Radio diagnosis

The researches find that the tumors found incidentally on imaging tests that are either non functioning or have mild cortisol excess are highly unlikely to grow significantly or to develop into cancer or Cushing syndrome, US and UK researchers have found. The results of this new meta-analysis therefore suggest that guidelines on the management of these tumors need to be update to reflect the clinical reality  that is; therefore patients do not need repeat imaging or testing over years of follow-up; say the authors.

Imaging tests for tumors

Adrenal masses are increasingly being detect incidentally when patients are undergoing ultrasound, MRI, or CT scans; and are find in around 5% of the general population. Because The majority are non functioning adrenal tumors (NFATs) and benign. However, around 15% are associate with excess hormone secretion, which, if not properly controlled; can lead to subclinical Cushing syndrome or; as more recently termed; mild autonomous cortisol excess.

Mild autonomous cortisol excess and even NFAT may be associate with increase cardiometabolic risk, and how they are followed-up and managed is the subject of debate. “These considerable differences in recommendations reflect the inadequacy of evidence that informs guidelines;” said senior author of the new meta-analysis; Irina Bancos, MD, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, in a press release issued by the University of Birmingham, UK, whose scientists collaborated on the work.

Increased cardiometabolic risk

“Therefore; they set out to provide new evidence to determine how many NFAT and mild autonomous cortisol excess tumors increase in size and how often they can cause severe cortisol excess or develop into cancerous tumors;” Bancos added. The study was published online June 25 in Annals of Internal Medicine by lead author Yasir S. Elhassan, MBBS, of University of Birmingham Institute of Metabolism and Systems Research, UK.

In an accompanying editorial, Massimo Terzolo, MD, and Giuseppe Reimondo, MD, PhD, San Luigi Gonzaga Hospital, University of Turin, Italy; praise Elhassan and colleagues for the “careful” way in which the study was conducted. And they stress that the “most novel finding of the present study is that both patients with nonfunctioning tumors and those with tumors causing autonomous cortisol secretion had at baseline and developed during follow-up comorbid conditions and incident cardiovascular events.”

Nonfunctioning tumors

Elhassan and colleagues identified 32 studies involving 4000 patients with noncancerous adrenal tumors that were classified as NFAT; mild autonomous cortisol excess, or either one or the other. therefore The research showed that only 2.5% of adrenal incidentalomas grew to a clinically significant degree over almost 4 years of follow-up. Moreover; none of the patients developed adrenal carcinoma and a tiny proportion developed overt Cushing syndrome.