The relationship between adrenal incidentalomas and mortality risk
To determine all-cause mortality risk in patients with and without adrenal incidentaloma.
Retrospective cohort study of patients with CT abdomen performed within 24 h of emergency room presentation at an academic medical center from January 1, 2005, to December 31, 2009, without history of adrenal disease, adrenal lab testing, or cancer. Incidentaloma cohort identified by database query of imaging reports followed by manual review and matched to no-nodule controls at 3:1 on age ± 1 year and exam date ± 3 months. Mortality ascertained by in-hospital deaths and National Death Index query. Survival analysis performed with Kaplan-Meier curves and Cox proportional hazards models.
Among 42,575 adults with abdominal CT exams, 969 adrenal incidentaloma patients and 2907 no-nodule controls were identified. All 3876 individuals entered survival analysis with 31,182 person-years at risk (median follow-up 8.9 years [IQR, 6.9–10.7]). All-cause mortality was significantly higher among those with adrenal incidentalomas (353/969, 36.4%) compared with those without (919/2907, 31.6%; mortality difference 7.6 per 1000 person-years; multivariable-adjusted hazard ratio [aHR] 1.14; 95% CI, 1.003–1.29). Exploratory analyses, limited by missing covariates, found that adrenal incidentalomas were associated with significantly increased incidence of malignancy (aHR 1.61; 95% CI, 1.22–2.12), diabetes (aHR 1.43; 95% CI, 1.18–1.71), heart failure (aHR 1.32; 95% CI, 1.07–1.63), peripheral vascular disease (aHR 1.28; 95% CI, 1.95–1.56), renal disease (aHR 1.21; 95% CI, 1.01–1.44), and chronic pulmonary disease (aHR 1.22; 95% CI, 1.01–1.46) compared with controls.
Adrenal incidentalomas are associated with increased mortality and may represent a clinically valuable biomarker.
• Adrenal incidentalomas are associated with increased mortality.
• Adrenal incidentaloma size is not predictive of mortality.
• On exploratory analyses, adrenal incidentalomas are associated with chronic illnesses.
KeywordsAdrenal gland neoplasms Incidental findings Cohort study Survival analysis Tomography, x-ray computed
American Association of Clinical Endocrinologists
American Association of Endocrine Surgeons
American College of Radiology
Adjusted hazard ratio
International Classification of Diseases Ninth Revision
National Death Index
The preliminary findings were presented as an oral presentation at the Radiological Society of North America Annual Meeting, November 26, 2018, Chicago, IL.
This study has received funding by the Einstein Montefiore Department of Radiology and a National Institutes of Health Clinical and Translational Science Awards grant number 1UL-1TR001073 from the National Center for Advancing Translational Sciences.
Compliance with ethical standards
The scientific guarantor of this publication is Michio Taya, MD MS.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
The first author has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• performed at one institution
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