ADRENAL İNSİDENTALOMALI HASTALARDA METABOLİK PARAMETRELER

Öz

Amaç: İnsidental olarak tespit edilen adrenal kitlesi olan hastalarda metabolik durumu belirlemek.

Gereç ve Yöntemler: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Endokrinoloji ve Metabolizma
Hastalıkları Bilim dalında Ocak 2010 ve Şubat 2014 tarihleri arasında yatırılarak fonksiyonel tarama yapılan adrenal insidentaloması olan 67 hasta çalışmaya dahil edildi.
Bulgular: 67 hastanın 34’ü erkek, 33’ü kadındı. Hastaların yaş ortalaması 57.1 ± 12, tüm hastaların vücut kütle
indeksi 29.1±6 kg/m² idi. Çalışmaya dahil edilen hastalara fonksiyonel tarama olarak; Cushing Sendromu, feok- romasitoma ve primer hiperaldesteronizme yönelik tarama testleri uygulandı. 67 hastanın 8 tanesi fonksiyone olarak (6 feokromasitoma, 1 Cushing Sendromu, 1 primerhiperaldesteronizm) tespit edildi. Hastaların 38 tane- sinde bozulmuş açlık glikozu veya tip 2 Diabetes Mellitus tespit edildi. Tüm hastaların ortalama glukoz değeri
127.6±18 mg/dl, fonksiyone olmayan hastaların ortalama glukozu 129±62 mg/dl, fonksiyone olan hastaların glukoz ortalaması ise 117.2±32 mg/dl olarak ölçüldü. Tüm hastalarda sistolik kan basıncı 125±18 mm/Hg, dias- tolik kan basıncı ise 77±10.9 mm/Hg olarak ölçüldü. Fonksiyone hastaların ortalama sistolik basıncı 135±10.4 mm/Hg iken, fonksiyone olmayan hastalarda 124±19 mm/Hg tespit edildi. Tüm hastaların trigliserit, HDL, LDL kolesterol ölçümleri alındı. Sırasıyla ortalama değerleri; 157.5±83 mg/dl (normal <150mg/dl), 39.3±9.5 mg/dl (normal >40mg/dl), 120.1±37 mg/dl (normal <100mg/dl) bulundu.

Sonuç: Çalışmamızda sürrenal insidentaloma hastalarının % 56’sında insülin direncini gösteren bozulmuş açlık
glukozu ve Tip 2 DM tespit edilmiştir. Klinik olarak fonksiyonel olmayan adrenal adenomların neden olduğu hafif kortizol fazlalığı tam olarak cushingoid görüntü gelişmesi için yeterli değilse de, insülin direnci ve bunun klinik sonuçlarına neden olabilmektedir. Bu artmış vücut kütle indeksi ve/veya insidentalomalı hastalarda subk- linik cushing sendromu sıklığı ile de ilişkili olabilir.

Anahtar kelimeler: Adrenal insidentalom, Cushing sendromu, İnsülin direnci

ABSTRACT
Aim: Our aim is to determine the metabolic state in patients with incidental adrenal mass.
Material and Methods: 67 patients in whom functional tests about adrenal incidental mass were assessed
in University of Necmettin Erbakan, Faculty of Medicine, Department of Endocrinology and Metabolism, were admitted to the study.
Results: Of these 67 patients, 34 were male and 33 were female. Mean age was 57.1±12, mean body
mass index was 29.1±6 kg/m². In patients enrolled to the study; cushing’s syndrome, pheochromocytoma, primary hyperaldosteronism tests were performed. Functional adrenal mass was detected in 8 patients (6 pheochromocytoma, 1 cushing’s syndrome, 1 primary hyperaldosteronism). Impaired fasting glucose or type
2 diabetes were identified in 38 patients. Mean glucose was 127.6±18 mg/dL in all patients. Mean glucose in patients with functional and non-functional mass were 117.2±32 mg/dL and 129±62 mg/dL respectively. Mean systolic blood pressure was 125±18 mmHg, and diastolic blood pressure was 77±10.9 mmHg in all patients. Mean systolic pressure was 135±10.4 mmHg in patients with functional mass and 124±19 mmHg in patients with non-functional mass. Mean triglyceride was 157.5 ± 83 mg/dL (normal <150), HDL was 39.3 ± 9.5 mg/dL (normal <40) and LDL was 120.1 ± 37 mg/dL (normal <100) in all patients.
Conclusion: In our study, impaired fasting glucose, indicating insulin resistance and Type 2 DM were detected
in 56% of patients with adrenal incidentaloma. Although the mild cortisol excess by non-functional adrenal adenomas is not sufficient for the development of cushingoid appearance, it can lead to insulin resistance and its clinical consequences. Increased body mass index may be associated with subclinical Cushing’s syndrome in patients with incidentaloma.

