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Abstract：
OBJECTIVE: The uncertainty on the management of small adrenal incidentalomas (AIs) still represents a challenge in real clinical practice. Considering the lack of knowledge on risk factors implicated in tumour enlargement, the aim of this study was to identify risk factors for morphological changes during follow-up of adrenal incidentalomas (AIs).
METHODS: We retrospectively evaluated demographic, clinical, radiological and biochemical parameters of 153 AIs (2007-2021). Patients with histological diagnosis of metastases or pheochromocytoma were excluded. To detect risk factors for tumor enlargement, diseases associated with AIs were included if their prevalence was higher than 2%. Patients were divided into two groups (A: radiological stability; B: tumor enlargement defined as > 5 mm/year in the main diameter).
RESULTS: Group A: 89.5% and group B: 10.5%, mean follow-up 38.6 ± 6.9 months (range 6-240). Tumor enlargement when occurred was within 36 months of follow-up. In group B high body weight (p < 0.03), dehydroepiandrosterone sulfate (DHEAS) (p < 0.05) and direct renin concentration (DRC) (p < 0.04) were higher than group A, while aldosterone levels were lower; moreover, considering comorbidities, glaucoma and dysglycemia (p < 0.01 for both) had higher prevalence in group B. Glaucoma and dysglycemia were independent predictors of enlargement. Patients affected by glaucoma, atrial fibrillation, dysglycemia had a lower dimensional change-free survival than non-affected.
CONCLUSIONS: Glaucoma might be a novel risk factor for AI enlargement. If subtle undetectable cortisol hypersecretion has a role is a topic for further research.
METHODS: We retrospectively evaluated demographic, clinical, radiological and biochemical parameters of 153 AIs (2007-2021). Patients with histological diagnosis of metastases or pheochromocytoma were excluded. To detect risk factors for tumor enlargement, diseases associated with AIs were included if their prevalence was higher than 2%. Patients were divided into two groups (A: radiological stability; B: tumor enlargement defined as > 5 mm/year in the main diameter).
RESULTS: Group A: 89.5% and group B: 10.5%, mean follow-up 38.6 ± 6.9 months (range 6-240). Tumor enlargement when occurred was within 36 months of follow-up. In group B high body weight (p < 0.03), dehydroepiandrosterone sulfate (DHEAS) (p < 0.05) and direct renin concentration (DRC) (p < 0.04) were higher than group A, while aldosterone levels were lower; moreover, considering comorbidities, glaucoma and dysglycemia (p < 0.01 for both) had higher prevalence in group B. Glaucoma and dysglycemia were independent predictors of enlargement. Patients affected by glaucoma, atrial fibrillation, dysglycemia had a lower dimensional change-free survival than non-affected.
CONCLUSIONS: Glaucoma might be a novel risk factor for AI enlargement. If subtle undetectable cortisol hypersecretion has a role is a topic for further research.
摘要：
目的：肾上腺小偶发瘤（AI）治疗的不确定性在实际临床实践中仍然是一个挑战。考虑到缺乏与肿瘤增大有关的危险因素的知识，本研究的目的是确定肾上腺偶发瘤(AI)随访期间形态学改变的危险因素.
方法：我们回顾性评估了人口学，临床,153个AI的放射和生化参数（2007-2021年）。排除组织学诊断为转移或嗜铬细胞瘤的患者。为了检测肿瘤增大的危险因素，如果与AI相关的疾病的患病率高于2%，则将其包括在内。将患者分为两组(A:放射学稳定性;B:定义为主要直径>5mm/年的肿瘤扩大)。
结果：A组：89.5%，B组：10.5%，平均随访38.6±6.9个月（范围6-240）。肿瘤肿大发生在随访36个月内。B组体重较高(p<0.03),硫酸脱氢表雄酮（DHEAS）（p<0.05）和直接肾素浓度（DRC）（p<0.04）均高于A组，而醛固酮水平较低；此外，考虑到合并症，B组青光眼和血糖异常(两者p<0.01)患病率较高。受青光眼影响的患者，心房颤动,与未受影响的患者相比,血糖异常患者的无维度变化生存率较低.
结论：青光眼可能是AI增大的新危险因素。如果微妙的不可检测的皮质醇过度分泌有作用是进一步研究的主题。
方法：我们回顾性评估了人口学，临床,153个AI的放射和生化参数（2007-2021年）。排除组织学诊断为转移或嗜铬细胞瘤的患者。为了检测肿瘤增大的危险因素，如果与AI相关的疾病的患病率高于2%，则将其包括在内。将患者分为两组(A:放射学稳定性;B:定义为主要直径>5mm/年的肿瘤扩大)。
结果：A组：89.5%，B组：10.5%，平均随访38.6±6.9个月（范围6-240）。肿瘤肿大发生在随访36个月内。B组体重较高(p<0.03),硫酸脱氢表雄酮（DHEAS）（p<0.05）和直接肾素浓度（DRC）（p<0.04）均高于A组，而醛固酮水平较低；此外，考虑到合并症，B组青光眼和血糖异常(两者p<0.01)患病率较高。受青光眼影响的患者，心房颤动,与未受影响的患者相比,血糖异常患者的无维度变化生存率较低.
结论：青光眼可能是AI增大的新危险因素。如果微妙的不可检测的皮质醇过度分泌有作用是进一步研究的主题。
