The Relationship between Adrenal Incidentalomas and Mortality Risk

Abstract

Background: The clinical significance of adrenal incidentaloma remain understudied. While increased mortality has been observed in incidentaloma patients with subclinical hypercortisolism, there is no study investigating mortality risk in patients identified prior to endocrinologic referral. This study aimed to determine risk of all-cause mortality in a cohort of patients with and without adrenal incidentaloma. Methods: Retrospective cohort study of patients with CT abdomen performed within 24 hours of emergency room presentation at Montefiore Medical Center in New York City from January 1, 2005 to December 31, 2009, without history of adrenal disease, adrenal lab testing, or cancer. Incidentaloma cohort identified by database query of imaging reports followed by manual review and matched to 'no nodule' controls at 3:1 on age ±1 year and exam date ±3 months. Findings: Among 42575 adults with abdominal CT exams, 969 adrenal incidentaloma patients and 2907 no nodule controls were identified. All 3876 individuals entered survival analysis with 31182 person-years at risk (median follow-up 8·9 years [IQR 6·9-10·7]). All-cause mortality was significantly higher among those with adrenal incidentalomas (353/969, 36.4%) compared to those without (919/2907, 31.6%; mortality difference 7·6 per 1000 person-years; multivariable-adjusted hazard ratio 1·14, 95% CI 1·003-1·29). Interpretation: Adrenal incidentalomas are associated with increased mortality irrespective of tumor phenotype and may represent a clinically valuable biomarker. Funding Statement: Funding to query the NDI database for mortality data was provided by the Einstein Montefiore Department of Radiology. Funding to support the training of the corresponding author in clinical research methods was provided by the National Institutes of Health Clinical and Translational Science Awards Grant Number 1UL-1TR001073. No funding source was involved in the writing or decision to submit this report for publication. The corresponding author had full access to all the data in the study and retains final responsibility for the decision to submit for publication. Declaration of Interests: All authors have nothing to disclose. Ethics Approval Statement: Institutional review board granted approval forand waived the informed consent requirement. The study was compliant with Health Insurance Portability and Accountability Act regulations.