Hormone-inactive adrenal tumors in clinician’s practice

Abstract

Objective. To study the clinical picture, malignancy potential of hormone-inactive adrenal tumors (HIAT) by the results of computed tomography (CT) to identify the most significant clinical and diagnostic signs.

Materials and methods. Case histories of 65 patients operated for HIAT (group 1) and 52 ambulatory records of HIAT patients (group 2) observed in the polyclinic were retrospectively studied. All patients underwent survey, antropometry, biochemical blood analysis, adrenal hormone level, CT of adrenal glands.

Results. The operated patients in 81.6 % of cases were under sixty, nonoperated – in 73 % of cases over sixty. The size of tumor in patients of group 1 in 84.7 % exceeded 4 cm, in group 2 – in 98.1 % was less than 4 cm. HIAT size, CT-density in NF were significantly lower (р = 0,000 and р = 0,000, respectively), but the level of morning cortisol, observation period and age were significantly higher in the group of nonoperated patients. (р = 0,013, р = 0,000 and р = 0,000, respectively). According to the results of comparative analysis of the clinical manifestations of the autonomous cortisol secretion (arterial hypertension, obesity) in the groups of nonoperated and operated patients with HIAT, statistically significant differences were established (р = 0,000, р = 0,002 respectively). In group 1, stage 2 AH was diagnosed more often and obesity – rarely. No statistically significant differences were detected in the analysis of carbohydrate metabolism disorders, osteoporosis, dyslipidemia (р = 0,531, р р = 0,322, р = 0,105). Correlation analysis of HIAT size with the period of dynamic observation and CT-density in NF showed a negative notable (р = -0,606, р = 0,000) and a positive moderate (р = 0,391, р = 0,036) (respectively) tightness of links by Chaddock scale. In case of a 1 cm increase in HIAT size, CT-density in NF is expected to rise by 1,857 HU.

Conclusions. 1. To determine the indications to adrenalectomy, it is necessary to take into account the size and native density of the adrenal tumor by the results of computed tomography as well as clinical and laboratory data. With the values of HIAT size ≥ 4.0 cm in combination with CT-density in NF ≥ 12 HU, adrenalectomy is recommended. 2. In case of a 1 cm increase in HIAT size, rise in CT-density by 1,857 HU is expected. It is worthwhile to control CT-phenotype of HIAT in nonoperated ambulatory patients to determine the malignancy potential of HIAT and up-to-date surgical treatment.

Keywords

adrenal incidentaloma / hormonal-inactive adrenal tumors

References

[1] Nieman L.K., Biller B.M., Findling J.W. et al. Treatment of Cushing's syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015; 100 (8): 2807–2831.

[2] Bel'tsevich D.G., Mel'nichenko G.A., Kuznetsov N.S. et al. Klinicheskie rekomendatsii Rossiyskoy assotsiatsii endokrinologov po differentsial'noy diagnostike intsidentalom nadpochechnikov. Endokrinnaya khirurgiya. 2016; 10 (4): 31–42 (in Russian).

[3] Бельцевич Д.Г., Мельниченко Г.А., Кузнецов Н.С. и др. Клинические рекомендации Российской ассоциации эндокринологов по дифференциальной диагностике инциденталом надпочечников. Эндокринная хирургия. 2016; 10 (4): 31–42.

[4] Manisha H. Shah, Whitney S. Goldner, Thorvardur R. Halfdanarson, et al. NCCN Guidelines Insights: Neuroendocrine and Adrenal Tumors, 2018. J Natl Compr Canc Netw. 2018; 16 (6): 693–702.

[5] Fassnacht M., Arlt W., Bancos I. et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016; 175 (2): G1–G34.

[6] Bovio S., Cataldi A., Reimondo G. et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomo graphy series. J Endocrinol Invest. 2006; 29 (4): 298–302.

[7] Bovio S., Cataldi A., Reimondo G. et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006; 29 (4): 298–302.

[8] Gavras I. The incidentally discovered adrenal mass. N Engl J Med. 2007; 356 (19): 2005–2006.

