Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort

Nazlı Gülsoy Kırnap; Sanem Öztekin; Neslihan Başçıl Tütüncü

doi:10.5798/dicletip.706119

Research Article

Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort

Year 2020, Volume: 47 Issue: 1, 154 - 161, 17.03.2020

Nazlı Gülsoy Kırnap Sanem Öztekin Neslihan Başçıl Tütüncü

https://doi.org/10.5798/dicletip.706119

Abstract

Amaç: Başka endikasyonlar ile yapılan görüntülemelerde tespit edilen adrenal insidentaloma (Aİ) vakalarının çoğu nonfonksiyone benign kitlelerdir. Otonom kortizol sekresyonu (OKS) genellikle Aİ’lerin değerlendirilmesi sırasında tanımlanmış bir klinik antitedir. OKS’de Otonom kortizol sekresyonunda artmış kardiyovasküler hastalık (KVH) riski bilinmektedir. Bu çalışmada amacımız; merkezimizde takip edilen Aİ ve özellikle OKS hastalarının uzun dönem klinik, radyolojik ve KVH risk parametrelerini değerlendirmektir.
Yöntemler: Toplam 279 Aİ vakasının klinik, radyolojik, hormonal ve labaratuvar takiplerini retrospektif değerlendirdik.
Bulgular: Aİ’lerin %76,7 ’si nonfonsiyone Aİ (NFAİ), %13,3’i OKS, %3,9’u Cushing sendromu, %1,8’i feokromositoma, %3,6 ’sı primer aldosteronizm, %0,7’si adrenokortikal karsinom (AKK) idi. Ortalama takip süresi 3,5±2,3 (1-14) yıl idi. Feokromositoma ve AKK vakaları diğer adrenal adenomlara göre anlamlı büyüktü (sırası ile 48±16,04, 71,5±16,23 ve ortalama 25,8±12,9 mm p<0,001). OKS’li hastaların toplam adenom boyutu NFAİ’lere göre daha büyüktü (sırası ile 37,3 mm-22,8 mm p<0.001). Adenom boyutu ile 1 mg deksametazon supresyon testi (DST) arasında anlamlı pozitif korelasyon vardı (p=0,001 r=0,21). OKS’li hastalarda NFAİ’lere göre DM veya IFG/IGT varlığı anlamlı yüksekti ( sırası ile %56,8 ve %35,5 p=0,027). NFAİ ve OKS’li hastaların, BMI, AKŞ, HbA1c, LDL kolesterol, TG kolesterol, sistolik ve diastolik TA ortalaması tanıda ve son vizitte benzerdi. Takipte adenom boyutunda anlamlı büyüme saptanmıştır (p=0,001). NFAİ’ler takipte tekrarlanan hormonal aktivite değerlendirmesinde nonfonksiyone kalmıştır.
Sonuç: Aİ’nin boyutu ne kadar büyük ise OKS olma olasılığı o kadar yüksektir. OKS’de DM, IFG/IGT riski yüksektir. OKS’nin klinik takibinde konvansiyonel klinik yaklaşım ve tedavi ile kardiyovasküler risk parametreleri NFAİ’ler gibi seyredebilir.

