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The relationship between adrenal incidentalomas and mortality risk

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Abstract

Objective

To determine all-cause mortality risk in patients with and without adrenal incidentaloma.

Methods

Retrospective cohort study of patients with CT abdomen performed within 24 h of emergency room presentation at an academic medical center from January 1, 2005, to December 31, 2009, without history of adrenal disease, adrenal lab testing, or cancer. Incidentaloma cohort identified by database query of imaging reports followed by manual review and matched to no-nodule controls at 3:1 on age ± 1 year and exam date ± 3 months. Mortality ascertained by in-hospital deaths and National Death Index query. Survival analysis performed with Kaplan-Meier curves and Cox proportional hazards models.

Results

Among 42,575 adults with abdominal CT exams, 969 adrenal incidentaloma patients and 2907 no-nodule controls were identified. All 3876 individuals entered survival analysis with 31,182 person-years at risk (median follow-up 8.9 years [IQR, 6.9–10.7]). All-cause mortality was significantly higher among those with adrenal incidentalomas (353/969, 36.4%) compared with those without (919/2907, 31.6%; mortality difference 7.6 per 1000 person-years; multivariable-adjusted hazard ratio [aHR] 1.14; 95% CI, 1.003–1.29). Exploratory analyses, limited by missing covariates, found that adrenal incidentalomas were associated with significantly increased incidence of malignancy (aHR 1.61; 95% CI, 1.22–2.12), diabetes (aHR 1.43; 95% CI, 1.18–1.71), heart failure (aHR 1.32; 95% CI, 1.07–1.63), peripheral vascular disease (aHR 1.28; 95% CI, 1.95–1.56), renal disease (aHR 1.21; 95% CI, 1.01–1.44), and chronic pulmonary disease (aHR 1.22; 95% CI, 1.01–1.46) compared with controls.

Conclusions

Adrenal incidentalomas are associated with increased mortality and may represent a clinically valuable biomarker.

Key Points

• Adrenal incidentalomas are associated with increased mortality.

• Adrenal incidentaloma size is not predictive of mortality.

• On exploratory analyses, adrenal incidentalomas are associated with chronic illnesses.

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Abbreviations

AACE:

American Association of Clinical Endocrinologists

AAES:

American Association of Endocrine Surgeons

ACR:

American College of Radiology

aHR:

Adjusted hazard ratio

CI:

Confidence interval

ICD-9:

International Classification of Diseases Ninth Revision

IQR:

Interquartile range

NDI:

National Death Index

SD:

Standard deviation

References

  1. Grumbach MM, Biller BM, Braunstein GD et al (2003) Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 138:424–429

    Article  Google Scholar 

  2. Young WF Jr (2007) Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 356:601–610

    Article  CAS  Google Scholar 

  3. Song JH, Chaudhry FS, Mayo-Smith WW (2008) The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol 190:1163–1168

    Article  Google Scholar 

  4. Hu M, Yip R, Yankelevitz DY, Henschke CI (2016) CT screening for lung cancer: frequency of enlarged adrenal glands identified in baseline and annual repeat rounds. Eur Radiol 26:4475–4481

    Article  Google Scholar 

  5. Mayo-Smith WW, Song JH, Boland GL et al (2017) Management of incidental adrenal masses: a white paper of the ACR incidental findings committee. J Am Coll Radiol 14:1038–1044

    Article  Google Scholar 

  6. Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773

    Article  Google Scholar 

  7. Zeiger MA, Thompson GB, Duh QY et al (2009) American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the management of adrenal incidentalomas: executive summary of recommendations. Endocr Pract 15:450–453

    Article  Google Scholar 

  8. Fassnacht M, Arlt W, Bancos I et al (2016) 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 175:G1–G34

    Article  CAS  Google Scholar 

  9. Kastelan D, Kraljevic I, Dusek T et al (2015) The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations? Eur J Endocrinol 173:275–282

    Article  CAS  Google Scholar 

  10. Cawood TJ, Hunt PJ, O'Shea D, Cole D, Soule S (2009) Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur J Endocrinol 161:513–527

    Article  CAS  Google Scholar 

  11. Kaltsas G, Chrisoulidou A, Piaditis G, Kassi E, Chrousos G (2012) Current status and controversies in adrenal incidentalomas. Trends Endocrinol Metab 23:602–609

    Article  CAS  Google Scholar 

  12. Di Dalmazi G, Vicennati V, Garelli S et al (2014) Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing's syndrome: a 15-year retrospective study. Lancet Diabetes Endocrinol 2:396–405

    Article  Google Scholar 

  13. Morelli V, Reimondo G, Giordano R et al (2014) Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab 99:827–834

    Article  CAS  Google Scholar 

  14. Debono M, Bradburn M, Bull M, Harrison B, Ross RJ, Newell-Price J (2014) Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. J Clin Endocrinol Metab 99:4462–4470

