Clinical characteristics of incidental adrenal masses and relationship with hematological indices as indicators of inflammation

Abstract

Adrenal incidentaloma (AI) is being diagnosed more frequently due to the increase in use of imaging modalities. Inflammatory processes can play a role in the development and prognosis of numerous diseases. We aimed to investigate the clinical and endocrinological characteristics of adrenal adenoma and its relationship with inflammatory markers. The present study retrospectively analysed 111 patients with adrenal incidentaloma who underwent radiological and clinical examinations between January 2018 and January 2022. Patients diagnosed with Cushing’s syndrome, pheochromocytoma or primary aldosteronism were classified as functional. Inflammation was assessed using neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), glucose lymphocyte ratio (GLR), systemic immune-inflammation index (SII) and prognostic nutritional index (PNI). Of the 111 patients included, 76.6% (n=85) had nonfunctional adenomas and 23.4% (n=26) had functional adenomas. Of the patients with functional adenomas, 50% (n=13) had Cushing’s syndrome, 26.9% (n=7) had pheochromocytoma and 23% (n=6) had primary aldosteronism. The median duration of follow-up was 22.0 (2.0–60.0) months. During the follow-up, two (2.4%) of the 85 patients with non-functional adenomas gained functionality and were diagnosed with Cushing’s disease. Functionality was not significantly associated with NLR, PLR, GLR, SII and PNI levels. There was a negative correlation between cortisol level after the overnight 1 mg dexamethasone suppression test and PNI (r:-0.207, p=0.030). Inflammatory hemogram parameters levels were not significantly different between patients with functional and non-functional adenomas. There was a significant negative correlation between the PNI level and cortisol secretion. PNI, which can be easily calculated by serum albumin level and absolute lymphocyte count, can be a useful guide for clinicians in the follow-up for the prognosis of functional adenoma.