Key words: Adrenal incidentaloma, Cushing’s syndrome, İnsulin resistance

Anahtar Kelimeler

• Adrenal insidentalom,Cushing sendromu,İnsülin direnci

Öz

Aim:Our aim is to determine the metabolic state in patients with incidental adrenal mass.Material and Methods: 67 patients in whom functional tests about adrenal incidental mass were assessed in University of Necmettin Erbakan, Faculty of Medicine, Department of Endocrinology and Metabolism, were admitted to the study. Results:Of these 67 patients, 34 were male and 33 were female. Mean age was 57.1±12, mean body mass index was 29.1±6 kg/m². In patients enrolled to the study; cushing’s syndrome, pheochromocytoma, primary hyperaldosteronism tests were performed. Functional adrenal mass was detected in 8 patients (6 pheochromocytoma, 1 cushing’s syndrome, 1 primary hyperaldosteronism). Impaired fasting glucose or type 2 diabetes were identified in 38 patients. Mean glucose was 127.6±18 mg/dL in all patients. Mean glucose in patients with functional and non-functional mass were 117.2±32 mg/dL and 129±62 mg/dL respectively. Mean systolic blood pressure was 125±18 mmHg, and diastolic blood pressure was 77±10.9 mmHg in all patients. Mean systolic pressure was 135±10.4 mmHg in patients with functional mass and 124±19 mmHg in patients with non-functional mass. Mean triglyceride was 157.5 ± 83 mg/dL (normal <150), HDL was 39.3 ± 9.5 mg/dL (normal <40) and LDL was 120.1 ± 37 mg/dL (normal <100) in all patients.Conclusion:In our study, impaired fasting glucose, indicating insulin resistance and Type 2 DM were detected in 56% of patients with adrenal incidentaloma. Although the mild cortisol excess by non-functional adrenal adenomas is not sufficient for the development of cushingoid appearance, it can lead to insulin resistance and its clinical consequences. Increased body mass index may be associated with subclinical Cushing’s syndrome in patients with incidentaloma

Anahtar Kelimeler

• Adrenal incidentaloma,Cushing’s syndrome,İnsulin resistance

Kaynakça

1. Carrol TB, Aron DC, Findling JW, Tyrell JB. Glukokortikoidler ve adrenal androjenler, Greenspantemal Ve Klinik Endokrinoloji, çev ed:Tütüncü NB, Güneş Kitabevi, Ankara.2013; 285-328.
2. Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T. The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection. Clinical Endocrinology. 2001;54(6):797–804.
3. Emral R, Uysal AR, Asik M, Gullu S, Corapcioglu D, Tonyukuk V et al. Prevalence of subclinical Cushing’s syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes. Endocrine Journal. 2003.;50(4):399-408.
4. Bernini G, Moretti A, Iacconi P, Miccoli P, Nami R, Lucani B et al. Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery. European Journal of Endocrinology. 2003;148(2): 213–219.
5. Tsuiki M, Tanabe A, Takagi S, Naruse M, Takano K. Cardiovascular risks and their long-term clinical outcome in patients with subclinical Cushing’s syndrome. Endocrine Journal. 2008;55(4):737–745.
6. Chiodini I, Morelli V, Salcuni AS, Eller Vainicher C, Torlontano M, Coletti F et al. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism. Journal of Clinical Endocrinology and Metabolism. 2010;95(6):2736– 26
7. Mantero F, Terzolo M, Arnaldi G, et al. A Survey on Adrenal Incidentaloma in Italy. J Clin Endocrinol Metab. 2000;85(2): 637-644
8. Terzolo M, Pia A, Ali A, et al. Adrenal Incidentaloma: A New Cause of the Metabolic Syndrome. J Clin Endocrinol Metab. 2002;87(3): 998-1003

9. Tauchmanova L, Rossi R, Biondi B, et al. Patients with subclinical Cushing’s syndrome due to adrenal adenoma have increased cardiovasculer risk. J Clin Endocrinol Metab. 2002;87(11):4872-4878
10. Muscogiuri G1, Sorice GP, Prioletta A, Mezza T, Cipolla C, Salomone E, Giaccari A, Pontecorvi A, Della Casa S. The size of adrenal incidentalomas correlates with insulin resistance. Is there a cause-effect relationship? Clin Endocrinol (Oxf). 2011;74(3):300-5.
11. Erbil Y, Ozbey N, Barbaros U, Unalp HR, Salmaslioglu A, Ozarmagan S. Cardiovascular risk in patients with nonfunctional adrenal incidentaloma: myth or reality? World J Surg. 2009;33(10):2099-105. TURAN ve ark.
12. Adrenal İnsidentaloma ve Metabolik Parametreler Bozok Med J 2015;5(2):1-3