Keywords

Adrenal insidentaloma, nonfonksiyone adrenal adenom

References

1. 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: 1-36. PMID: 27390021.
2. S.A. Paschou, A. Vryonidou, D.G. Goulis. Adrenal incidentalomas: a guide to assessment, treatment and follow-up. Maturitas. 2016; 92: 79–85. PMID: 27621243.
3. Di Dalmazi G, Pasquali R, Beuschlein F, Reincke M. Subclinical hypercortisolism: a state, a syndrome, or a disease? Eur J Endocrinol. 2015; 173: 61-71. PMID: 26282599.
4. ChiodiniI.Clinical review: diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab. 2011; 96: 1223–36. PMID: 21367932.
5. Chiodini I, Vainicher CE, Morelli V, et al. Mechanisms in endocrinology: endogenous subclinical hypercortisolism and bone: a clinical review. Eur J Endocrinol. 2016; 175: 265–82. PMID: 27412441.
6. Rossi R, Tauchmanova L, Luciano A, et al. Subclinical Cushing’ssyndrome in patientswith adrenal incidentaloma: clinical and biochemical features. JCEM 2000; 85: 1440–8. PMID: 10770179.
7. Terzolo M, Pia A, Ali A, et al. Adrenal incidentaloma: a newcause of the metabolic syndrome? JCEM 2002; 87: 998–1003. PMID: 11889151.
8. Debono M, Bradburn M, Bull M, et al. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. JCEM 2014; 99: 4462–70. PMID: 25238207.
9. Zeiger MA, Thompson GB, Duh Q-Y, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons (AACE/AAES) Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009; 15: 450–3. PMID: 19632968.
10. Nieman LK, Biller BM, Findling JW, et al.The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008; 93: 1526‐40. PMID: 18334580.
11. Morelli V, Scillitani A, Arosio M, Chiodini I. Follow-up of patientswith adrenal incidentaloma, in ordance with the Europeansociety of endocrinology guidelines: Couldwe be safe? J Endocrinol Invest. 2017; 40: 331-3. PMID: 27744612.
12. Koschker AC, Fassnacht M, Hahner S, Weismann D, Allolio B. Adrenocortical carcinoma–improving patient care by establishing new structures. Exp Clin Endocrinol Diabetes. 2006 ; 114: 45-51. Review. PMID: 16570232.
13. Bülow B, Jansson S, Juhlin C, et al. Adrenal incidentaloma - follow-up resultsfrom a Swedish prospective study. Eur J Endocrinol. 2006; 154: 419-23. PMID: 16498055.
14. Kim J, Bae KH, Choi YK, et al. Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinol Metab (Seoul) 2013; 28: 20-5.PMID: 24396646.
15. Russell RP, Masi AT, Richter ED. Adrenal cortical adenomas and hypertension A clinical pathologic analysis of 690 cases with matched controls and a review of the literature. Medicine (Baltimore) 1972; 51: 211–25.PMID: 5021770.
16. Grumbach MM, Biller BM, Braunstein GD, et al. Management of theclinically in apparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003; 138: 424–29. PMID: 12614096.
17. Olsen H, Nordenström E, Bergenfelz A, et al. Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden. Endocrine 2012; 42: 164–73.PMID: 22350586.
18. Vassilatou E, Vryonidou A, Ioannidis D, et al. Bilateral adrenal incidentalomasdifferfromunilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications. Eur J Endocrinol Eur Fed Endocr Soc. 2014; 171: 37–45. PMID: 24743396.
19. Satman I, Omer B, Tutuncu Y, et al. TURDEP-II Study Group. Twelve-yearrends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80. PMID: 23407904.
20. Di Dalmazi G, Vicennati V, Garelli S, et al. Cardiovascular events and mortality in patients with adrenal incidentalomas that are eithernon-secretingor associated within termediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes & Endocrinology. 2014; 2: 396–405. PMID: 24795253.
21. Morelli V, Reimondo G, Giordano R, et al. Long-termfollow-up in adrenal incidentalomas: anItalianmulticenterstudy. JCEM 2014; 99: 827–34. PMID: 24423350.
22. Sbardella E, Minnetti M, D'Aluisio D, et al. Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas. Eur J Endocrinol. 2018; 178: 501-11. PMID: 29510982.
23. Patrova J, Kjellman M, Wahrenberg H, Falhammar H. Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center. Endocrine. 2017; 58: 267-75. PMID: 28887710.
24. 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. Eur J Endocrinol 2010; 162: 779–85. PMID: 20103607.

