ECE2022 Eposter Presentations Adrenal and Cardiovascular Endocrinology (131 abstracts)
Tumor enlargement in adrenal incidentaloma is related to glaucoma and statin treatment: are there two new prognostic features?
Alice Ferrero 1 , Tommaso Daffara 2 , Chiara Mele 2 , Marco Zavattaro 3 , Martina Romanisio 2 , Beatrice Cavigiolo 3 , Samuele Costelli 2 , Marina Caputo 3,4 , Paolo Marzullo 3 , Flavia Prodam 3,4 & Gianluca Aimaretti 3
1Endocrinology, Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy; 2Endocrinology, Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy; 3Endocrinology, Università del Piemonte Orientale, Novara, Italy., Department of Translational Medicine, Novara, Italy; 4Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
Aim: The uncertainty on the management of small adrenal incidentalomas (AIs) in guidelines still represents a challenge in real clinical practice. The aim of the study was to identify risk factors for morphological or functional changes during follow-up by using clinical, radiological, and pathological features.
Methods: We retrospectively evaluated demographic (gender and age at diagnosis), clinical (weight, height, body mass index, smoking habit, comorbidities), radiological characteristics (localization, diameter, HU for CT scan; T1 and T2, and the loss of intensity at chemical shift for MRI) and biochemical parameters of adrenal hypersecretion of 177 AIs (2007-2021). To detected risk factors for tumor enlargement or hypersecretion, diseases associated with AIs were included if the prevalence was higher than 2%. Patients were divided into two groups according to dimension during follow-up (group A: radiological stability; group B: tumor enlargement at radiological scans).
Results: 90.4% of patients belongs to group A, while 9.6% to group B. Chronic obstructive pulmonary disease (COPD), neoplasms, and glaucoma were the most frequent associated diseases. Group B showed larger diameter at diagnosis (P=0.09), higher aldosterone (P<0.001), DHEAS (P=0.007), ARR (P=0.01), lower DRC (P <0.04) levels and higher weight than group A. Open laparotomy was chosen most frequently in group B (P <0.004). AI diameter was negatively correlated with age (r −0.159, P <0.04), 17-OHP levels (r −0.461, P=0.05), statin treatment inversely to the drug potency (r −0.193, P <0.02), and positively with ACTH (r 0.198, P=0.06) and urinary normetanephrine levels (r 0.248, P <0.01). Analyzing AIs changing over time, an enlargement occurred within 36 months of follow-up and only glaucoma was an independent predictor of it (B=3.370, exβ =29.077; P <0.005). Considering concomitant treatments, at 36 months of follow-up, 100% of subjects showing an enlargement were not taking statins, compared to 45.2% of subjects with stable disease (P=0.06). Subjects suffering from glaucoma, atrial fibrillation, impaired glucose metabolism (T2DM or IGT), COPD (in males only) had a lower dimensional change-free survival than non-affected.
Conclusions: The presence of glaucoma and treatment with statins seems to be a risk and a protective factor, respectively, for an AI enlargement. Further prospective studies of validation are needed. If subtle undetectable cortisol hypersecretion and proliferation cellular mechanisms have a role are two topics for further research.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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