Insights on the Natural History of Adrenal Incidentalomas
Authors: Massimo Terzolo, Giuseppe Reimondo
Journal: Annals of Internal Medicine (2019)

Editorials16 July 2019Insights on the Natural History of Adrenal IncidentalomasMassimo Terzolo, MD and Giuseppe Reimondo, MD, PhDMassimo Terzolo, MDSan Luigi Gonzaga Hospital, University of Turin, Turin, Italy (M.T., G.R.) and Giuseppe Reimondo, MD, PhDSan Luigi Gonzaga Hospital, University of Turin, Turin, Italy (M.T., G.R.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1482 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The adrenal incidentaloma is possibly the most common adrenal disorder encountered in everyday practice because extensive use of high-resolution cross-sectional imaging frequently leads to the incidental finding of an adrenal tumor (1). These clinically inapparent tumors are called adrenal incidentalomas to highlight their unexpected discovery through a diagnostic work-up done for reasons unrelated to previous suspicion of adrenal disease. Studies show that an adrenal incidentaloma is found in 4% to 5% of abdominal computed tomography scans (1, 2), and because of technological improvements in imaging, this frequency is expected to increase in the near future.The natural history of adrenal ...References1. Aron DC. The adrenal incidentaloma: disease of modern technology and public health problem. Rev Endocr Metab Disord. 2001;2:335-42. [PMID: 11705137] CrossrefMedlineGoogle Scholar2. Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003;138:424-9. [PMID: 12614096] LinkGoogle Scholar3. Bernard MH, Sidhu S, Berger N, et al. A case report in favor of a multistep adrenocortical tumorigenesis. J Clin Endocrinol Metab. 2003;88:998-1001. [PMID: 12629075] CrossrefMedlineGoogle Scholar4. Terzolo M, Bovio S, Reimondo G, et al. Subclinical Cushing's syndrome in adrenal incidentalomas. Endocrinol Metab Clin North Am. 2005;34:423-39, x. [PMID: 15850851] CrossrefMedlineGoogle Scholar5. Elhassan YS, Alahdab F, Prete A, et al. Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess. A systematic review and meta-analysis. Ann Intern Med. 2019;171:107-16. doi:10.7326/M18-3630 LinkGoogle Scholar6. Terzolo M, Stigliano A, Chiodini I, et al; Italian Association of Clinical Endocrinologists. AME position statement on adrenal incidentaloma. Eur J Endocrinol. 2011;164:851-70. [PMID: 21471169] doi:10.1530/EJE-10-1147 CrossrefMedlineGoogle Scholar7. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology clinical practice guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175:G1-34. [PMID: 27390021] doi:10.1530/EJE-16-0467 CrossrefMedlineGoogle Scholar8. Morelli V, Scillitani A, Arosio M, et al. Follow-up of patients with adrenal incidentaloma, in accordance with the European Society of Endocrinology guidelines: could we be safe? J Endocrinol Invest. 2017;40:331-3. [PMID: 27744612] doi:10.1007/s40618-016-0558-x CrossrefMedlineGoogle Scholar9. Di Dalmazi G, Kisker C, Calebiro D, et al. Novel somatic mutations in the catalytic subunit of the protein kinase A as a cause of adrenal Cushing's syndrome: a European multicentric study. J Clin Endocrinol Metab. 2014;99:E2093-100. [PMID: 25057884] doi:10.1210/jc.2014-2152 CrossrefMedlineGoogle Scholar10. Sydney GI, Ioakim KJ, Paschou SA. Insulin resistance and adrenal incidentalomas: a bidirectional relationship. Maturitas. 2019;121:1-6. [PMID: 30704559] doi:10.1016/j.maturitas.2018.12.002 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: San Luigi Gonzaga Hospital, University of Turin, Turin, Italy (M.T., G.R.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1482.Corresponding Author: Massimo Terzolo, MD, Internal Medicine, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano (TO) 10043, Italy; e-mail, massimo.[email protected]it.Current Author Addresses: Drs. Terzolo and Reimondo: Internal Medicine, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano (TO) 10043, Italy.This article was published at Annals.org on 25 June 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNatural History of Adrenal Incidentalomas With and Without Mild Autonomous Cortisol Excess Yasir S. Elhassan , Fares Alahdab , Alessandro Prete , Danae A. Delivanis , Aakanksha Khanna , Larry Prokop , Mohammad H. Murad , Michael W. O'Reilly , Wiebke Arlt , and Irina Bancos Metrics Cited byAge-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort studyAssociation Between Mortality and Levels of Autonomous Cortisol Secretion by Adrenal Incidentalomas A Cohort StudyAlbin Kjellbom, MD, Ola Lindgren, MD, Shobitha Puvaneswaralingam, MD, Magnus Löndahl, MD, and Henrik Olsen, MDMay an adrenal incidentaloma change its nature?Adrenal Incidentalomas are Tied to Increased Risk of Diabetes: Findings from a Prospective StudyIs Follow-up of Adrenal Incidentalomas Always Mandatory?Therapy of mild cortisol excess 16 July 2019Volume 171, Issue 2Page: 135-136KeywordsAdrenal adenomaAdrenal tumorsCardiovascular diseasesCortisolDisclosureEndocrinologyForecastingHormonesHospital medicineSurgery ePublished: 25 June 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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