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.
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。