Endocrine Abstracts

Introduction: Adrenal hyperplasia is found in more than 15% of abdominal imaging procedures in adults, unrelated to endocrine disorders, especially after the COVID era. Adrenal management is consequently recommended.

Aim: To retrospectively evaluate the adrenal status in terms of morphological progression and functional impairment of adrenal function, in a cohort of cases admitted at least yearly in the National Institute of Endocrinology, Bucharest, Romania, between 2019-2023.

Patients and Methods: 141 patients (104 women, 37 men) were evaluated for bilateral adrenal hyperplasia. Adrenal function was assessed by basal and dynamic cortisol (suppression tests) and ACTH, testosterone, DHEA-S, aldosterone and renin as well as urinary and plasma metanephrines and normetanephrines.

Results: There were recorded 18 (12.8%) cases of ACTH dependent Cushing, 14 (9.9%) cases of ACTH independent Cushing, 9 (6.3%) cases of Non Classical congenital adrenal hyperplasia (CAH), 7(4.9%) cases of pheochromocytoma/PPGL, 4 (2.8%) cases of primary hyperaldosteronism, 3 (2.1%) cases of metastatic adrenals, 3 (2.1%) of CCAH and 3(2.1%) paraneoplastic Cushing and 2 (1.4%) of each: adrenal carcinoma and androgens secreting tumors; 58 (41.1%) cases remained non-functional. All PPGL cases underwent surgery with one case of bilateral adrenalectomy. Bilateral adrenal surgery was performed for ACTH independent Cushing (n=2) while unilateral surgery was performed for 7 cases. For ACTH dependent Cushing there was only one case of bilateral adrenalectomy, 7 cases of pituitary surgery and 4 cases of pituitary + bilateral adrenal surgery with only 2 cases where unilateral adrenalectomy was chosen. Only 4 cases of non-functional adrenal lesions underwent unilateral surgery because of their higher growth rate. From those with mild autonomous cortisol secretion (n=18, 12.8%), a number of (n=6) were submitted to unilateral adrenal surgery and declared cured; the site of surgery was decided upon size. From those MACS followed up without surgery, the cortisol autonomy increased during follow-up in 2, remained similar in 8 and diminished in other 2. Several comorbidities (diabetes, high blood pressure, dyslipidemia, osteoporosis) were also subject to follow-up in MACS cases.

Conclusion: The detailed follow-up at 6-12 months of patients with nodular or non-nodular adrenal hyperplasia is required, for proper and individualized management