    Article  CAS  Google Scholar 

  15. Patrova J, Kjellman M, Wahrenberg H, Falhammar H (2017) Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center. Endocrine 58:267–275

    Article  CAS  Google Scholar 

  16. Lopez D, Luque-Fernandez MA, Steele A, Adler GK, Turchin A, Vaidya A (2016) “Nonfunctional” adrenal tumors and the risk for incident diabetes and cardiovascular outcomes: a cohort study. Ann Intern Med 165:533–542

    Article  Google Scholar 

  17. Becker J, Woloszyn J, Bold R, Campbell MJ (2018) The adrenal incidentaloma: an opportunity to improve patient care. J Gen Intern Med 33:256

  18. Bellin E, Fletcher DD, Geberer N, Islam S, Srivastava N (2010) Democratizing information creation from health care data for quality improvement, research, and education-the Montefiore Medical Center Experience. Acad Med 85:1362–1368

    Article  Google Scholar 

  19. Bellin E (2017) How to ask and answer questions using electronic medical record data. CreateSpace, North Charleston, South Carolina

  20. Bellin E (2015) Riddles in accountable healthcare: a primer to develop analytic intuition for medical homes and population health. CreateSpace, North Charleston, South Carolina

  21. Quan H, Li B, Couris CM et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682

    Article  Google Scholar 

  22. Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  Google Scholar 

  23. Hong AR, Kim JH, Park KS et al (2017) Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice. Eur J Endocrinol 177:475–483

    Article  CAS  Google Scholar 

  24. Androulakis II, Kaltsas GA, Kollias GE et al (2014) Patients with apparently nonfunctioning adrenal incidentalomas may be at increased cardiovascular risk due to excessive cortisol secretion. J Clin Endocrinol Metab 99:2754–2762

    Article  CAS  Google Scholar 

  25. Akkan T, Altay M, Unsal Y, Dagdeviren M, Beyan E (2017) Nonfunctioning adrenal incidentaloma affecting central blood pressure and arterial stiffness parameters. Endocrine 58:513–520

    Article  CAS  Google Scholar 

  26. Muscogiuri G, Colao A, Orio F (2015) Insulin-mediated diseases: adrenal mass and polycystic ovary syndrome. Trends Endocrinol Metab 26:512–514

    Article  CAS  Google Scholar 

  27. Peppa M, Boutati E, Koliaki C et al (2010) Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship? Metabolism 59:1435–1441

    Article  CAS  Google Scholar 

  28. Kamio T, Shigematsu K, Kawai K, Tsuchiyama H (1991) Immunoreactivity and receptor expression of insulinlike growth factor I and insulin in human adrenal tumors. An immunohistochemical study of 94 cases. Am J Pathol 138:83–91

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Ilvesmaki V, Kahri AI, Miettinen PJ, Voutilainen R (1993) Insulin-like growth factors (IGFs) and their receptors in adrenal tumors: high IGF-II expression in functional adrenocortical carcinomas. J Clin Endocrinol Metab 77:852–858

    CAS  PubMed  Google Scholar 

  30. Corwin MT, Chalfant JS, Loehfelm TW, Fananapazir G, Lamba R, Mayo-Smith WW (2018) Incidentally detected bilateral adrenal nodules in patients without cancer: is further workup necessary? AJR Am J Roentgenol 210:780–784

  31. Derwahl M, Studer H (2002) Hyperplasia versus adenoma in endocrine tissues: are they different? Trends Endocrinol Metab 13:23–28

    Article  CAS  Google Scholar 

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Acknowledgements

The preliminary findings were presented as an oral presentation at the Radiological Society of North America Annual Meeting, November 26, 2018, Chicago, IL.

Funding

This study has received funding by the Einstein Montefiore Department of Radiology and a National Institutes of Health Clinical and Translational Science Awards grant number 1UL-1TR001073 from the National Center for Advancing Translational Sciences.

Author information

Author notes

  1. Michio Taya

    Present address: Graduate Medical Education, Virginia Mason Medical Center, 925 Seneca Street, Seattle, WA, 98101, USA

  2. Viktoriya Paroder

    Present address: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

Authors and Affiliations

  1. Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th Street, Bronx, New York, NY, 10467, USA

    Michio Taya, Viktoriya Paroder & Linda B. Haramati

  2. Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th Street, Bronx, New York, NY, 10467, USA

    Eran Bellin & Linda B. Haramati

  3. Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th Street, Bronx, New York, NY, 10467, USA

    Eran Bellin

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  1. Michio Taya
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Correspondence to Michio Taya.

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The scientific guarantor of this publication is Michio Taya, MD MS.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Taya, M., Paroder, V., Bellin, E. et al. The relationship between adrenal incidentalomas and mortality risk. Eur Radiol 29, 6245–6255 (2019). https://doi.org/10.1007/s00330-019-06202-y

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