Ultraschall Med 2017; 38(04): 411-419
DOI: 10.1055/s-0041-107996
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

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

Nebenniereninzidentalome und subklinisches Cushing-Syndrom: eine longitudinale Verlaufsbeobachtung mittels Endosonografie
Maike Collienne
1   Division of Endocrinology & Diabetology, Philipps University Marburg, Faculty of Medicine, University Hospital Marburg, Germany
,
Nina Timmesfeld
2   Institute of Medical Biometry and Epidemiology, Philipps University Marburg, Germany
,
Simona Raluca Bergmann
1   Division of Endocrinology & Diabetology, Philipps University Marburg, Faculty of Medicine, University Hospital Marburg, Germany
,
Joachim Goebel
1   Division of Endocrinology & Diabetology, Philipps University Marburg, Faculty of Medicine, University Hospital Marburg, Germany
,
Peter Herbert Kann
1   Division of Endocrinology & Diabetology, Philipps University Marburg, Faculty of Medicine, University Hospital Marburg, Germany
› Author Affiliations
Further Information

Publication History

28 April 2015

04 September 2015

Publication Date:
03 November 2015 (online)

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.

Zusammenfassung

Ziel Zufällig entdeckte hormonell-inaktive Nebenniereninzidentalome (AI) und solche mit subklinischen Cushing-Syndrom (SCS) erfordern ein diagnostisches Work-up inklusive Verlaufsbeobachtungen. Wir wählten hierfür in dieser Studie die Endosonografie (EUS). Unser Ziel war es, die Wachstumsraten der AI und SCS zu bestimmen.

Material und Methoden In diese retrospektive Analyse wurden 93 der 229 Patienten mit AI und SCS, die in unserer Klinik im Zeitraum von 1997 bis 2013 untersucht wurden, eingeschlossen. Die Verlaufsbeobachtungen erforderten mindestens zwei endosonografische Untersuchungen und die Erfassung des endokrinen Status. Es wurden Renin im Plasma, Aldosteron im Serum, Katecholamine im 24-Stunden-Sammelurin und ein Dexamethason-Hemmtest (2 mg) durchgeführt. Anhand dessen definierten wir drei Gruppen: hormonell-inaktive Adenome (NFA), hormonell-inaktive noduläre Hyperplasien (NFH) und SCS.

Ergebnisse 86 Patienten hatten hormonell-inaktive Tumore [NFM] (59 NFA, 48 NFH) und sieben Patienten hatten ein SCS (10 Tumore). Zu Beginn betrug der durchschnittliche Durchmesser 19,4 (± 9,3) mm (NFM) und 19,6 (± 9,2) mm (SCS). Der durchschnittliche Beobachtungszeitraum war 31,6 ± 28,7 Monate lang. Die geschätzten Wachstumsraten pro Jahr waren gering: 0,35 mm/a [NFA], 0,02 mm/a [NFH] und 0,53 mm/a [SCS]. Weiterhin konnte kein Fortschreiten hinzu einem malignen Wachstumsmuster beobachtet werden.

Schlussfolgerung Die Wachstumsraten aller Tumore waren in dieser Studie gering. Es konnte kein Unterschied zwischen diesen beobachtet werden.

