Abstract
BackgroundThe escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population. It is currently unclear whether patients with obesity more likely develop AI and the current rise in the prevalence of AI could be at least partly associated with the respective rise in obesity. We compared the prevalence and characteristics of non-functional (NF) and autonomous cortisol secreting (ACS) adrenal incidentalomas (AIs) after the study population was stratified by different body mass indexes (BMI) and age groups.MethodsRetrospective cross-sectional study comprising of 432 patients (40.6% male, 59.4% female) with NFAI (N = 290) and ACS (N = 142), of median age 63.4 (54.0–71.6) years and median BMI 28.6 (25.5–31.7) kg/m2. The data collection contained 11.132 points including demographic, anthropometric, radiologic, hormonal and metabolic parameters.ResultsWe observed 68–87% higher prevalence of AI across different age groups in NFAI and ACS in obese/overweight compared to normal weight subjects. Patients with ACS were older (P = 0.008), with higher basal cortisol (P < 0.001), lower basal DHEAS (P = 0.001), lower suppression DHEAS (P = 0.027) and higher aldosterone (P = 0.039). AIs with ACS were larger than NFAI (P < 0.001). Interestingly, ACS group had lower body mass (P = 0.023) and did not differ in BMI, blood pressure, heart rate, lipid profile, fasting glucose and presence of diabetes mellitus type 2 when compared to NFAI., By contrast to the similarity of metabolic profiles in ACS and NFAI, some components of adverse metabolic traits were rather associated with higher BMI and older age, in particular in NFAI.ConclusionThe prevalence of NFAI and ACS were significantly higher in overweight/obese subgroup across the age distribution. Stratification by age and BMI displayed significant differences in some metabolic traits, in particular in NFAI.
Highlights
The escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population
AI was diagnosed by Computed tomography (CT) (388 (92.2%)), in the rest by magnetic resonance imaging (MRI) [11 missing data]. 183 (43.9%) of patients presented with right-sided AI, 147 (35.3%) with left sided AI
Our study does not prove causality of relationship between obesity and development of AIs, it eloquently portrays the importance of considering the primary role of body mass indexes (BMI) when addressing the prevalence as well as patients’ and tumor’s characteristics in both, autonomous cortisol secreting (ACS) and Nonfunctional adrenal incidentaloma (NFAI) groups
Summary
The escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population. Adrenal incidentaloma (AI) is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease [1] It has recently become increasingly common finding reported in 3–5% in general population [2,3,4] and up to 10% in elderly [5, 6], as compared to mean prevalence of 0.5 to 2% in studies from 80s and 90s [7]. This escalating prevalence has been associated with the improvement of radiologic techniques and widespread imaging in aging population [8]. IR itself has been linked with anabolic and mitogenic effects on adrenal cortex through the activation of insulin and insulin like growth factor 1 (IGF 1) receptors [3]
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