Long-term follow-up in adrenal incidentalomas: an Italian Multicenter Study.

Context. The long-term consequences of subclinical hypercortisolism (SH) in patients with adrenal incidentalomas (AI) are unknown. Setting-Patients. In this retrospective multicentric study, 206 AI patients with a ≥5 yrs follow-up (median, range: 72.3, 60-186 months) were enrolled. Intervention-Main Outcome Measure. The adrenocortical function, adenoma size, metabolic changes and incident cardiovascular events (CVE) were assessed. We diagnosed SH in 11.6% of patients, in the presence of cortisol after 1mg-dexamethasone suppression test (1mg-DST) >5 μg/dL (138 nmol/L) or ≥2 out of: low ACTH, increased urinary free cortisol and 1mg-DST >3 μg/dL (83 nmol/L). Results. At baseline, age, CVE and type-2 diabetes (T2DM) prevalence were higher in patients with than in patients without SH (62.2±11yrs vs 58.5±10yrs; 20.5% vs 6%; 33.3% vs 16.8%, respectively, P<0.05). SH and T2DM were associated with prevalent CVE (OR 3.1, 95%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 without SH at baseline. An adenoma size >2.4 cm was associated with the risk of developing SH (SN 73.3%, SP 60.5%, P=0.014). 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 ≥2 metabolic parameters (OR 3.32, 95%CI 1.6-6.9) and with incident CVE (OR 2.7, 95%CI 1.0-7.1) regardless of age and follow-up. Conclusion. SH is associated with the risk of incident CVE. Beside the clinical follow-up, in patients with an AI >2.4 cm also a long-term biochemical follow-up is required, for the risk of SH development.