ECE2024 Eposter Presentations Adrenal and Cardiovascular Endocrinology (155 abstracts)
Clinical and hormonal characterisation of 71 patients with bilateral macronodular adrenocortical disease (BMAD)
Andreea Vladan 1 , Ionela Baciu 1,2 , Nicoleta Baculescu 1,2 , Iulia Burcea 1,2 , Cristina Capatana 1,2 , Ramona Dobre 1,2 , Roxana Dusceac 2 , Simona Galoiu 1,2 , Radu Iorgulescu 3 , Dan Niculescu 1,2 , Raluca Trifanescu 1,2 , Anda Dumitrascu 2 , Larisa Buduluca 2 , Mircea Diculescu 1,4 , Serban Radian 1,2 & Catalina Poiana 1,2
1Carol Davila University of Medicine and Pharmacy; 2Parhon National Institute of Endocrinology; 3Sf Ioan Emergency Hospital, Bucharest; 4Fundeni Clinical Institute
Background: BMAD is defined as development of multiple large nodules, >1 cm diameter, with bilateral involvement of the adrenal glands. It is typically associated with endogenous Cushing’s syndrome (CS) and occurs in adults, in the 4th-7th decade of life.
Aim: To describe the clinical presentation, the biochemical peculiarities and the management of 71 patients diagnosed with BMAD in a tertiary endocrinology centre.
Results: We described 71 patients with BMAD (54F/17M), aged 65 years old (32-82, median/range), age at onset 61 years old (30-78, median/range). 59 patients were diagnosed incidentally by computed tomography (47), MRI (8) or abdominal ultrasound (4), while 9 of them were referred to the endocrinologist with high suspicion of CS and 2 to be screened for endocrine causes of hypertension. 46 patients were overweight or obese, with a median BMI of 27 kg/m2 (17.5-44.2), 28 patients had diabetes or prediabetes and 56 patients presented hypertension. 37 patients presented CS, 3 of whom associated primary aldosteronism – 19 patients with MACS, 32 patients presented nonfunctional bilateral macronodular adrenocortical disease and one single patient was diagnosed with adrenocortical carcinoma. Cortisol after dexamethasone 1 mg overnight was 3.43 mg/dl (1.04-23.75) in patients with CS. UFC was high in 3 patients with CS. Median ACTH was 5.19 pg/ml (1-19.98) in patients with CS. All patients had done an enhanced computed tomography, the maximum diameter of the adrenal nodule was 2.8 cm (1.19-7.8). 15 patients with CS were screened for aberrantly expressed hormone receptors, 7 patients presented a positive response after a mixed meal, suggestive for GIP expression, 1 patient presented a positive response after Diphereline administration suggestive for GnRH/l H/FSH/beta-hCG expression. 19 patients were submitted to adrenal surgery, 4 of whom needed bilateral adrenalectomy, while the other patients were followed-up. The median follow-up was 3 years (0-19). During follow-up, 2 of the 15 patients who were submitted to unilateral adrenalectomy had inefficient suppression of cortisol in dexamethasone suppression tests.
Conclusions: Diagnosis of BMAD in our cohort was done mainly by imaging. CS due to BMAD is frequently pauci-symptomatic, warranting biochemical screening in patients with metabolic syndrome and atypical Cushing’s. Bilateral adrenalectomy is curative. Management depends on the severity of Cushing’s and availability of medical therapy (requiring biochemical aberrant adrenal receptor profiling). Patients subjected to conservative management need long-term follow-up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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