Incidentaloma natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, patients with adrenal incidentaloma may progress to develop [[Dyslipidemia]], [[Osteoporosis]], [[Hyperglycemia]], [[Malignant hypertension]], [[Intracranial hemorrhage]], [[Acute coronary syndrome]], [[Aortic dissection]], malignant transformation, and metastasis. Prognosis is usually good in benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population. [[Adrenocortical carcinoma]] (ACC) carries a poor prognosis and is unlike most | If left untreated, patients with adrenal incidentaloma may progress to develop [[Dyslipidemia]], [[Osteoporosis]], [[Hyperglycemia]], [[Malignant hypertension]], [[Intracranial hemorrhage]], [[Acute coronary syndrome]], [[Aortic dissection]], [[malignant]] transformation, and [[metastasis]]. Prognosis is usually good in [[benign]] adrenal incidentalomas, death is not directly related to the [[Adrenal mass causes|adrenal mass]], but to [[Cardiovascular Disease|cardiovascular accidents,]] [[malignancy]], and chronic disorders, as observed in the general population. [[Adrenocortical carcinoma]] (ACC) carries a poor prognosis and is unlike most [[tumors]] of the [[Adrenal cortex|adrenal cortex,]] which are [[benign]] ([[adenomas]]) and only occasionally cause [[Cushing's syndrome]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The symptoms of adrenal incidentaloma usually develop in the | *The symptoms of adrenal incidentaloma usually develop in the fifth decade of life, and start with symptoms such as [[weight loss]], [[anorexia]]. [[diabetes]], high incidence of [[vertebral fractures]], [[dyslipidemia]], [[impaired glucose tolerance]] or [[Diabetes mellitus type 2|type 2 diabetes mellitus]], and evidence of [[atherosclerosis]], paroxysmal attacks of [[Hypertension|hypertension,]] [[palpitation]], [[diaphoresis]], [[headache]], [[pallor]], and [[tremor]], [[hypertension]] and [[hypokalemia]]. | ||
*If left untreated, patients with adrenal incidentaloma may progress to develop [[Dyslipidemia]], [[Osteoporosis]], [[Hyperglycemia]], [[Malignant hypertension]], [[Intracranial hemorrhage]], [[Acute coronary syndrome]], [[Aortic dissection]], malignant transformation, and metastasis. | *If left untreated, patients with adrenal incidentaloma may progress to develop [[Dyslipidemia]], [[Osteoporosis]], [[Hyperglycemia]], [[Malignant hypertension]], [[Intracranial hemorrhage]], [[Acute coronary syndrome]], [[Aortic dissection]], [[malignant]] transformation, and [[metastasis]]. | ||
*It seems that the majority of masses | *It seems that the majority of masses remain hormonally and morphologically unchanged.<ref name="pmid1745970">{{cite journal| author=Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM| title=Incidentally discovered adrenal tumors: an institutional perspective. | journal=Surgery | year= 1991 | volume= 110 | issue= 6 | pages= 1014-21 | pmid=1745970 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1745970 }}</ref>Some cases develop [[mass]] enlargement or [[Adrenal gland|adrenal]] hyperfunction.<ref name="pmid11751069">{{cite journal| author=Barzon L, Fallo F, Sonino N, Boscaro M| title=Development of overt Cushing's syndrome in patients with adrenal incidentaloma. | journal=Eur J Endocrinol | year= 2002 | volume= 146 | issue= 1 | pages= 61-6 | pmid=11751069 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11751069 }}</ref> | ||
* Nine precents of cases showed appearance of another [[mass]] in the contralateral [[adrenal gland]].<ref name="pmid9005978">{{cite journal| author=Bondanelli M, Campo M, Trasforini G, Ambrosio MR, Zatelli MC, Franceschetti P et al.| title=Evaluation of hormonal function in a series of incidentally discovered adrenal masses. | journal=Metabolism | year= 1997 | volume= 46 | issue= 1 | pages= 107-13 | pmid=9005978 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9005978 }}</ref>[[Mass]] enlargement was generally limited to 1–2 cm increase in diameter over a period of 1–3 years. | |||
* Reduction or even disappearance of the [[Adrenal mass causes|adrenal mass]] have been reported in up to 40% of adrenal incidentalomas, most often in the case of cystic lesions, hematomas, or adrenal pseudotumors. | |||
* Nine | |||
* Reduction or even disappearance of the adrenal mass have been reported in up to 40% | |||
===Complications=== | ===Complications=== | ||
| Line 40: | Line 36: | ||
