Background: Adrenal incidentalomas (AI) are clinically silent adrenal masses that are detected incidentally during imaging procedures performed for unrelated diseases. The aim of this study was to investigate the prevalence of sub-clinical hypercortisolism (SH) and associated co-morbidities in patients with unilateral AI (UAI) and bilateral AI (BAI).
Methods: We evaluated 152 patients, 105 (69.1%) with UAI and 47 (30.9%) with BAI. SH was diagnosed in the presence of serum cortisol levels after 1 mg dexamethasone suppression test (DST) or after 2-day low-dose DST (LDDST) > 50 nmol/L with at least one of the following parameters: midnight serum cortisol > 208 nmol/L, 24-h urinary free cortisol > 245 nmol/24 h, or ACTH < 10 ng/L. Bone mineral density (BMD) was measured at lumbar spine (LS) and femoral neck (FN).
Results: Age, BMI, and waist circumference were comparable, and diabetes, hypertension and dyslipidemia occurred with similar frequency in both groups. The overall prevalence of SH was 20.5% based on post-1 mg DST, and 20.0% based on post-LDDST cortisol levels, and it was more prevalent in BAI than UAI patients (31.1% vs 15.2%, respectively, p=0.026). LS BMD was lower in BAI than in UAI patients (0.96±0.14 vs 0.87±0.15, p=0.002). There were no differences in FN BMD. The prevalence of osteoporosis was higher in BAI compared to UAI patients (37.1% vs 15.9%, respectively, p=0.011).
Conclusions: Patients with BAI had higher prevalence of SH and osteoporosis than those with UAI. Frequency of other co-morbidities was similar. This may be due to the higher degree of autonomous cortisol secretion or different tissue-specific sensitivity to glucocorticoids.
Uvod: Adrenalni incidentalomi (AI) jesu tumori otkriveni različitim vizualizacionim metodama ucinjenim bez sumnje na adrenalnu patologiju. Cilj studije je bio da se ispita prevalenca supkliničkog hiperkorticizma (SH) i pridruženih bolesti kod pacijenata sa unilateralnim (UAI) i bilateralnim AI (BAI).
Metode: Ispitivanje je obuhvatilo 152 pacijenta, 105 (69,1%) sa UAI i 47 (30,9%) sa BAI. SH je definisan na osnovu serumskog kortizola >50 nmol/L nakon prekonoćnog deksametazon (1 mg) supresivnog testa (DST) ili nakon dvodnevnog niskodoznog DST (LDDST) sa 2 mg deksametazona, uz još jedan navedeni parametar (ponoćni serumski kortizol > 208 nmol/L, 24-h urinarni slobodni kortizol > 245 nmol/L ili ACTH < 10 ng/L). Kostna gustina je merena na nivou lumbalnog dela kičme i vrata femura.
Rezultati: Pacijenti sa BAI se nisu razlikovali u odnosu na pacijente sa UAI po starosti, BMI, obimu struka, učestalosti dijabetesa, hipertenzije i dislipidemije. Prevalenca SH u celoj grupi iznosila je 20,5% (prekonoćni DST), odnosno 20,0% (LDDST) i bila je značajno veća kod pacijenata sa BAI u odnosu na pacijente sa UAI (31,1% vs 15,2%, p=0,026). Kostna gustina na nivou kičme je bila značajno niža kod pacijenata sa BAI u odnosu na UAI (0,96±0,14 vs 0,87±0,15, p=0,002). Nije nađena razlika u kostnoj gustini na nivou vrata femura. Prevalenca osteoporoze je bila značajno veća kod pacijenata sa BAI u odnosu na UAI (37,1% vs 15,9%, p=0,011).
Zaključak: Pacijenti sa BAI imaju značajno veću prevalencu SH i osteoporoze, ali ne i bolesti pridruženih u metaboličkom sindromu, u odnosu na pacijente sa UAI. To može biti posledica veće autonomne sekrecije kortizola ili različite tkivno-specifične osetljivosti na kortikosteroide.
Keywords: adrenal incidentaloma; osteoporosis; subclinical hypercortisolism.