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The clinical significance of adrenal incidentalomas.
MedLine Citation:
PMID:  21210792     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background  The term adrenal incidentaloma (AI) indicates an adrenal mass lesion > 1 cm in diameter discovered during testing for conditions unrelated to adrenal disease. The overall prevalence of these lesions ranges between 3% and 10%. Their incidence increases with age, and it is clinically important to identify AI associated with hormonal activity and/or malignant potential. Design  A detailed Medline search of all English language articles related to AI was carried out, and the clinical implications related to their hormonal activity and malignant potential are discussed. Results  The subclinical hypercortisolism observed in a significant percentage of patients with AI is associated with some of the detrimental effects of continuous autonomous cortisol secretion, including a higher prevalence of hypertension, dyslipidaemia, impaired glucose tolerance or type 2 diabetes mellitus and an increased risk for osteoporotic fractures. However, it remains to be proven whether treatment to reverse subtle glucocorticoid excess is beneficial. Clinically silent phaeochromocytomas and primary adrenal cancer are conditions associated with significantly high morbidity and mortality and require urgent treatment, while the prevalence and clinical significance of autonomous mineralocorticoid secretion are less clearly defined. Size and radiological features are the main predictors of malignant potential. Conclusions  Patients harbouring AI should be evaluated for the possibility of malignancy and/or subclinical hypercortisolism which is associated with cardiovascular risk and bone loss. However, in the absence of prospective controlled studies correlating biochemical activity with end-organ complications, the long-term consequences of AI remain uncertain and their management remains largely pragmatic. Eur J Clin Invest 2010.
Authors:
Ioannis I Andoulakis; Gregory Kaltsas; George Piaditis; Ashley B Grossman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-7
Journal Detail:
Title:  European journal of clinical investigation     Volume:  -     ISSN:  1365-2362     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0245331     Medline TA:  Eur J Clin Invest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.
Affiliation:
Department of Pathophysiology, National University of Athens, Mikras Asias, Athens, Greece Department of Endocrinology and Diabetes, General Hospital of Athens 'G. Genimatas', Leoforos Mesogion, Athens, Greece Department of Endocrinology, St Bartholomew's Hospital, Barts and the London School of Medicine, West Smithfield, London, UK.
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