Advertisement

Journal of Endocrinological Investigation

, Volume 40, Issue 3, pp 331–333 | Cite as

Follow-up of patients with adrenal incidentaloma, in accordance with the European society of endocrinology guidelines: Could we be safe?

  • V. Morelli
  • A. Scillitani
  • M. Arosio
  • I. ChiodiniEmail author
Opinion

Abstract

Recently, the European Society of Endocrinology (ESE) published new guidelines on the management of adrenal incidentalomas. At the same time Lopez and coworkers published on the Annals of Internal Medicine an important study showing that even patients with non-functioning adrenal tumors have an increased risk of incident diabetes. In consideration of previous data and of the results of the study of Lopez and coworkers, some points emerge from the ESE Guidelines that deserve attention. Firstly, it must be observed that the term “autonomous cortisol secretion,” introduced by the ESE Panel in the place of the commonly used “subclinical hypercortisolism,” seems questionable, since the guidelines do not suggest determining the adrenocorticotroph hormone levels that could give the certain proof of a truly autonomous cortisol secretion. Secondly, the ESE Guidelines suggest against repeated hormonal workup in AI patients with a normal hormonal secretion at initial evaluation, but also in those with a “possible autonomous cortisol secretion,” if in the absence of comorbidities potentially related to hypercortisolism. Thirdly, the ESE Guidelines suggest against further imaging during follow-up in patients with an adrenal mass below 4 cm in size with clear benign features on imaging studies. Considering the available literature data that are briefly summarized in this comment, we believe that no sufficient evidence is available to date for giving sharp-cutting recommendations about the uselessness of a biochemical and morphological follow-up in AI patients, even in those with initially benign and not hypersecreting adrenal adenomas. However, if a recommendation has to be given on the basis of the present evidences, we should suggest to biochemically and morphologically follow-up AI patients for at least 5 years.

Keywords

Subclinical hypercortisolism Adrenal incidentalomas ESE Guidelines 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study informed consent is not required.

References

  1. 1.
    Chiodini I, Albani A, Ambrogio AG, Campo M, De Martino MC, Marcelli G et al (2016) Six controversial issues on subclinical Cushing’s syndrome. Endocrine epub ahead of print, doi:  10.1007/s12020-016-1017-3
  2. 2.
    Chiodini I, Morelli V (2016) Subclinical hypercortisolism: how to deal with it. Front Horm Res 46:28–38CrossRefPubMedGoogle Scholar
  3. 3.
    Masserini B, Morelli V, Palmieri S, Eller-Vainicher C, Zhukouskaya V, Cairoli E et al (2015) Lipid abnormalities in patients with adrenal incidentalomas: role of subclinical hypercortisolism and impaired glucose metabolism. J Endocrinol Invest 38:623–628CrossRefPubMedGoogle Scholar
  4. 4.
    Tuna MM, Imga NN, Doğan BA, Yılmaz FM, Topçuoğlu C, Akbaba G et al (2014) Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis. J Endocrinol Invest 37:765–768CrossRefPubMedGoogle Scholar
  5. 5.
    Shen J, Sun M, Zhou B, Yan J (2014) Nonconformity in the clinical practice guidelines for subclinical Cushing’s syndrome: which guidelines are trustworthy? Eur J Endocrinol 171:421–431CrossRefPubMedGoogle Scholar
  6. 6.
    Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A et al (2016) Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol 175:G1–G34CrossRefPubMedGoogle Scholar
  7. 7.
    Lopez D, Luque-Fernandez MA, Steele A, Adler GK, Turchin A, Vaidya A (2016) “Nonfunctional” adrenal tumors and the risk for incident diabetes and cardiovascular outcomes: a cohort study. Ann Intern Med epub ahead of print. doi: 10.7326/M16-0547
  8. 8.
    Barzon L et al (1999) Risk factors and long-term follow-up of adrenal incidentalomas. J Clin Endocrinol Metab 84:520–526PubMedGoogle Scholar
  9. 9.
    Morelli V, Reimondo G, Giordano R, Della Casa S, Policola C, Palmieri S et al (2010) Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab 99:827–834CrossRefGoogle Scholar
  10. 10.
    Bernini GP et al (2005) Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas. Br J Cancer 92:1104–1109CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Anagnostis P et al (2010) Long term follow-up of patients with adrenal incidentalomas—a single center experience and review of the literature. Exp Clin Endocrinol Diabetes 118:610–616CrossRefPubMedGoogle Scholar
  12. 12.
    Vassilatou E et al (2009) Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin Endocrinol 70:674–679CrossRefGoogle Scholar
  13. 13.
    Di Dalmazi G et al (2014) Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes Endocrinol 2:396–405CrossRefPubMedGoogle Scholar
  14. 14.
    Fagour A et al (2009) Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study. Eur J Endocrinol 160:257–264CrossRefPubMedGoogle Scholar
  15. 15.
    Giordano R et al (2010) Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas. Eur J Endocrinol 162:779–785CrossRefPubMedGoogle Scholar
  16. 16.
    Muth A et al (2011) Adrenal study group of Western Sweden. Cohort study of patients with adrenal lesions discovered incidentally. Br J Surg 98:1383–1391CrossRefPubMedGoogle Scholar
  17. 17.
    Cho YY et al (2013) Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas. Korean J Intern Med 28:557–564CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Comlekci A et al (2010) Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocr 37:40–46CrossRefGoogle Scholar
  19. 19.
    Yener S et al (2010) Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas. J Endocrinol Invest 33:32–36CrossRefPubMedGoogle Scholar
  20. 20.
    Libè R et al (2002) Long-term follow-up study of patients with adrenal incidentalomas. Eur J Endocrinol 147:489–494CrossRefPubMedGoogle Scholar
  21. 21.
    Debono M, Bradburn M, Bull M, Harrison B, Ross RJ, Newell-Price J (2014) Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. J Clin Endocrinol Metab 99:4462–4467CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Morelli V, Eller-Vainicher C, Palmieri S, Cairoli E, Salcuni AS, Scillitani A et al (2016) Prediction of vertebral fractures in patients with monolateral adrenal incidentalomas. J Clin Endocrinol Metab 101:2768–2775CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2016

Authors and Affiliations

  • V. Morelli
    • 1
    • 2
  • A. Scillitani
    • 3
  • M. Arosio
    • 2
    • 4
  • I. Chiodini
    • 1
    Email author
  1. 1.Unit of Endocrinology and Metabolic Diseases, Padiglione GranelliFondazione IRCCS Cà-Granda, Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Department of Medical Sciences and Community HealthUniversity of MilanMilanItaly
  3. 3.Unit of Endocrinology“Casa Sollievo della Sofferenza”, Hospital, IRCCS, San Giovanni RotondoFoggiaItaly
  4. 4.Unit of Endocrine Diseases and DiabetologyOspedale San Giuseppe, Gruppo MultimedicaMilanItaly

Personalised recommendations