequent in men (57%) and the population was younger (median 55 years) than the Italian patient cohort.
“AIs in Korean patients were more frequent in men (57%) and the population was younger (median 55 years) than the Italian patient cohort.”
From Adrenal incidentaloma (2020) · cites this paper as [81]
Fewer AIs underwent surgical resection in the Korean COAR study than in the Italian cohort.
“Also, fewer AIs underwent surgical resection in the Korean study.”
From Adrenal incidentaloma (2020) · cites this paper as [81]
Some studies suggest a higher prevalence of left-sided adrenal tumors detected on imaging, for example, the COAR study cohort.
“However, some studies suggest a higher prevalence of left-sided adrenal tumors detected on imaging (81,88,89), for example, the COAR study cohort described above (81).”
From Adrenal incidentaloma (2020) · cites this paper as [81]
Diabetes/metabolic syndrome, renal damage, impaired bone mineral density, and osteoporosis have been reported more prevalent in AI patients with PA.
“Diabetes mellitus/metabolic syndrome (278,279), renal damage (280), impaired bone mineral density (81), and osteoporosis (264,281,282) have also been reported to be more prevalent in AI patients with PA.”
From Adrenal incidentaloma (2020) · cites this paper as [81]
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Self-citation
- Authors
- Ahn, S. H., Kim, J. H., Baek, S. H., Kim, H., Cho, Y. Y., Suh, S., Kim, B.-J., Hong, S., Koh, J.-M., Lee, S. H., & Song, K.-H.
- Affiliations
- Inha University (KR)
- Samsung Medical Center (KR)
- Asan Medical Center (KR)
- Gyeongsang National University (KR)
- Dong-A University Hospital (KR)
- Konkuk University (KR)
- Corresponding author
- Lee, Seung Hun
- Song, Kee-Ho
- ORCID
- Venue
- Yonsei Medical Journal
- Publisher
- XMLink
- Published
- 2018
- Volume
- 59
- Issue
- 4
- Pages
- 501
- ISSN
- 0513-5796 (ISSN-L)
- 1976-2437
- PMC
- PMC5949292
- OpenAlex
- W2801632382
- Cited by
- 43
- References
- 41
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 3 · 2020: 7 · 2019: 2 · 2018: 2
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Yonsei Medical Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Asan Institute for Life Sciences, Asan Medical Center
- Dong-A ST
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenal incidentaloma, Korean patients, ethnic differences, subclinical hypercortisolism, primary aldosteronism, adrenocortical carcinoma, 24-hour urinary free cortisol, dexamethasone suppression test, metanephrine, plasma aldosterone, renin-aldosterone system, CT imaging characteristics, ACTH
- MeSH terms
- Adrenal Gland Neoplasms, Adult, Aged, Cross-Sectional Studies, Dexamethasone, Female, Humans, Hydrocortisone, Italy, Male, Middle Aged, Prospective Studies, Renin, Retrospective Studies, Tomography, X-Ray Computed, Republic of Korea
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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