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Maximum adenoma diameter, regardless of uni- or bilaterality, is a risk factor for autonomous cortisol secretion in adrenal incidentalomas

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Abstract

Purpose

To evaluate differences between patients with unilateral and bilateral adrenal incidentalomas (AIs) in the prevalence of autonomous cortisol secretion (ACS) and related comorbidities.

Methods

In this multicentre retrospective study, AIs ≥ 1 cm without overt hormonal excess were included in the study. ACS was defined by a post-dexamethasone suppression test (DST) serum cortisol ≥ 5.0 µg/dl, in the absence of signs of hypercortisolism. For the association of ACS with the prevalence of comorbidities, post-DST serum cortisol was also analysed as a continuous variable.

Results

Inclusion criteria were met by 823 patients, 66.3% had unilateral and 33.7% bilateral AIs. ACS was demonstrated in 5.7% of patients. No differences in the prevalence of ACS and related comorbidities were found between bilateral and unilateral AIs (P > 0.05). However, we found that tumour size was a good predictor of ACS (OR = 1.1 for each mm, P < 0.001), and the cut-off of 25 mm presented a good diagnostic accuracy to predict ACS (sensitivity of 69.4%, specificity of 74.1%).

During a median follow-up time of 31.2 (IQR = 14.4–56.5) months, the risk of developing dyslipidaemia was increased in bilateral compared with unilateral AIs (HR = 1.8, 95% CI = 1.1–3.0 but, this association depended on the tumour size observed at the end of follow-up (HR adjusted by last visit-tumour size = 0.9, 95% CI = 0.1–16.2).

Conclusions

Tumour size, not bilaterality, is associated with a higher prevalence of ACS. During follow-up, neither tumour size nor bilaterality were associated with the development of new comorbidities, yet a larger tumour size after follow-up explained the association of bilateral AIs with the risk of dyslipidaemia.

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Acknowledgements

SENDIMAD: BECA SENDIMAD de Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019. IRYCIS: Convocatoria intramural de ayudas a proyectos de investigación de investigadores noveles, investigadores clínicos asociados y/o grupos emergentes del Hospital Universitario Ramón y Cajal.

Author information

Authors and Affiliations

  1. Neuroendocrinology Unit, Department of Endocrinology and Nutrition. Hospital, Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS. Madrid, Madrid, Spain

    M. Araujo-Castro

  2. Department of Endocrinology and Nutrition, Hospital Virgen de la Concha, Zamora, Spain

    C. Robles Lázaro

  3. Department of Endocrinology and Nutrition, Hospital Universitario la Paz, Madrid, Spain

    P. Parra Ramírez

  4. Department of Endocrinology and Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain

    R. García Centeno

  5. Department of Endocrinology and Nutrition, Hospital Royo Villanova, Zaragoza, Spain

    P. Gracia Gimeno

  6. Department of Endocrinology and Nutrition, Hospital Universitario de Puerto Real, Cádiz, Spain

    M. T. Fernández-Ladreda

  7. Department of Endocrinology and Nutrition, Hospital Universitario de la Princesa, Madrid, Spain

    M. A. Sampedro Núñez & M. Marazuela

  8. Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, University of Alcalá, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

    H. F. Escobar-Morreale

  9. Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

    P. Valderrabano

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  1. M. Araujo-Castro
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Correspondence to M. Araujo-Castro.

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Araujo-Castro, M., Robles Lázaro, C., Parra Ramírez, P. et al. Maximum adenoma diameter, regardless of uni- or bilaterality, is a risk factor for autonomous cortisol secretion in adrenal incidentalomas. J Endocrinol Invest 44, 2349–2357 (2021). https://doi.org/10.1007/s40618-021-01539-y

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