Arch Med Sci. 2012 Feb 29;8(1):97-103. doi: 10.5114/aoms.2012.27288.

Hormonal activity in clinically silent adrenal incidentalomas.

Archives of medical science : AMS

Anna Babińska, Małgorzata Siekierska-Hellmann, Krzysztof Błaut, Anna Lewczuk, Piotr Wiśniewski, Maria Gnacińska, Lukasz Obołończyk, Renata Swiątkowska-Stodulska, Krzysztof Sworczak

PMID: 22457682 PMCID: PMC3309444 DOI: 10.5114/aoms.2012.27288

Abstract

INTRODUCTION: The rapid development of modern imaging techniques, has led to an increase in accidentally discovered adrenal masses without clinically apparent hormonal abnormalities. Such tumours have been termed "incidentalomas". The diagnostic work-up in patients with adrenal incidentalomas is aimed at the determination of hormonal activity of the tumour and identification of patients with potentially malignant tumours. The aim of our study was a retrospective analysis of selected clinical characteristics and hormonal studies in accidentally discovered adrenal tumours.

MATERIAL AND METHODS: Fourty hundred sixty-three patients with serendipitously discovered adrenal masses, diagnosed and treated in the Department of Endocrinology and Internal Diseases, Medical University of Gdansk as well as in the affiliated Endocrinology Clinic between 1993 and October of 2009 were included in the analysis. Out of all patients, 245 were referred for adrenalectomy.

RESULTS: We found that clinically "silent" tumours often demonstrate subclinical hormonal activity. In our report, increased 24-h urinary excretion of cortisol correlated positively with tumour size (p < 0.001). Moreover, a statistical relationship was demonstrated between tumour size and serum cortisol concentration assessed in the 1 mg dexamethasone suppression test (p < 0.001). Increased values of dehydroepiandrosterone/dehydroepiandrosterone sulphate were more often found in malignant than in benign tumours (p < 0.01). Urinary concentrations of 17-ketosteroids correlate positively with diagnosis of adrenocortical cancer (p = 0.02).

CONCLUSIONS: We found that clinically "silent" tumours often demonstrate subclinical hormonal activity (subclinical Cushing syndrome, subclinical pheochromocytoma, low-symptomatic adrenocortical cancer).

Keywords: adrenal incidentaloma; low-symptomatic adrenocortical cancer; subclinical Conn syndrome; subclinical Cushing syndrome; subclinical pheochromocytoma

References

1. Clin Endocrinol (Oxf). 1998 Aug;49(2):165-71 - PubMed
2. Endocr Relat Cancer. 2007 Mar;14(1):13-28 - PubMed
3. Neoplasma. 2001;48(3):221-6 - PubMed
4. Eur J Endocrinol. 2003 Oct;149(4):273-85 - PubMed
5. J Clin Endocrinol Metab. 2002 Nov;87(11):4872-8 - PubMed
6. Endocr Rev. 2003 Aug;24(4):539-53 - PubMed
7. Horm Res. 1998;50(4):237-42 - PubMed
8. J Clin Endocrinol Metab. 1992 Sep;75(3):826-32 - PubMed
9. Endocrinol Metab Clin North Am. 2000 Mar;29(1):159-85, x - PubMed
10. Ann Intern Med. 2003 Mar 4;138(5):424-9 - PubMed
11. Endocrinol Metab Clin North Am. 2000 Mar;29(1):107-25, ix - PubMed
12. Eur J Endocrinol. 2002 Oct;147(4):489-94 - PubMed
13. J Clin Endocrinol Metab. 1999 Feb;84(2):520-6 - PubMed
14. Horm Res. 1997;47(4-6):284-9 - PubMed
15. J Clin Endocrinol Metab. 1996 May;81(5):1726-9 - PubMed
16. Clin Endocrinol (Oxf). 1998 Jan;48(1):89-97 - PubMed
17. Oncol Rep. 2002 Nov-Dec;9(6):1373-8 - PubMed
18. Eur J Endocrinol. 2002 Apr;146(4):523-9 - PubMed
19. J Cancer Res Clin Oncol. 2001;127(3):143-55 - PubMed
20. J Endocrinol Invest. 1997 Sep;20(8):501-4 - PubMed
21. Horm Metab Res. 2008 May;40(5):338-41 - PubMed
22. Eur J Endocrinol. 2002 Jan;146(1):61-6 - PubMed
23. Langenbecks Arch Surg. 2008 Mar;393(2):121-6 - PubMed
24. Exp Clin Endocrinol Diabetes. 2008 Apr;116(4):246-51 - PubMed
25. J Clin Endocrinol Metab. 1996 Feb;81(2):740-4 - PubMed

Publication Types

• Journal Article