SIPMeL

Login

087 - Up to date 2010 on adrenal incidentaloma: from guidelines to the clinical practice

Autor(s): G. Reimondo, M. Terzolo

Issue: RIMeL - IJLaM, Vol. 6, N. 3-S1, 2010 (MAF Servizi srl ed.)

Page(s): 87-90

Adrenal incidentaloma is not a single entity; conversely, it is an ‘umbrella’ definition encompassing a spectrum of different pathological entities that share the same path of discovery. The likelihood of any specific condition depends greatly on the definition of incidentaloma and the circumstances of discovery. Unfortunately, published reports are inconsistent in applying definite inclusion and exclusion criteria, making their results difficult to interpret. All of the subjects with an incidentally discovered adrenal mass should be screened for either catecholamine excess or hypercortisolism, with the exception of patients with adrenal masses whose imaging characteristics are typical for myelolipoma or adrenal cyst. Primary hyperaldosteronism should be considered in hypertensive and/or hypokalemic patients. A controversial issue is the definition of the subclinical dysfunction detected in patients with adrenal incidentalomas. Available data suggest that the 1 mg DST should be the first screening test; however, there is no consensus on how to perform the test as on the cutpoint values to consider the test as positive. To provide a standard, in 2002 the NIH state-of-the-science conference panel recommended the 1-mg DST with the traditional threshold of 5 g/ dL to define adequate suppression. A recent addition to this controversy comes from the French Society of Endocrinology who recommended a cutoff for the 1-mg DST at 1.8 g/dl in the screening of subclinical Cushing’s syndrome. Conversely, according to the AACE/AAES Medical Guidelines for the Management of Adrenal Incidentalomas, diagnosis of subclinical Cushing’s syndrome is made if the serum cortisol level is more than 5.0 g/dl after a 1-mg DST in a patient with an adrenal adenoma and absence of typical physical stigmas of hypercortisoli sm. Moreover, available data on follow-up of patients with adrenal incidentalomas suggest that the large majority of adrenal lesions classified as benign or non-secreting at diagnosis remain stable over time. However, is biologically plausible to assume that the patients with subclinical Cushing syndrome should suffer from the classic complications of full-blown Cushing’s syndrome, such as arterial hypertension, obesity, or diabetes. Nevertheless, there is still scanty information on the long-term detrimental effects, if any, of silent hypercortisolism.

Article in PDF format

Back to current issue