NONFONKSİYONE ADRENAL İNSİDENTALOMALARDA İNSULİN REZİSTANSI VE YENİ İNFLAMATUAR BELİRTEÇLER

Yıl 2019, Cilt: 21 Sayı: 3, 406 - 416, 31.12.2019

Zehra Akgün Aşkın Güngüneş Şenay Durmaz

https://doi.org/10.24938/kutfd.611526

Öz

Amaç: Son dönemlerde, nonfonksiyone adrenal insidentaloma
(NFAİ) saptanma sıklığının artması ve bu kitlelerin henüz rutin metodlarla ölçülemeyen
bazı aktif metabolitleri salgıladığına dair ciddi kuşkular uyandırması sebebiyle,
bu çalışmada NFAİ’lı hastalarda yeni inflamatuvar belirteçler olan ortalama trombosit
hacmi (MPV), trombosit dağılım genişliği (PDW), nötrofil/lenfosit oranı (N/L), platelet/lenfosit
(P/L) oranı ile insülin resistansı ilişkisinin belirlenmesi amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya Endokrinoloji polikliniğine başvuran
ve NFAİ tanısı konan 60 hasta ve herhangi bir nedenle çekilen üst abdomen bilgisayarlı
tomografi (BT)’de adrenal kitlesi olmayan ve herhangi başka patolojiye rastlanmayan
60 sağlıklı kontrol grubu dahil edildi.

Bulgular: Kontrol grubu ile fonksiyonel olmayan adrenal
insidentaloma hastaları arasında cinsiyet, yaş, antropometrik ölçümler, açlık plazma
glukozu ve lipid profili açısından anlamlı fark yoktu. Ortalama MPV, PDW, N/L
oranı, P/L oranı karşılaştırıldığında
NFAİ’lı hastalarda sağlıklı kontrol grubuna göre istatistiksel anlamlı fark bulunamadı.
NFAİ hastaları, sağlıklı kontrol grubundan daha yüksek açlık insülin seviyesine
(p=0.016) ve HOMA-IR düzeylerine sahipti (p=0.01). HOMA-IR ile MPV, PDW, N/L
oranı ve P/L oranı arasında
hiçbiri ile korelasyon saptanmadı.

Sonuç: NFAİ hastalarda MPV, N/L, P/L oranları gibi yeni
ateroskleroz ve subklinik inflamatuvar markerlarda değişiklik olmadığını gösterdik.
İnsülin direnci NFAİ hastalarında kontrol grubuna göre daha sık gözlenmektedir ve
bu açıdan hastaların yakın takibi gerekmektedir. Bu hastalardaki insülin direncinin
fizyopatolojisini açıklayacak daha ileri prospektif çalışmalara ihtiyaç vardır. 

Anahtar Kelimeler

Nonfonksiyone adrenal insidentaloma, ortalama trombosit volumu, trombosit dağılım genişliği, nötrofil/lenfosit oranı, platelet/lenfosit oranı, insülin rezistansı

Insulin Resistance in Nonfunctioning Adrenal Incidentaloma and New Inflammatory Markers

Öz

Objective: Due to the increase of incidence of nonfunctioning
adrenal incidentaloma (NFAI) recently, and the suspicion that these masses secrete
some active metabolites that cannot yet be measured by routine methods, we aimed
to determine the relationships between insulin resistance and new inflammatory markers
such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte
ratio (N/L), platelet/lymphocyte ratio (P/L) in patients with NFAI in our study.

Material and Methods: Sixty patients admitted to the endocrinology
outpatient clinic and diagnosed as NFAI and 60 healthy controls without adrenal
mass and no other pathology on upper abdomen computed tomography (CT) for any reason
were included in the study.