===Prognosis=== | ===Prognosis=== | ||
* In the vast majority of patients with apparently benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population.<ref name="pmid9597935">{{cite journal| author=Barry MK, van Heerden JA, Farley DR, Grant CS, Thompson GB, Ilstrup DM| title=Can adrenal incidentalomas be safely observed? | journal=World J Surg | year= 1998 | volume= 22 | issue= 6 | pages= 599-603; discussion 603-4 | pmid=9597935 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9597935 }}</ref> | * In the vast majority of patients with apparently [[benign]] [[Adrenal gland|adrenal]] incidentalomas, death is not directly related to the [[Adrenal mass causes|adrenal mass]], but to cardiovascular accidents, [[malignancy]], and chronic disorders, as observed in the general population.<ref name="pmid9597935">{{cite journal| author=Barry MK, van Heerden JA, Farley DR, Grant CS, Thompson GB, Ilstrup DM| title=Can adrenal incidentalomas be safely observed? | journal=World J Surg | year= 1998 | volume= 22 | issue= 6 | pages= 599-603; discussion 603-4 | pmid=9597935 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9597935 }}</ref> | ||
* | * [[Incidence|Incidences]] of complications are: cardiac disease in 43%, [[malignancy]] in 22%, [[Chronic obstructive pulmonary disease|chronic obstructive pulmonary diseases]] in 11%, [[Alzheimer's disease|azheimer’s disease]] in 6%, [[cerebrovascular accident]] in 4%, [[pneumonia]] or [[sepsis]] in 4%, ruptured [[abdominal aortic aneurysm]] in 2.5%, [[Renal insufficiency|renal failure]] in 2.5%, and other causes in 5%. | ||
* [[Adrenocortical carcinoma]] (ACC) carries a poor prognosis and is unlike most | * [[Adrenocortical carcinoma]] (ACC) carries a poor prognosis and is unlike most [[tumors]] of the [[Adrenal cortex|adrenal cortex,]] which are [[benign]] ([[adenomas]]) and only occasionally cause [[Cushing's syndrome]]. | ||
* Five-year disease-free survival | * Five-year disease-free survival after a complete resection of a stage I–III ACC is 30%. | ||
* The most important prognostic factors are | * The most important prognostic factors are: | ||
* The most common causes of death were related to [[cardiovascular diseases]] ([[acute myocardial infarction]], [[Ventricular arrhythmias|ventricular arrhythmia]], [[Congestive heart failure|cardiac failure]], [[multi-infarct dementia]], and [[Cerebral infarction|acute cerebrovascular infarct]]) | * Age of the patient | ||
* Mean age at death was 72.8 years. | * [[Cancer staging|Stage]] of the [[tumor]] | ||
* [[Mitotic|mitotic activity]] | |||
* Venous [[invasion]] | |||
* Weight of 50g | |||
* Diameter of 6.5 cm | |||
* The most common causes of death were related to [[cardiovascular diseases]] ([[acute myocardial infarction]], [[Ventricular arrhythmias|ventricular arrhythmia]], [[Congestive heart failure|cardiac failure]], [[multi-infarct dementia]], and [[Cerebral infarction|acute cerebrovascular infarct]]). | |||
* [[Mean]] age at death was 72.8 years. | |||
* Whether the relatively high [[Mortality rate|rate of mortality]] due to [[Circulatory system|cardiovascular]] disease is related to [[hypercortisolism]] was not investigated. | * Whether the relatively high [[Mortality rate|rate of mortality]] due to [[Circulatory system|cardiovascular]] disease is related to [[hypercortisolism]] was not investigated. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
If left untreated, patients with adrenal incidentaloma may progress to develop Dyslipidemia, Osteoporosis, Hyperglycemia, Malignant hypertension, Intracranial hemorrhage, Acute coronary syndrome, Aortic dissection, malignant transformation, and metastasis. Prognosis is usually good in benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population. Adrenocortical carcinoma (ACC) carries a poor prognosis and is unlike most tumors of the adrenal cortex, which are benign (adenomas) and only occasionally cause Cushing's syndrome.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of adrenal incidentaloma usually develop in the fifth decade of life, and start with symptoms such as weight loss, anorexia. diabetes, high incidence of vertebral fractures, dyslipidemia, impaired glucose tolerance or type 2 diabetes mellitus, and evidence of atherosclerosis, paroxysmal attacks of hypertension, palpitation, diaphoresis, headache, pallor, and tremor, hypertension and hypokalemia.
