Incidentaloma surgery
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Incidentaloma Microchapters |
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Incidentaloma surgery On the Web |
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American Roentgen Ray Society Images of Incidentaloma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Surgery is the mainstay of treatment for [disease or malignancy].
Surgery
With regard to developing SCS in a nonfunctioning adenoma, Barzon et al. (60) followed 130 patients with an adrenal incidentaloma, and the estimated cumulative risk of developing SCS at 1 and 5 yr was 3.8 and 6.6%, respectively.
Most studies have reported a higher prevalence of hypertension, obesity, insulin resistance, dyslipidemia, and osteoporosis in patients with SCS (22, 52, 53, 61–66).
There is growing evidence for the deleterious effects of excess cortisol on bone in patients of both sexes with SCS.
A high prevalence of vertebral fractures (43 to 72%) has been reported in patients with subclinical hypercortisolism (67–69).
A possible role of glucocorticoid receptor polymorphism in determining metabolic and bone complications in patients with adrenal incidentaloma has recently been suggested (70).
The decision to operate should take into account the presence of the metabolic consequences of cortisol excess, as well as the severity of the hypothalamic-pituitary-adrenal (HPA) axis abnormality. In general, the more severe the abnormality of the HPA axis, the more likely the patient would benefit from surgery. In a recent retrospective study of 41 patients with adrenal incidentaloma and SCS, there was a significant improvement in blood pressure and fasting blood glucose in patients who underwent surgery, but a worsening of blood pressure and fasting blood glucose in those who chose to be managed conservatively during a follow-up period of 18–48 months (71). Until the results of prospective studies are available, a reasonable strategy may be to consider adrenalectomy for younger patients and those with new onset or a worsening of underlying comorbidities such as diabetes mellitus, hypertension,
obesity, or osteoporosis (1, 21, 72)