Results: There were no significant differences between
control group and patients with NFAI in terms of gender, age, anthropometric measurements,
fasting plasma glucose and lipid profile. The mean MPV, PDW, N/L ratio and P/L
ratio were not significantly
different between healthy control group and NFAI group. The patients with NFAI had
higher fasting insulin level (p=0.016) and
higher HOMA-IR value than their healthy control group (p=0.01). There were no correlations
between HOMA-IR and MPV, PDW, N/L
ratio, P/L ratio.

Conclusion: We demonstrated no difference in new markers of atherosclerosis and systemic inflammation such as MPV, PDW, N/L ratio and P/L ratio in patients with NFAI. Insulin resistance was
more frequent in the patients with NFAI than in controls, therefore, close follow-up
is required. The further prospective studies to explain the
physiopathology of insulin resistance in these patients are needed. 

Anahtar Kelimeler

Nonfunctioning adrenal incidentaloma, mean platelet volume, platelet distribution width, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, insulin resistance

Kaynakça

• 1. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev. 1995;16(4):460-84.
• 2. Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003;138(5):424-9.
• 3. Young WF Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000;29(1):159-85.
• 4. Barzon L, Boscaro M. Diagnosis and management of adrenal incidentalomas. J Urol. 2000;163(2):398-407.
• 5. Song JH, Mayo-Smith WW. Current status of imaging for adrenal gland tumors. Surg Oncol Clin N Am. 2014;23(4):847-61.
• 6. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A 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.
• 7. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A 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(2):637-44.
• 8. Tsagarakis S, Roboti C, Kokkoris P, Vasiliou V, Alevizaki C, Thalassinos N. Elevated post-dexamethasone suppression cortisol concentrations correlate with hormonal alterations of the hypothalamo-pituitary adrenal axis in patients with adrenal incidentalomas. Clin Endocrinol (Oxf). 1998;49(2):165-71.
• 9. Peppa M, Koliaki C, Raptis SA. Adrenal incidentalomas and cardiometabolic morbidity:an emerging association with serious clinical implications. J Intern Med. 2010;268(6:555-66.
• 10. Wagnerova H, Dudasova D, Lazurova I. Hormonal and metabolic evaluation of adrenal incidentalomas. Neoplasma. 2009;56(6):521–5.
• 11. Peppa M, Koliaki C, Nikolopoulos P, Raptis SA. Skeletal muscle insulin resistance in endocrine disease. J Biomed Biotechnol. 2010;2010:527850.
• 12. Ermetici F, Malavazos AE, Corbetta S, Morricone L, Dall'Asta C, Corsi MM et al. Adipokine levels and cardiovascular risk in patients with adrenalincidentaloma. Metabolism. 2007;56(5):686-92.
• 13. Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T, Sasano H. Analysis of cortisol secretion in hormonally inactive adrenocortical incidentalomas: study of in vitro steroid secretion and immunohistochemical localization of steroidogenic enzymes. Endocr J. 2001;48(2):167-74.
• 14. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-The evidence report. National Institutes of Health. Obes Res. 1998;6:51S-209S.
• 15. Deurenberg P, Weststrate JA, Seidell JC. Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr. 1991;65(2):105-114.
• 16. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9.
• 17. Barutçu S, Tuna M M, Kılınç F, Pekkolay Z. Nonfonksiyonel adrenal insidentaloma insülin direnci ile ilişkili olabilir. JCEI. 2014;5(4):589-591.
• 18. Feinstein R, Kanety H, Papa MZ, Lunenfeld B, Karasik A. Tumor necrosis factor-alpha suppresses insulin-induced tyrosine phosphorylation of insulin receptor and its substrates. J Biol Chem. 1993;268(35):26055-8.
