Endocrine Abstracts

Background: The majority of adrenal incidentalomas are benign and patients can be reassured, but a personalized and multidisciplinary approach is required when dealing with these lesions, since they might be linked with various comorbidities. The aim of our study was to carry out an in-depth analysis of the biochemical workup of adrenal incidentalomas and comparing the results with controls.

Methods: 252 patients with an incidentally discovered adrenal adenoma were identified. A retrospective cross-sectional analysis of this cohort was carried out. A corresponding cohort of 252 gender and aged-matched patients (+/- 5 years) who underwent a CT scan for a similar indication and on the same day as the cases was recruited. A comparison of numerous parameters was carried out.

Results: From a total cohort of 252 patients, 55.8% were females. The mean age at diagnosis was 69 years (IQR 60-75 years). 84.1% had an overnight dexamethasone suppression test (ODST) performed, out of whom 65.1% had a cortisol post-ODST <50nmol/l. The median longest radiological diameter was 20.0mm (IQR16.0-26.0). From the patients with an adenoma, there was a statistically significant difference between those who were deceased and those alive in the following parameters: MCV (P=0.008), Urea (P=0.046), Age (P=0.006) and T4 (P=0.009). When comparing cases with controls, statistically significant different results were observed in lymphocytes (P=0.002), higher in cases, and total cholesterol (P=0.036), neutrophil-to-lymphocyte ratio (NLR)/monocyte ratio (P=0.006) and NLR/monocyte/platelet ratio (P =0.001), lower in cases. In our cohort, mortality was highest amongst the controls, compared to cases (P =0.015). Among all cases and controls, the following parameters were found to be significantly higher in those still alive at the end of the study: haemoglobin (P<0.001), lymphocytes (P<0.001), total cholesterol (P=0.047), LDL-c (P=0.008), Lymphocyte-monocyte ratio (LMR) (P<0.001) and eGFR (P=0.003). On the other hand, the following parameters were higher in those deceased: Neutrophils (P=0.004), urea (P <0.001), ALP (P =0.001), fasting blood glucose (FBG) (P =0.008), Age (P <0.001), Neutrophil-lymphocyte ratio (NLR) (P<0.001), Platelet-lymphocyte ratio (PLR) (P=0.009), Systemic immune inflammatory index (SII) (P<0.001), NLR/monocyte ratio (P <0.001), NLR/monocyte/platelet ratio (P<0.001) and creatinine (P=0.002).

Conclusion: Our cohort of adrenal adenomas did not exhibit a higher mortality rate compared to controls and some of the haematological parameters linked with increased mortality were more favourable among the adenoma cohort.