Adrenal insidentaloma’lı hastalarda klinik, biyokimyasal ve radyolojik retrospektif analiz

Year 2022, Volume: 15 Issue: 2, 382 - 392, 31.08.2022

Zeynep Ebru Eser , Ramazan Gen , Kadir Eser , Kerem Sezer , Esen Akbay

https://doi.org/10.26559/mersinsbd.1109724

Abstract

Giriş: Bu çalışmada, adrenal insidentaloma nedeniyle takip edilen hastaların epidemiyolojik, demografik, klinik özellikleri, tedavi yaklaşımları ve yaşam sürelerinin değerlendirilmesi amaçlanmıştır. Yöntem: 2010–2014 yılları arasında Mersin Üniversitesi Araştırma ve Uygulama Hastanesi Endokrinoloji Bölümünde adrenal insidentaloma nedeniyle tedavi ve takipleri yapılan 46 hastanın verileri retrospektif olarak incelendi. Bulgular: Çalışmaya alınan olguların 13’ü erkek, 33’ü kadın ve yaş ortalaması 54.09±10.7 idi. En sık başvuru nedeni %34.78 hastada karın ağrısı, en sık tanı konulan radyolojik yöntem % 60.87 dinamik sürrenal BT, en sık yerleşim yeri sol surrenal bezdi. Kitle çapı ortalama 26.8±16.5 mm arasında idi. Hipertansiyon sıklığı %50, obezite sıklığı %47.8, tip 2 diyabet sıklığı %21.7, osteoporoz sıklığı ise %42.8 ve metabolik sendrom sıklığı %41.3 olarak saptandı. Hormonal değerlendirme sonuçlarına göre %82.61’inde fonksiyonsuz adrenal adenom (FAA), %15.21’inde subklinik Cushing sendromu (SCS), %2.1’inde aldesteronoma görüldü. Adrenalektomiye giden 8 olguda myelolipom, feokromasitoma ve adrenokortikal adenom tanısı konuldu. Bir hasta karaciğer yetmezliğinden exitus oldu. Hastaların takiplerinde hormonal aktivasyon ve lezyon boyutunda büyüme saptanmadı. Sonuç: AI’ların çok farklı patolojik ve radyolojik görünümler ile karşımıza çıkmasından dolayı demografik, etiyolojik, klinik, laboratuar ve radyolojik verilerin bir bütün olarak değerlendirilmesi tedavi ve takibinde önemlidir.

Keywords

Adrenal insidentaloma, subklinik cushing sendromu, fonksiyonsuz adrenal adenom, teşhis, tedavi

Supporting Institution

yok

Project Number

yok

Thanks

yok

Clinical, biochemical and radiological retrospective analysis in patients with adrenal incidentaloma

Abstract

Introduction: The aim of this study was to evaluate the epidemiological, demographic, clinical features, treatment approaches and survival of patients followed up for adrenal incidentaloma. Methods: The data of 46 patients who underwent treatment and follow-up for adrenal incidentaloma in Mersin University Health Research and Practice Hospital, Endocrinology Department between 2010 and 2014 were retrospectively analyzed. Results: The study group consisted of 13 male and 33 female patients. The mean age was 54.09 ± 10.7 years. The most common reason for admission was abdominal pain in 34.78% of patients, the most commonly diagnosed radiological method was 60.87% dynamic surrenal CT, and the most common localization was right surrenal gland. The mean diameter of the mass was 26.8±16.5 mm. The prevalence of hypertension was 50%, obesity was 47.8%, type 2 diabetes was 21.7%, osteoporosis was 42.8% and metabolic syndrome was 41.3%. According to the results of hormonal evaluation, 82.61% of the patients had dysfunctional adrenal adenoma (FAA), 15.21% of them had subclinical Cushing syndrome (SCS) and 2.1% of them had aldesteronoma. Myelolipoma, benign pheochromocytoma and adrenocortical adenoma were diagnosed in 8 patients who underwent adrenalectomy. One patient died due to liver failure. No hormonal activation and lesion size growth was detected in the follow-up of the patients. Conclusion: Because of the different pathological and radiological features of AI, it is important to evaluate demographic, etiological, clinical, laboratory and radiological data as a whole in treatment and follow-up.

Keywords

Adrenal incidentaloma, subclinical Cushing syndrome, dysfunctional adrenal adenoma, diagnosis, treatment

