Accuracy of new recommendations for adrenal incidentalomas in the evaluation of excessive cortisol secretion and follow-up

Eur J Clin Invest. 2019 Feb;49(2):e13048. doi: 10.1111/eci.13048. Epub 2018 Dec 7.


Objective: To evaluate whether the 2016 European Society of Endocrinology (ESE) recommendations for the management of adrenal incidentalomas accurately classifies those patients who do not require further follow-up.

Design and methods: Single centre retrospective study. From 2010 to 2015, 130 patients with adrenal incidentaloma were evaluated and followed-up. Clinical, analytical and radiological data were recorded and the presence of comorbidities was assessed. Patients were grouped as nonfunctional or subclinical Cushing syndrome according to American guidelines; and nonfunctional, possible autonomous cortisol secretion and autonomous cortisol secretion, according to ESE guidelines.

Results: Based on American guidelines, 94% of patients had nonfunctional adrenal incidentalomas and 6% had subclinical Cushing syndrome. Based on ESE guidelines, patients were classified into nonfunctional (54%), possible autonomous cortisol secretion (40%) and autonomous cortisol secretion (6%) groups. No differences were observed in demographic characteristics and comorbidities between groups in either classification. Following ESE guidelines, no patient in the nonfunctional group was reclassified into the possible autonomous or autonomous cortisol secretion groups during follow-up, but one patient in the possible autonomous cortisol secretion group was reclassified into the autonomous cortisol secretion group. Also, 30 patients included in the groups of possible autonomous or autonomous cortisol secretion experienced progression of a comorbidity associated with cortisol excess, with diabetes mellitus as the most frequent comorbidity observed.

Conclusion: Although adrenal incidentalomas with an excess of cortisol secretion were more frequently diagnosed with the new ESE recommendations, patients who did not require longer follow-up after first evaluation were accurately classified.

Keywords: adrenal incidentaloma; autonomous cortisol secretion; subclinical cushing syndrome.

MeSH terms

  • Adrenal Gland Neoplasms / complications
  • Adrenal Gland Neoplasms / therapy*
  • Aftercare
  • Aged
  • Cushing Syndrome / complications
  • Cushing Syndrome / therapy*
  • Diabetes Mellitus, Type 2 / complications
  • Dyslipidemias / complications
  • Female
  • Humans
  • Hydrocortisone / metabolism*
  • Hypertension / complications
  • Male
  • Obesity / complications
  • Practice Guidelines as Topic
  • Retrospective Studies


  • Hydrocortisone

Supplementary concepts

  • Adrenal incidentaloma