 
  • References

  • 1 Giordano R, Marinazzo E, Berardelli R. et al. Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas. European Journal of Endocrinology 2010; 162: 779-785 ; epub
  • 2 Barzon L, Sonino N, Fallo F. et al. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003; 149: 273-285
  • 3 Young WF. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 2007; 356: 601-610 ; epub
  • 4 Mantero F, Terzolo M, Arnaldi G. et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000; 85: 637-644
  • 5 Durante C, Costante G, Lucisano G. et al. The natural history of benign thyroid nodules. JAMA 2015; 313: 926-935 ; epub
  • 6 Cawood TJ, Hunt PJ, O'Shea D. et al. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?. Eur J Endocrinol 2009; 161: 513-527 ; epub
  • 7 Chiodini I. Clinical review: Diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab 2011; 96: 1223-1236 ; epub
  • 8 Kann PH. Endosonographic Imaging of Benign and Malignant Pheochromocytomas. Journal of Clinical Endocrinology & Metabolism 2004; 89: 1694-1697 ; epub
  • 9 Kann PH, Balakina E, Ivan D. et al. Natural course of small, asymptomatic neuroendocrine pancreatic tumours in multiple endocrine neoplasia type 1: an endoscopic ultrasound imaging study. Endocr Relat Cancer 2006; 13: 1195-1202 ; epub
  • 10 Barzon L. Development of overt Cushing's syndrome in patients with adrenal incidentaloma. European Journal of Endocrinology 2002; 146: 61-66 ; epub
  • 11 Libè R, Dall'Asta C, Barbetta L. et al. Long-term follow-up study of patients with adrenal incidentalomas. Eur J Endocrinol 2002; 147: 489-494
  • 12 Bülow B, Ahrén B. Adrenal incidentaloma--experience of a standardized diagnostic programme in the Swedish prospective study. J Intern Med 2002; 252: 239-246
  • 13 Vassilatou E, Vryonidou A, Michalopoulou S. et al. Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin Endocrinol (Oxf) 2009; 70: 674-679 ; epub
  • 14 Yener S, Ertilav S, Secil M. et al. Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas. J Endocrinol Invest 2010; 33: 32-36 ; epub
  • 15 Arnaldi G, Boscaro M. Adrenal incidentaloma. Best Practice & Research Clinical Endocrinology & Metabolism 2012; 26: 405-419 ; epub
  • 16 Bovio S, Cataldi A, Reimondo G. et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 2006; 29: 298-302
  • 17 Fan J, Tang J, Fang J. et al. Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions. Medical science monitor international medical journal of experimental and clinical research 2014; 20: 2132-2141 ; epub
  • 18 Song JH, Chaudhry FS, Mayo-Smith WW. The Incidental Adrenal Mass on CT: Prevalence of Adrenal Disease in 1049 Consecutive Adrenal Masses in Patients with No Known Malignancy. American Journal of Roentgenology 2008; 190: 1163-1168 ; epub
  • 19 Menegaux F, Chéreau N, Peix J. et al. Management of adrenal incidentaloma. Journal of Visceral Surgery 2014; 151: 355-364 ; epub
  • 20 Nieman LK. Approach to the Patient with an Adrenal Incidentaloma. Journal of Clinical Endocrinology & Metabolism 2010; 95: 4106-4113 ; epub
  • 21 Zeiger MA, Thompson GB, Duh Q. et al. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract 2009; 15: 1-20
  • 22 Morelli V, Masserini B, Salcuni A. et al. Subclinical Hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects. Clinical Endocrinology 2010; ; epub DOI: 10.1111/j.1365-2265.2010.03794.x.
  • 23 Koch CA. In reply. Neurosurgery 2013; 73: E192 ; epub
  • 24 Kann PH, Kann B, Fassbender WJ. et al. Small neuroendocrine pancreatic tumors in multiple endocrine neoplasia type 1 (MEN1): least significant change of tumor diameter as determined by endoscopic ultrasound (EUS) imaging. Exp Clin Endocrinol Diabetes 2006; 114: 361-365 ; epub
  • 25 Waldmann J, Bartsch DK, Kann PH. et al. Adrenal involvement in multiple endocrine neoplasia type 1: results of 7 years prospective screening. Langenbecks Arch Surg 2007; 392: 437-443 ; epub
  • 26 Boland GWL, Blake MA, Hahn PF. et al. Incidental Adrenal Lesions: Principles, Techniques, and Algorithms for Imaging Characterization. Radiology 2008; 249: 756-775 ; epub
  • 27 Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: current status. Am J Roentgenol 2002; 179: 559-568 ; epub
  • 28 Barzon L. Risk Factors and Long-Term Follow-Up of Adrenal Incidentalomas. Journal of Clinical Endocrinology & Metabolism 1999; 84: 520-526 ; epub
  • 29 Grumbach MM. NIH state-of-the-science statement on management of the clinically inapparent adrenal mass ("incidentaloma"). NIH Consens State Sci Statements 2002; 19: 1-25
  • 30 Koch CA, Pacak K, Chrousos GP. The molecular pathogenesis of hereditary and sporadic adrenocortical and adrenomedullary tumors. The Journal of clinical endocrinology and metabolism 2002; 87: 5367-5384 ; epub
  • 31 Aron D, Terzolo M, Cawood T. Adrenal incidentalomas. Best Practice & Research Clinical Endocrinology & Metabolism 2012; 26: 69-82 ; epub
  • 32 Pantalone KM, Gopan T, Remer EM. et al. Change in adrenal mass size as a predictor of a malignant tumor. Endocr Pract 2010; 16: 577-587 ; epub
  • 33 Di Dalmazi G, Vicennati V, Garelli S. et al. Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing's syndrome: a 15-year retrospective study. 2014 http://download.thelancet.com/pdfs/journals/landia/PIIS2213858713702110.pdf (06.03.2014)
  • 34 Di Dalmazi G, Vicennati V, Rinaldi E. et al. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. European Journal of Endocrinology 2012; 166: 669-677 ; epub
  • 35 Kaltsas G, Chrisoulidou A, Piaditis G. et al. Current status and controversies in adrenal incidentalomas. Trends in Endocrinology & Metabolism 2012; 23: 602-609 ; epub
  • 36 Terzolo M, Bovio S, Pia A. et al. Management of adrenal incidentaloma. Best Practice & Research Clinical Endocrinology & Metabolism 2009; 23: 233-243 ; epub
  • 37 Terzolo M, Stigliano A, Chiodini I. et al. AME Position Statement on adrenal incidentaloma. European Journal of Endocrinology 2011; 164: 851-870 ; epub