• 19. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science.1993;259(5091):87-91.
• 20. Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM et al. The hormone resistin links obesity to diabetes. Nature. 2001;409(6818):307-12.
• 21. Turan E, Kulaksızoğlu M, Karakurt F, Kaya A. Adrenal insidentalomalı hastalarda metabolik parametreler. Bozok Tıp Dergisi. 2015;5(2):1-3.
• 22. Ivović M, Marina LV, Vujović S, Tančić-Gajić M, Stojanović M, Radonjić NV et al. Nondiabetic patients with either subclinical Cushing's or nonfunctional adrenal incidentalomas have lower insulin sensitivity than healthy controls: clinical implications. Metabolism. 2013;62(6):786-92.
• 23. Terzolo M, Pia A, Alì A, Osella G, Reimondo G, Bovio S et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab. 2002;87(3):998-1003.
• 24. Sippel RS, Chen H. Subclinical Cushing's syndrome in adrenal incidentalomas. Surg Clin North Am. 2004;84(3):875-85.
• 25. Terzolo M, Reimondo G, Bovio S, Angeli A. Subclinical Cushing's syndrome. Pituitary. 2004;7(4):217-23.
• 26. Rossi R, Tauchmanova L, Luciano A, Di Martino M, Battista C, Del Viscovo L et al. Subclinical Cushing's syndrome in patients with adrenalincidentaloma: clinical and biochemical features. J Clin Endocrinol Metab. 2000;85(4):1440-8.
• 27. Eller-Vainicher C, Morelli V, Salcuni AS, Torlontano M, Coletti F, Iorio L et al. Post-surgical hypocortisolism after removal of an adrenal incidentaloma:is it predictable by an accurate endocrinological work-up before surgery? Eur J Endocrinol. 2010;162(1):91-9.
• 28. Valli N, Catargi B, Ronci N, Vergnot V, Leccia F, Ferriere JM et al. Biochemical screening for subclinicalcortisol-secreting adenomas amongst adrenal incidentalomas. Eur J Endocrinol. 2001;144(4):401-8.
• 29. Garrapa GG, Pantanetti P, Arnaldi G, Mantero F, Faloia E. Body composition and metabolic features in women with adrenal incidentaloma or Cushing's syndrome. J Clin Endocrinol Metab. 2001;86(11):5301-6.
• 30. Masserini B, Morelli V, Palmieri S, Eller-Vainicher C, Zhukouskaya V et al. Lipid abnormalities in patients with adrenal incidentalomas: role of subclinical hypercortisolism and impaired glucose metabolism. J Endocrinol Invest. 2015;38(6):623-8.
• 31. Peppa M, Boutati E, Koliaki C, Papaefstathiou N, Garoflos E, Economopoulos T et al. Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship? Metabolism. 2010;59(10):1435-41.
• 32. 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. Eur J Endocrinol. 2003;148(2):213-9.
• 33. Androulakis II, Kaltsas G, Piaditis G, Grossman AB. The clinical significance of adrenal incidentalomas. Eur J Clin Invest. 2011;41(5):552-60.
• 34. van Rooy MJ, Pretorius E. Metabolic syndrome, platelet activation and the development of transient ischemic attack or thromboembolic stroke. Thromb Res. 2015;135(3):434-42.
• 35. Kaya H, Ertaş F, İslamoğlu Y, Kaya Z, Atılgan ZA, Çil H et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost. 2014;20(1):50-4.
• 36. Akboga MK, Canpolat U, Yuksel M, Yayla C, Yilmaz S, Turak O et al. Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: A single center large-scale study. Platelets. 2016;27(2):178-83.
• 37. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet-to-lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012;23(4):265–73.
• 38. Coban E, Ozdogan M, Yazicioglu G, Akcit F. The mean platelet volume in patients with obesity. Int J Clin Pract. 2005;59(8):981-2.
• 39. Furuncuoğlu Y, Tulgar S, Dogan AN, Cakar S, Tulgar YK, Cakiroglu B. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci. 2016;20(7):1300-6.
• 40. Altieri B, Tirabassi G, Della Casa S, Ronchi CL, Balercia G, Orio F et al. Adrenocortical tumors and insulin resistance: What is the first step? Int J Cancer. 2016;138(12):2785-94.