- If left untreated, patients with adrenal incidentaloma may progress to develop Dyslipidemia, Osteoporosis, Hyperglycemia, Malignant hypertension, Intracranial hemorrhage, Acute coronary syndrome, Aortic dissection, malignant transformation, and metastasis.
- It seems that the majority of masses remain hormonally and morphologically unchanged.[1]Some cases develop mass enlargement or adrenal hyperfunction.[2]
- Nine precents of cases showed appearance of another mass in the contralateral adrenal gland.[3]Mass enlargement was generally limited to 1–2 cm increase in diameter over a period of 1–3 years.
- Reduction or even disappearance of the adrenal mass have been reported in up to 40% of adrenal incidentalomas, most often in the case of cystic lesions, hematomas, or adrenal pseudotumors.
Complications
- Common complications of adrenal incidentaloma include:[4]
- Hypertension
- Glucose intolerance
- Diabetes mellitus
- Obesity
- Dyslipidemia
- Osteoporosis
- Hyperglycemia due to opposition of insulin effect by high doses of adrenaline secreted by the tumor.
- Malignant hypertension that may cause cerebrovascular accidents such as:
- Metastasis to:
- Lymph nodes
- Bones
- Lungs
- Liver
Prognosis
- In the vast majority of patients with apparently benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population.[5]
- Incidences of complications are: cardiac disease in 43%, malignancy in 22%, chronic obstructive pulmonary diseases in 11%, azheimer’s disease in 6%, cerebrovascular accident in 4%, pneumonia or sepsis in 4%, ruptured abdominal aortic aneurysm in 2.5%, renal failure in 2.5%, and other causes in 5%.
- Adrenocortical carcinoma (ACC) carries a poor prognosis and is unlike most tumors of the adrenal cortex, which are benign (adenomas) and only occasionally cause Cushing's syndrome.
- Five-year disease-free survival after a complete resection of a stage I–III ACC is 30%.
- The most important prognostic factors are:
- Age of the patient
- Stage of the tumor
- mitotic activity
- Venous invasion
- Weight of 50g
- Diameter of 6.5 cm
- The most common causes of death were related to cardiovascular diseases (acute myocardial infarction, ventricular arrhythmia, cardiac failure, multi-infarct dementia, and acute cerebrovascular infarct).
- Mean age at death was 72.8 years.
- Whether the relatively high rate of mortality due to cardiovascular disease is related to hypercortisolism was not investigated.
References
- ↑ Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM (1991). "Incidentally discovered adrenal tumors: an institutional perspective". Surgery. 110 (6): 1014–21. PMID 1745970.
- ↑ Barzon L, Fallo F, Sonino N, Boscaro M (2002). "Development of overt Cushing's syndrome in patients with adrenal incidentaloma". Eur J Endocrinol. 146 (1): 61–6. PMID 11751069.
- ↑ Bondanelli M, Campo M, Trasforini G, Ambrosio MR, Zatelli MC, Franceschetti P; et al. (1997). "Evaluation of hormonal function in a series of incidentally discovered adrenal masses". Metabolism. 46 (1): 107–13. PMID 9005978.
- ↑ Dekkers OM, Horváth-Puhó E, Jørgensen JO, Cannegieter SC, Ehrenstein V, Vandenbroucke JP; et al. (2013). "Multisystem morbidity and mortality in Cushing's syndrome: a cohort study". J Clin Endocrinol Metab. 98 (6): 2277–84. doi:10.1210/jc.2012-3582. PMID 23533241.
- ↑ Barry MK, van Heerden JA, Farley DR, Grant CS, Thompson GB, Ilstrup DM (1998). "Can adrenal incidentalomas be safely observed?". World J Surg. 22 (6): 599–603, discussion 603-4. PMID 9597935.