Adrenal Incidentaloma and Subclinical Cushing’s Syndrome: A Longitudinal Follow-Up Study by Endoscopic Ultrasound

2015 ◽  
Vol 38 (04) ◽  
pp. 411-419 ◽  
Author(s):  
Maike Collienne ◽  
Nina Timmesfeld ◽  
Simona Bergmann ◽  
Joachim Goebel ◽  
Peter Kann
Keyword(s):  
Growth Rate ◽  
Cushing’S Syndrome ◽  
Endoscopic Ultrasound ◽  
Adrenal Incidentaloma ◽  
Cushing's Syndrome ◽  
Endocrine Function ◽  
Maximum Diameter ◽  
Subclinical Cushing’S Syndrome ◽  
The Mean

Abstract Purpose Adrenal incidentaloma (AI) and adrenal masses in cases of subclinical Cushing’s syndrome (SCS) initially require follow-up imaging. In this study we used endoscopic ultrasound (EUS) as a method for high-resolution imaging. The aim was to evaluate the growth rate of AI and SCS by EUS. Materials and Methods This retrospective analysis included 93 out of 229 patients with AI or SCS who were investigated longitudinally by EUS in our university hospital between 1997 and 2013. The longitudinal follow-up required at least two investigations by EUS and evaluation of endocrine function. Plasma renin, serum aldosterone, 24 h urinary catecholamines and 2 mg dexamethasone suppression test were performed. EUS was performed at baseline and during follow-up. Each time, the maximum diameter was measured. Three groups were defined: non-functioning adenomas (NFA), non-functioning nodular hyperplasias (NFH) and SCS. Results 86 patients had non-functioning masses [NFM] (59 NFA, 48 NFH) and 7 patients had SCS (10 masses). At baseline the mean diameter was 19.4 (± 9.3) mm (NFM) and 19.6 (± 9.2) mm (SCS). The mean follow-up period was 31.6 ± 28.7 months. The estimated mean growth rates per year were low: They were 0.35 mm/yr [NFA], 0.02 mm/yr [NFH] and 0.53 mm/yr [SCS]. Furthermore, there was no malignant progression of any mass. Conclusion The growth rate as determined by EUS was low for all tumor entities observed in this study. There was no difference in tumor growth between the groups.

scholarly journals Development of overt Cushing's syndrome in patients with adrenal incidentaloma

2002 ◽  
pp. 61-66 ◽  
Author(s):  
L Barzon ◽  
F Fallo ◽  
N Sonino ◽  
M Boscaro
Keyword(s):  
Cushing’S Syndrome ◽  
Cumulative Risk ◽  
Adrenal Incidentaloma ◽  
Cushing's Syndrome ◽  
Adrenal Incidentalomas ◽  
Subclinical Hypercortisolism ◽  
Subclinical Cushing’S Syndrome ◽  
Risk Of Progression ◽  
Glucocorticoid Production

OBJECTIVE: The natural course of adrenal incidentalomas, especially those with subclinical autonomous glucocorticoid production, i.e. subclinical Cushing's syndrome, and the risk that such conditions will evolve towards overt Cushing's syndrome are unknown. DESIGN: Longitudinal follow-up evaluation of a series of 284 consecutive patients with adrenal incidentaloma. METHODS AND RESULTS: Out of 284 consecutive patients with adrenal incidentaloma studied at our Institution in the last 15 years, 98 patients (23 with subclinical hypercortisolism) underwent surgery. Of 130 non-operated patients with a follow-up of at least 1 year, eight had subclinical hypercortisolism at diagnosis. We describe in detail four patients who developed overt Cushing's syndrome after 1-3 years of follow-up. Only one of these patients had subclinical hypercortisolism at first diagnosis. Estimated cumulative risk for a non-secreting adrenal incidentaloma to develop subclinical hyperfunction was 3.8% after 1 year and 6.6% after 5 years. For patients with masses with subclinical autonomous glucocorticoid overproduction, estimated cumulative risk to develop overt Cushing's syndrome was 12.5% after 1 year. CONCLUSIONS: In patients with adrenal incidentalomas the risk of progression towards overt Cushing's syndrome is not low, at variance with previous reports. A careful biochemical and hormonal follow-up is advisable in all patients who do not need surgery at first presentation.

