The existing follow-up studies on patients with incidentally discovered adrenal adenoma (AA) focused almost exclusively on repeat imaging and endocrine work-up on a short period. Of consecutive 152 patients with AA referred to our center from 1989 to 2003, we have assessed the risk of developing metabolic disorders and vascular complications in the 74 patients (51 women and 23 men, median age 57, range 25-74 years) followed for at least 5 years (median 84, range 60228 months) who did not underwent surgery. The diagnosis of AA was based on either typical CT characteristics or repeat scan after 3-6 months; median size of AA was 2.9 cm (range 1-6 cm). Comparing the clinical and biochemical characteristics at diagnosis and at the last follow-up, we observed a slight worsening of the cardiovascular risk profile that was non statistically significant considering advancing age (obesity 12.1% at diagnosis vs 14.8% at the last follow-up, hypertension 48.6% vs 60.8%, metabolic syndrome, defined according to ATP III criteria, 22.9% vs 28.3%, impaired glucose tolerance 25.7% vs 27.0%, diabetes mellitus 6.7% vs 16.2%, dyslipidemia 45.9% vs 51.3%). At diagnosis, 4 patients had a previous cardiovascular event and 5 patients had a new cardiovascular event during follow-up. There was no correlation between hormonal data and the change of the cardiovascular risk profile. At diagnosis 11 patients (14.8%) had subclinical Cushing's syndrome (defined by the presence of at least two alterations among elevated UFC, elevated midnight serum cortisol, low ACTH levels, cortisol after 1 mg DST 5 g/dl). At the last follow-up these patients did not present a worsen cardiovascular risk profile compared to the diagnosis (only 1 patient developed diabetes mellitus and 1 had a novel diagnosis of hypertension). An increase in AA size of >0.5 cm was reported in 9 (12.1%) patients and 2 of them had an increase >1.0 cm. We found a high prevalence of cardiovascular risk factors at diagnosis in patients with incidentally detected AA who, however, develop new metabolic and vascular complications unfrequently in the long-term. Moreover, AA have a limited potential of growth. These data suggest that most patients with incidental AA should be managed conservatively.
Evaluation of Cardiovascular Risk Factors in Patients with Incidentally Discovered Adrenal Adenoma during a Follow-Up Longer Than Five Years.
REIMONDO, Giuseppe Matteo;ALLASINO, Barbara;ARDITO, Arianna;ZAGGIA, Barbara;ANGELI, Alberto;TERZOLO, Massimo
2009-01-01
Abstract
The existing follow-up studies on patients with incidentally discovered adrenal adenoma (AA) focused almost exclusively on repeat imaging and endocrine work-up on a short period. Of consecutive 152 patients with AA referred to our center from 1989 to 2003, we have assessed the risk of developing metabolic disorders and vascular complications in the 74 patients (51 women and 23 men, median age 57, range 25-74 years) followed for at least 5 years (median 84, range 60228 months) who did not underwent surgery. The diagnosis of AA was based on either typical CT characteristics or repeat scan after 3-6 months; median size of AA was 2.9 cm (range 1-6 cm). Comparing the clinical and biochemical characteristics at diagnosis and at the last follow-up, we observed a slight worsening of the cardiovascular risk profile that was non statistically significant considering advancing age (obesity 12.1% at diagnosis vs 14.8% at the last follow-up, hypertension 48.6% vs 60.8%, metabolic syndrome, defined according to ATP III criteria, 22.9% vs 28.3%, impaired glucose tolerance 25.7% vs 27.0%, diabetes mellitus 6.7% vs 16.2%, dyslipidemia 45.9% vs 51.3%). At diagnosis, 4 patients had a previous cardiovascular event and 5 patients had a new cardiovascular event during follow-up. There was no correlation between hormonal data and the change of the cardiovascular risk profile. At diagnosis 11 patients (14.8%) had subclinical Cushing's syndrome (defined by the presence of at least two alterations among elevated UFC, elevated midnight serum cortisol, low ACTH levels, cortisol after 1 mg DST 5 g/dl). At the last follow-up these patients did not present a worsen cardiovascular risk profile compared to the diagnosis (only 1 patient developed diabetes mellitus and 1 had a novel diagnosis of hypertension). An increase in AA size of >0.5 cm was reported in 9 (12.1%) patients and 2 of them had an increase >1.0 cm. We found a high prevalence of cardiovascular risk factors at diagnosis in patients with incidentally detected AA who, however, develop new metabolic and vascular complications unfrequently in the long-term. Moreover, AA have a limited potential of growth. These data suggest that most patients with incidental AA should be managed conservatively.
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