Abstract
Due to the growing availability of imaging examinations the percentage of patients with incidentally diagnosed adrenal tumors has increased. The vast majority of these lesions are benign, non-functioning adenomas, although according to various estimates even up to 30%–50% of patients with adrenal incidentaloma may present biochemical hypercortisolemia, without typical clinical features of Cushing’s syndrome. Adrenal adenomas secreting small amounts of glucocorticoids may cause morphological and functional changes in the myocardium and blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with adrenal adenoma. Vascular changes precede the development of cardiovascular diseases and can increase morbidity and mortality in patients with adrenal incidentaloma. This risk may result not only from the traditional risk factors. Seemingly hormonally inactive adrenal tumors can indeed produce small amounts of glucocorticoids that have metabolic implications. Therefore, evaluation of patients with incidental adrenal findings presenting with subclinical cardiovascular disease seems of particular importance.
Highlights
Adrenal incidentaloma (AI) is an abnormal tissue mass in the adrenal gland with diameter ≥1 cm, found during imaging examinations performed for non-endocrine reasons
A similar conclusion was formed by Cansu G.B. et al based on the studies conducted in 35 non-functional adrenal incidentaloma (NFAI) patients with no traditional cardiovascular disease (CVD) risk factors
No differences in the abovementioned parameters were observed between NFAI and subclinical Cushing’s syndrome (SCS)
Summary
Adrenal incidentaloma (AI) is an abnormal tissue mass in the adrenal gland with diameter ≥1 cm, found during imaging examinations performed for non-endocrine reasons. Pheochromocytoma, aldosteronism, or overt cortisol excess due to hyperfunction may be observed in patients with AI. Cortisol excess is the most frequent endocrine dysfunction among patients with. Mansmann et al found 41% of AI to be adenomas, 19% metastases, 10% adrenal cortical carcinoma (ACC), 9% myelolipomas, and 8% pheochromocytomas, with other benign lesions, such as adrenal cysts, ganglioneuromas, hematomas, and infectious or infiltrative lesions representing rare pathologies [10]. ACC is rare finding and can be functional or nonfunctional with regard to hormone synthesis and clinical features. Risk of ACC increases with the diameter of a tumor. High cortisol levels lead to endothelial damage, activation of inflammation, increased oxidative stress, and fibroproliferation, leading to functional and structural change in the heart and blood vessels [21,22]
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