Hamiyet Yılmaz, MD, Neslihan Başıl Tütüncü, MD, Mustafa Şhin, MD
Başent University Faculty of Medicine, Department of Endocrinology
Objective: To evaluate the risk of developing endocrine hyperactivity and carcinoma during a period of up to five years in patients with apparently benign and nonfunctioning adrenal incidentalomas.
Patients and Methods: Thirty two patients (mean age: 57.0 ± 8.3 years) were investigated in a prospective follow-up study for a median time of 24 months. Twenty eight patients had unilateral and four had bilateral masses. Initial avarage mass diameter was 17.47 ± 6.60 mm. All patients were followed-up yearly by physical examination, metabolic parameters, hormonal evaluation (morning cortisol after 3mg dexamethasone suppression, urinary metanephrines and upright aldosterone/PRA)
Results: Among the clinical characteristics, 48% of patients were obese, 20% were hypertensive, 13 had type 2 diabetes and impaired glucose tolerance. During follow-up period no significant change in the functional status was observed and no malignant transformation occured. Only one patient developed subclinical Cushing syndrome at the end of the first year and referred to surgery. Change in mass size was correlated with HOMA-IR (p=0.002), upright aldosterone/PRA (p: 0.041), cortisol after dexamethasone suppression (p=0.048) and 24-hour urinary normetanephrine (p=0.005) levels. Gender, body mass index, glucose metabolism and blood pressure were not found to be correlated with change in mass size and functional status.
Conclusions: Due to the extremely low risk of developing malignancy during up to five years of follow-up, conservative approach for the management of adrenal incidentalomas is thought to be appropriate. However, possibility of evolution to hormonal hypersecretion makes long-term follow-up of two-to- five years seems to be obligatory.