Project Number

yok

References

• Hsieh LB, Mackinney E, Wang TS.When to Intervene for Subclinical Cushing's Syndrome. Surg Clin North Am. 2019 Aug;99(4):747-758. doi: 10.1016/j.suc.2019.04.011. Epub 2019 May 27. Review.
• Jason DS, Oltmann SC. Evaluation of an Adrenal Incidentaloma. Surg Clin North Am. 2019 Aug;99(4):721-729. doi: 10.1016/j.suc.2019.04.009. Epub 2019 May 9. Review.
• Cyranska-Chyrek E, Szczepanek-Parulska E, Olejarz M, Ruchala M.Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Single Tertiary Reference Center. Int J Environ Res Public Health. 2019 May 27;16(10). pii: E1872. doi: 10.3390/ijerph16101872.
• Taya M, Paroder V, Bellin E, Haramati LB. The relationship between adrenal incidentalomas and mortality risk. Eur Radiol. 2019 Apr 16. doi: 10.1007/s00330-019-06202-y. [Epub ahead of print].
• Maher DI, Williams E, Grodski S, Serpell JW, Lee JC. Adrenal incidentalomafollow-up is influenced by patient, radiologic, and medical provider factors: A review of 804 cases. Surgery. 2018 Dec;164(6):1360-1365. doi: 10.1016/j.surg.2018.07.011. Epub 2018 Aug 28.
• Celejewski K, Pogorzelski R, Toutounchi S, et al. Adrenal Incidentaloma- Diagnostic and Treating Problem - Own Experience. Open Med (Wars). 2018 Aug 15;13:281-284. doi: 10.1515/med-2018-0043. ECollection 2018.
• Morelli V, Palmieri S.Adrenal incidentaloma: differential diagnosis and management strategies. Minerva Endocrinol. 2019 Mar;44(1):4-18. doi: 10.23736/S0391-1977.18.02868-7. Epub 2018 May 28. Review.
• Kerkhofs TM, Roumen RM, Demeyere TB, van der Linden AN, Haak HR. Adrenal tumors with unexpected outcome: a review of the literature. Int J Endocrinol.2015;2015:710514. doi: 10.1155/2015/710514. Epub 2015 Mar 25.)
• Kloos RT, Gross MD, Francis IR, et al. Incidentally discovered adrenal masses. Endocr Rev, 1995; 16: 460-84.
• Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study group on adrenal tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000;85:637–44.
• Barzon L, Scaroni C, Sonino N, et al. Incidentally discovered adrenal tumours: endocrine and scintigraphic correlates. J Clin Endocrinol Metab. 1998, 83; 55-62.
• Chidiac RM, Aron DC. Incidentalomas. A disease of modern technology. Endocrinol Metab Clin North Am, 1997; 26: 233-253.
• Reincke M, Nieke J, Krestin GP, et al. Preclinical Cushing’s syndrome in adrenal incidentaloma: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab. 1992; 75: 826-832.
• Morioko M, Fujii T, Matsuki T, et al. Preclinical Cushing’s syndrome: report of seven cases and review of the literature. Int J Urology, 2000; 7: 126-132.
• Rossi R, Tauchmanova L, Luciano A, et al. Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab, 2000; 85: 1440-1448.
• Libe R, Dall’Asta C, Barbetta L, et al. Long term follow up study of patients with adrenal incidentalomas. Eur J Endocrinol, 2002; 147: 489-494.
• Kasperlik-Zeluska, AA, et al. Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients. Clin Endocrinol (Oxf), 1997; 46-1: 29-37.
• Reincke M. Subclinical Cushing's syndrome. Endocrinol Metab Clin North Am, 2000; 29-1: 43-56
• Tsagarakis S, Roboti C, Kokkoris P, et al. Elevated postdexamethasone suppression cortisol concentrations corralate with hormonal alterations of the hypothalamo-pituitary-adrenal axis in patients with adrenal incidentalomas. Clin Endocrinol(Oxf), 1998; 49: 165-171
• Bardet S, Rochmer V, Murat A, et al. 131I-6-iodomethylnorcholesterol scintigraphy: an assessment of oits role in the investigation of adrenocortical incidentalomas. Clin Endocrinol, 1996; 44: 587-596.
• Ambrosi B, Passini E, et al. The clinical evaluation of silent adrenal masses. J Endocrinol Invest, 1997; 20: 90-107
• Comlekci A, Yener S, Ertilav S, et al. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine 2010;37:40–6.
• Angeli A, Terzolo M. Adrenal incidentaloma- a modern disease with old Complications (editorial comment). J Clin Endocrinol Metab, 2002; 87: 4869- 4871.
• Angeli A, Osella G, Ali A, Terzolo M. Adrenal insidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res, 1997; 47: 279-283.
• Yener S, Ertilav S, Secil M, at al. Increased risk of unfavorable metabolic outcome during short-term follow-up in subjects with nonfunctioning adrenal adenomas. Med Princ Pract. 2012;21(5):429-34.
• Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88:5593-5602.
• Chiodini I, Torlantano M, Carnevale V, et al. Bone loss rate in adrenal incidentalomas: a longitudinal study. J Clin Endocrinol Metab, 2001; 86: 5337- 5341
• Chiodini I, Tauchmanova L, Torlantano M, et al. Bone involvement in eugonodal male patients with adrenal incidentaloma and subclinical hypercortisolism. J Clin Endocrinol Metab, 2002; 87: 5491-5494.
• Tauchmanova L, Rossi R, Nuzzo V, et al. Bone loss determined by quantitative ultrasonometry coorelates inversely with disease activity in patients with endogenous glucocorticoid excess due to adrenal mass. Eur J Endocrinol, 2001; 145: 241-247