[9] Eric Mirallié, Claire Blanchard, Cécile Caillard et al. Adrenocortical carcinoma: Impact of surgical treatment. Ann Endocrinol (Paris). 2019; 80 (5–6): 308–313.

[10] Eric Mirallié, Claire Blanchard, Cécile Caillard, et al. Adrenocortical carcinoma: Impact of surgical treatment. Ann Endocrinol (Paris). 2019; 80 (5–6): 308–313.

[11] Jung Min Lee, Mee Kyoung Kim, Seung Hyun Ko et al. Clinical Guidelines for the Management of Adrenal Incidentaloma. Endocrinol Metab (Seoul). 2017; 32 (2): 200–218.

[12] Jung Min Lee, Mee Kyoung Kim, Seung Hyun Ko, et al. Clinical Guidelines for the Management of Adrenal Incidentaloma. Endocrinol Metab (Seoul). 2017; 32 (2): 200–218.

[13] Papierska L., Ćwikła J., Rabijewski M. et al. Adrenal 131I-6β-iodomethylnorcholesterol scintigraphy in choosing the side for adrenalectomy in bilateral adrenal tumors with subclinical hypercortisolemia. Abdom Imaging 2015; 40: 2453–2460.

[14] Dong Wang, Zhi-Gang Ji, Han-Zhong Li, et al. Adrenalectomy was recommended for patients with subclinical Cushing's syndrome due to adrenal incidentaloma. Cancer Biomark. 2018; 21 (2): 367–372.

[15] Valentina Morelli, Serena Palmieri. Adrenal incidentaloma: differential diagnosis and management strategies. Minerva Endocrinol. 2019; 44 (1): 4–18.

[16] Morelli V., Palmieri S. Adrenal incidentaloma: differential diagnosis and management strategies. Minerva Endocrinol. 2019; 44 (1); 4–18.

[17] Morelli V., Palmieri S. Adrenal incidentaloma: differential diagnosis and management strategies. Minerva Endocrinol 2019; 44 (1): 4–18.

[18] Mark Sherlock, Andrew Scarsbrook, Afroze Abbas. Adrenal Incidentaloma. Endocrine Reviews. 2020; 41 (6): 775–820.

[19] Dylan S. Jason, Sarah C. Oltmann. Evaluation of an Adrenal Incidentaloma. Surg Clin North Am. 2019; 99 (4): 721–729.

[20] Unger N. Adrenal incidentaloma: Diagnostic and therapeutic concept from an endocrinological perspective. Chirurg. 2019; 90 (1): 3–8.

[21] Cyrańska-Chyrek E., Grzymisławska M., Ruchała M.. Diagnostic pitfalls of adrenal incidentaloma. Endokrynol Pol. 2017; 68 (3): 360–377.

[22] Ewa Cyrańska-Chyrek, Małgorzata Grzymisławska, Marek Ruchała. Diagnostic pitfalls of adrenal incidentaloma. Endokrynol Pol. 2017; 68 (3): 360–377.

[23] Bokhyan V.Yu., Pavlovskaya A.I., Gubina G.I., Stilidi I.S. Klinicheskaya otsenka gistologicheskikh sistem diagnostiki adrenokortikal'nykh opukholey. Arkhiv patologii. 2015; 77 (3): 17–22.

[24] Бохян В.Ю., Павловская А.И., Губина Г.И., Стилиди И.С. Клиническая оценка гистологических систем диагностики адренокортикальных опухолей. Архив патологии. 2015; 77 (3): 17–22.

[25] Korb T.A., Chernina V.Yu., Blokhin I.A. et al. Vizualizatsiya nadpochechnikov: v norme i pri patologii (obzor literatury). Problemy endokrinologii 2021; 67 (3): 26–36 (in Russian).

[26] Корб Т.А., Чернина В.Ю., Блохин И.А. и др. Визуализация надпочечников: в норме и при патологии (обзор литературы). Проблемы эндокринологии 2021; 67 (3): 26–36.

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