Non functioning adrenal incidentalomas may be associated with insulin resistance

Year 2014, Volume: 5 Issue: 4, 589 - 591, 01.12.2014

Sezgin Barutçu Mazhar Müslüm Tuna Faruk Kılınç Zafer Pekkolay Hikmet Soylu Alpaslan Tuzcu

https://doi.org/10.5799/ahinjs.01.2014.04.0464

Cited By: 1

Abstract

Objective: Adrenal incidentaloma are bulks which are stated incidentally by imagining methods or in abdominal laparotomy when there is no suspicion of any disease in adrenal gland. With increase in using abdominal ultrasonography and BT, the frequency of determining adrenal incidentaloma also increases. In this study, we aimed to examine demographical features and insulin resistance in patients with non functioning adrenal incidentaloma (NFAI). Methods: 30 (20 female–10 male) patients, who followed due to NFAI at Dicle University Medical Faculty Department of Endocrinology between years of 2007-2013, and age, BMI matched 66 healthy subjects were included in the study. Results of physical examination, USG and BT were recorded from patients\' files. All patients were underwent following analyses for excluding a functioning adrenal mass, overnight dexamethasone suppression test, 24 hour urinary metanephrine and normetanephrine, plasma aldosterone/ renin activity ratio. Insulin resistance was calculated in accordance with homeostatic model assessment- insulin resistance formula. Results: The average of age was 45.9 ± 10.9 years and body mass ındex (BMI) 28.5 ± 5.8. There were no significantly difference in terms of age, gender and BMI between groups. Fasting blood glucose and insulin resistance were significantly higher in patients with non-functional adrenal incidentaloma than control group (p=0.022, p=0.005i respectively). No significant difference was found between groups, in terms of LDL, HDL and triglyceride levels. Conclusion: patients with NFAI are more prone to have insulin resistance and hyperglycemia. Thus, clinicians should evaluate those patients with NFAI, in terms of metabolic parameters. J Clin Exp Invest 2014; 5 (4): 589-591

Keywords

adrenal incidentaloma, insulin resistance, homeostatic model assessment

Nonfonksiyonel adrenal insidentaloma insülin direnci ile ilişkili olabilir

Abstract

Amaç: Adrenal insidentalomalar; adrenal bezle ilişkili
herhangi bir hastalık kuşkusu yokken görüntüleme yöntemleri
veya abdominal laparotomide tesadüfen saptanan
kitlelerdir. Abdominal görüntüleme yöntemlerinin kullanımının artması ile adrenal insidentalomaların tespit edilme
sıklığı da artmıştır. Bu çalışmada nonfonksiyonel adrenal
insidentalomalı (NFAI) hastaların demografik özellikleri ve
insülin direncini araştırmayı amaçladık.
Yöntemler: Çalışmaya 2007-2013 yılları arasında Dicle
Üniversitesi Tıp Fakültesi Endokrinoloji Anabilim Dalı’nda
NFAI nedeniyle takip edilen 30 hasta (20 kadın, 10 erkek)
ve 66 sağlıklı birey (44 kadın, 22 erkek) dahil edildi. Hasta
dosyalarından hastalara ait fizik muayene, ultrason, bilgisayarlı
tomografi sonuçları kaydedildi. Tüm hastalara 1
mg deksametazon testi, idrar metanefrin ve normetanefrin,
serum aldosteron ve renin düzeyi bakılmıştı. Açlık kan
şekeri (AKŞ) ve insülin değerleri mevcut olan hastaların
homeostatic model assessment- insulin resistance (HOMA-IR)
formülüne göre insülin direnci hesaplandı, yaş ve
beden kitle indeksi (BKİ) farklı olmayan kontrol grubundaki
sağlıklı bireylerle karşılaştırıldı.
Bulgular: Hastaların yaş ortalaması 45,9±10,9, BKİ
28,5±5,8 kg/m2 idi. Gruplar arasında yaş, cinsiyet ve BKİ
açısından fark yoktu. AKŞ ve HOMA IR, NFAI grubunda
kontrol grubuna göre anlamlı olarak yüksekti (sırasıyla,
p= 0,022 ve p=0,005). LDL, HDL kolesterol ve trigliserid
düzeyleri bakımında gruplar arasında farklılık gözlenmedi
(p > 0,05).
Sonuç: Nonfonksiyonel adrenal insidentalomalı hastalar
insulin direnci ve metabolik parametreler açısından riskli
olduklarından bu açıdan değerlendirilmelidir.

Keywords

Adrenal insidentaloma, insulin direnci, homeostatic model assessment

References

• Barzon L, Sonino N, Fallo F, et al. Prevalence and natu- ral history of adrenal incidentaloma Eur J Endocrinol 2003;149:273-285.
• Herrera MF, Grant CS, van Heerden JA, et al. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991;110:1014–1021.
• J. A. Zarco-González, M. F. Herrera. Adrenal incidentalo- ma. Scand J Surg 2004; 93: 298–301.
• Mantero F, Terzolo M, Arnaldi G. A survey on adrenal inci- dentaloma in Italy. Study group on adrenal tumors of the Italian society of Endocrinology. J Clin Endocrinol Metab 2000; 85: 637-644.
• McAuley KA, Williams SM, Mann JI, et al. Diagnosing in- sulin resistance in the general population. Diabetes Care 2001;24:460–464.
• Pyorala M, Miettinen H, Halonen P, et al. Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow- up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 2000;20:538–544.
• Ivovic M, Vujovic S, Penezic Z, et al. İnsülin sensitivity in patients with adrenal incidentaloma. Srp Arh Celok Lek 2006; 134:315-319.
• Grundy SM, Brewer Jr HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/ American Heart Association Confer- ence on Scientific Issues Related to Definition. Circula- tion 2004;109:433-438.
• Reaven G, Abbasi F, McLaughlin T. Obesity, insulin resis- tance, and cardiovascular disease. Recent Prog Horm Res 2004;59:207-223.
• Ivović M, Marina LV, Vujović S, et al. Metabolism 2013;62:786-792.
• Peppa M, Boutati E, Kollaki C, et al. Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship? Me- tabolism 2010;59:1435-1441.
• Ernetici F, Malavazos AE, Corbetta S, et al. Adipokine levels and cardiovascular risk in patients with adrenal in- cidentaloma. Metabolism 2007;56:686-692.
• Tuna MM, Imga NN, Doğan BA, et al. Non-functioning adrenal incidentalomas are associated with higher hyper- tension prevalence and higher risk of atherosclerosis. J Endocrinol Invest 2014;37:765-768.
• Arduc A, Isik S, Ozuguz U, et al. Relationship between thyroid nodules and non-functioning adrenal incidentalo- mas and their association with insulin resistance. Endocr Res 2014;39:99-104.
• Garrapa G, Paola P, Giorgio A, et al. Body composi- tion in adrenal ıncidentaloma. J Clin Endocrinol Metab 2001;86:5301–5306.