Year 2020, Volume: 47 Issue: 1, 154 - 161, 17.03.2020

Nazlı Gülsoy Kırnap Sanem Öztekin Neslihan Başçıl Tütüncü

https://doi.org/10.5798/dicletip.706119

Abstract

References

1. 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: 1-36. PMID: 27390021.
2. S.A. Paschou, A. Vryonidou, D.G. Goulis. Adrenal incidentalomas: a guide to assessment, treatment and follow-up. Maturitas. 2016; 92: 79–85. PMID: 27621243.
3. Di Dalmazi G, Pasquali R, Beuschlein F, Reincke M. Subclinical hypercortisolism: a state, a syndrome, or a disease? Eur J Endocrinol. 2015; 173: 61-71. PMID: 26282599.
4. ChiodiniI.Clinical review: diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab. 2011; 96: 1223–36. PMID: 21367932.
5. Chiodini I, Vainicher CE, Morelli V, et al. Mechanisms in endocrinology: endogenous subclinical hypercortisolism and bone: a clinical review. Eur J Endocrinol. 2016; 175: 265–82. PMID: 27412441.
6. Rossi R, Tauchmanova L, Luciano A, et al. Subclinical Cushing’ssyndrome in patientswith adrenal incidentaloma: clinical and biochemical features. JCEM 2000; 85: 1440–8. PMID: 10770179.
7. Terzolo M, Pia A, Ali A, et al. Adrenal incidentaloma: a newcause of the metabolic syndrome? JCEM 2002; 87: 998–1003. PMID: 11889151.
8. Debono M, Bradburn M, Bull M, et al. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. JCEM 2014; 99: 4462–70. PMID: 25238207.
9. Zeiger MA, Thompson GB, Duh Q-Y, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons (AACE/AAES) Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009; 15: 450–3. PMID: 19632968.
10. Nieman LK, Biller BM, Findling JW, et al.The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008; 93: 1526‐40. PMID: 18334580.
11. Morelli V, Scillitani A, Arosio M, Chiodini I. Follow-up of patientswith adrenal incidentaloma, in ordance with the Europeansociety of endocrinology guidelines: Couldwe be safe? J Endocrinol Invest. 2017; 40: 331-3. PMID: 27744612.
12. Koschker AC, Fassnacht M, Hahner S, Weismann D, Allolio B. Adrenocortical carcinoma–improving patient care by establishing new structures. Exp Clin Endocrinol Diabetes. 2006 ; 114: 45-51. Review. PMID: 16570232.
13. Bülow B, Jansson S, Juhlin C, et al. Adrenal incidentaloma - follow-up resultsfrom a Swedish prospective study. Eur J Endocrinol. 2006; 154: 419-23. PMID: 16498055.
14. Kim J, Bae KH, Choi YK, et al. Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinol Metab (Seoul) 2013; 28: 20-5.PMID: 24396646.
15. Russell RP, Masi AT, Richter ED. Adrenal cortical adenomas and hypertension A clinical pathologic analysis of 690 cases with matched controls and a review of the literature. Medicine (Baltimore) 1972; 51: 211–25.PMID: 5021770.
16. Grumbach MM, Biller BM, Braunstein GD, et al. Management of theclinically in apparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003; 138: 424–29. PMID: 12614096.
17. Olsen H, Nordenström E, Bergenfelz A, et al. Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden. Endocrine 2012; 42: 164–73.PMID: 22350586.
18. Vassilatou E, Vryonidou A, Ioannidis D, et al. Bilateral adrenal incidentalomasdifferfromunilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications. Eur J Endocrinol Eur Fed Endocr Soc. 2014; 171: 37–45. PMID: 24743396.
19. Satman I, Omer B, Tutuncu Y, et al. TURDEP-II Study Group. Twelve-yearrends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80. PMID: 23407904.
20. Di Dalmazi G, Vicennati V, Garelli S, et al. Cardiovascular events and mortality in patients with adrenal incidentalomas that are eithernon-secretingor associated within termediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes & Endocrinology. 2014; 2: 396–405. PMID: 24795253.
21. Morelli V, Reimondo G, Giordano R, et al. Long-termfollow-up in adrenal incidentalomas: anItalianmulticenterstudy. JCEM 2014; 99: 827–34. PMID: 24423350.
22. Sbardella E, Minnetti M, D'Aluisio D, et al. Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas. Eur J Endocrinol. 2018; 178: 501-11. PMID: 29510982.
23. Patrova J, Kjellman M, Wahrenberg H, Falhammar H. Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center. Endocrine. 2017; 58: 267-75. PMID: 28887710.
24. 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. Eur J Endocrinol 2010; 162: 779–85. PMID: 20103607.

There are 24 citations in total.

Details

Primary Language	Turkish
Subjects	Health Care Administration
Journal Section	Research Article
Authors	Nazlı Gülsoy Kırnap This is me Sanem Öztekin This is me Neslihan Başçıl Tütüncü This is me
Publication Date	March 17, 2020
Submission Date	August 2, 2019
Published in Issue	Year 2020 Volume: 47 Issue: 1

Cite

APA	Kırnap, N. G., Öztekin, S., & Tütüncü, N. B. (2020). Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort. Dicle Tıp Dergisi, 47(1), 154-161. https://doi.org/10.5798/dicletip.706119
AMA	Kırnap NG, Öztekin S, Tütüncü NB. Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort. diclemedj. March 2020;47(1):154-161. doi:10.5798/dicletip.706119
Chicago	Kırnap, Nazlı Gülsoy, Sanem Öztekin, and Neslihan Başçıl Tütüncü. “Adrenal İnsidentaloma Ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort”. Dicle Tıp Dergisi 47, no. 1 (March 2020): 154-61. https://doi.org/10.5798/dicletip.706119.
EndNote	Kırnap NG, Öztekin S, Tütüncü NB (March 1, 2020) Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort. Dicle Tıp Dergisi 47 1 154–161.
IEEE	N. G. Kırnap, S. Öztekin, and N. B. Tütüncü, “Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort”, diclemedj, vol. 47, no. 1, pp. 154–161, 2020, doi: 10.5798/dicletip.706119.
ISNAD	Kırnap, Nazlı Gülsoy et al. “Adrenal İnsidentaloma Ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort”. Dicle Tıp Dergisi 47/1 (March 2020), 154-161. https://doi.org/10.5798/dicletip.706119.
JAMA	Kırnap NG, Öztekin S, Tütüncü NB. Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort. diclemedj. 2020;47:154–161.
MLA	Kırnap, Nazlı Gülsoy et al. “Adrenal İnsidentaloma Ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort”. Dicle Tıp Dergisi, vol. 47, no. 1, 2020, pp. 154-61, doi:10.5798/dicletip.706119.
Vancouver	Kırnap NG, Öztekin S, Tütüncü NB. Adrenal İnsidentaloma ve Otonom Kortizol Sekresyonu Vakalarının İzlemi: 14 Yıllık Tek Merkez Çalışması- Retrospektif Kohort. diclemedj. 2020;47(1):154-61.

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