Subclinical Cushing's syndrome in adrenal incidentaloma

1998 ◽  
Vol 48 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Terzolo ◽  
Osella ◽  
Alì ◽  
Borretta ◽  
Cesario ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Incidentaloma ◽  
Cushing's Syndrome ◽  
Subclinical Cushing’S Syndrome

Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas

2010 ◽  
Vol 162 (4) ◽  
pp. 779-785 ◽  
Author(s):  
R Giordano ◽  
E Marinazzo ◽  
R Berardelli ◽  
A Picu ◽  
M Maccario ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cumulative Risk ◽  
Cushing's Syndrome ◽  
Endocrine Function ◽  
Adrenal Incidentalomas ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Clinical Improvement

ObjectiveTo evaluate long-term morphological, functional, and clinical outcome in adrenal incidentalomas.Design and methodsA total of 118 patients (77 F and 47 M; age 62.3±1.0 years) with adrenal incidentalomas were evaluated at baseline and followed-up for median 3 years (range 1–10 years) by clinical, biochemical, hormonal, and morphological evaluation. Among them, six patients with diagnosis of subclinical Cushing's syndrome (SCS) underwent surgery.ResultsAt entry, 86% (n=102) of tumors were nonfunctioning (NF) and 14% (n=16) showed SCS. Comparing NF with SCS patients, a significantly higher percentage of dyslipidemia was found in the group of SCS patients (50 vs 23%,P=0.033). During follow-up, adrenal function remained normal in all NF patients, none of them developed subclinical or overt endocrine disease. The cumulative risk of mass enlargement was globally low (25%), but progressive up to 8 years. SCS was confirmed in all patients, and none of them shifted to overt Cushing's syndrome. The cumulative risk of developing metabolic–cardiovascular abnormalities was globally low (22%), but progressive up to 8 years and new diseases were recorded in the group of NF patients only (three patients with dyslipidemia, four with impaired fasting glucose/impaired glucose tolerance, and three with diabetes mellitus). SCS patients who underwent surgery did not show any significant clinical improvement.ConclusionsThe risk of mass enlargement, hormonal, and metabolic impairment over time is globally low. Conservative management seems to be appropriate, but further prospective studies are needed to establish the long-term outcome of such patients, especially for metabolic status, cardiovascular risk profile and their relationship with endocrine function.

scholarly journals An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing’s Syndrome: A Diagnosis Dilemma

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
A. Tahri ◽  
W. Abdellaoui ◽  
S. Benyakhlef ◽  
K. Boujtat ◽  
I. Mahroug ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Incidentaloma ◽  
Cushing's Syndrome ◽  
Adrenocortical Adenoma ◽  
Subclinical Cushing’S Syndrome ◽  
Unique Case ◽  
Partial Adrenalectomy ◽  
Adrenal Cyst ◽  
Uncommon Presentation ◽  
Tomography Scan

Adrenal cysts are a rare entity that is usually nonfunctional and asymptomatic. Their association with adrenal neoplasms was rarely described in the literature. We report a unique case of a 40 -year-old woman who was referred for evaluation of a left adrenal incidentaloma with subclinical Cushing’s syndrome. The tumor was suspicious for malignancy regarding computed tomography scan (CT scan) features. Therefore, a laparoscopic left partial adrenalectomy was performed. Pathology examination showed multilocular spaces lined by endothelial cells which are compatible with endothelial adrenal cyst, associated to an adrenocortical adenoma. We further discuss the management of adrenal cyst with review of the literature.

scholarly journals Serum Adiponectin Level as a Predictor of Subclinical Cushing’s Syndrome in Patients with Adrenal Incidentaloma

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Asli Dogruk Unal ◽  
Semra Ayturk ◽  
Derya Aldemir ◽  
Neslihan Bascil Tutuncu
Keyword(s):  
Cushing’S Syndrome ◽  
Adiponectin Level ◽  
Adrenal Incidentaloma ◽  
Signs And Symptoms ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Subclinical Cushing’S Syndrome ◽  
Free Cortisol ◽  
Detailed Medical History ◽  
And Control

Subclinical Cushing’s syndrome (SCS) is a condition of slight but chronic cortisol excess in patients with adrenal incidentaloma (AI) without typical signs and symptoms of Cushing’s syndrome. Adiponectin has potent roles in modulating energy balance and metabolic homeostasis and acts in opposition to glucocorticoids. This study aimed to evaluate adiponectin level in SCS and nonfunctional AI (NAI) patients and its relation with metabolic parameters. Patients with AI (n=40) and metabolically healthy controls (n=30) were included. In AI patients and controls, detailed medical history assessment, physical examinations, anthropometric measurements, and laboratory measurements were performed. Age, body mass index, waist circumference, and lipid profiles were significantly higher and waist-to-hip ratio and adiponectin level were significantly lower in the AI patients than in the controls. The midnight cortisol and urinary free cortisol levels were significantly higher in the SCS patients (n=8) than in the NAI patients (n=32). Adiponectin level of the SCS group was significantly lower than those of the NAI and control groups. The sensitivity and specificity for an adiponectin level of ≤13.00 ng/mL in predicting the presence of SCS were 87.5% and 77.4%, respectively. In conclusion, adiponectin is valuable in predicting the presence of SCS in AI patients.

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