Follow-up of patients with adrenal incidentaloma, in accordance with the European society of endocrinology guidelines: Could we be safe?

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Abstract

Recently, the European Society of Endocrinology (ESE) published new guidelines on the management of adrenal incidentalomas. At the same time Lopez and coworkers published on the Annals of Internal Medicine an important study showing that even patients with non-functioning adrenal tumors have an increased risk of incident diabetes. In consideration of previous data and of the results of the study of Lopez and coworkers, some points emerge from the ESE Guidelines that deserve attention. Firstly, it must be observed that the term “autonomous cortisol secretion,” introduced by the ESE Panel in the place of the commonly used “subclinical hypercortisolism,” seems questionable, since the guidelines do not suggest determining the adrenocorticotroph hormone levels that could give the certain proof of a truly autonomous cortisol secretion. Secondly, the ESE Guidelines suggest against repeated hormonal workup in AI patients with a normal hormonal secretion at initial evaluation, but also in those with a “possible autonomous cortisol secretion,” if in the absence of comorbidities potentially related to hypercortisolism. Thirdly, the ESE Guidelines suggest against further imaging during follow-up in patients with an adrenal mass below 4 cm in size with clear benign features on imaging studies. Considering the available literature data that are briefly summarized in this comment, we believe that no sufficient evidence is available to date for giving sharp-cutting recommendations about the uselessness of a biochemical and morphological follow-up in AI patients, even in those with initially benign and not hypersecreting adrenal adenomas. However, if a recommendation has to be given on the basis of the present evidences, we should suggest to biochemically and morphologically follow-up AI patients for at least 5 years. © 2016, Italian Society of Endocrinology (SIE).
Original languageEnglish
Pages (from-to)331-333
Number of pages3
JournalJournal of Endocrinological Investigation
Volume40
Issue number3
DOIs
Publication statusPublished - 2017

Cite this

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title = "Follow-up of patients with adrenal incidentaloma, in accordance with the European society of endocrinology guidelines: Could we be safe?",
abstract = "Recently, the European Society of Endocrinology (ESE) published new guidelines on the management of adrenal incidentalomas. At the same time Lopez and coworkers published on the Annals of Internal Medicine an important study showing that even patients with non-functioning adrenal tumors have an increased risk of incident diabetes. In consideration of previous data and of the results of the study of Lopez and coworkers, some points emerge from the ESE Guidelines that deserve attention. Firstly, it must be observed that the term “autonomous cortisol secretion,” introduced by the ESE Panel in the place of the commonly used “subclinical hypercortisolism,” seems questionable, since the guidelines do not suggest determining the adrenocorticotroph hormone levels that could give the certain proof of a truly autonomous cortisol secretion. Secondly, the ESE Guidelines suggest against repeated hormonal workup in AI patients with a normal hormonal secretion at initial evaluation, but also in those with a “possible autonomous cortisol secretion,” if in the absence of comorbidities potentially related to hypercortisolism. Thirdly, the ESE Guidelines suggest against further imaging during follow-up in patients with an adrenal mass below 4 cm in size with clear benign features on imaging studies. Considering the available literature data that are briefly summarized in this comment, we believe that no sufficient evidence is available to date for giving sharp-cutting recommendations about the uselessness of a biochemical and morphological follow-up in AI patients, even in those with initially benign and not hypersecreting adrenal adenomas. However, if a recommendation has to be given on the basis of the present evidences, we should suggest to biochemically and morphologically follow-up AI patients for at least 5 years. {\circledC} 2016, Italian Society of Endocrinology (SIE).",
keywords = "Adrenal incidentalomas, ESE Guidelines, Subclinical hypercortisolism, hydrocortisone, adrenal incidentaloma, Article, comorbidity, follow up, human, hydrocortisone release, hypercortisolism, medical society, practice guideline, tumor volume, Adrenal Gland Neoplasms, endocrinology, incidental finding, pathology, standards, Endocrinology, Follow-Up Studies, Humans, Incidental Findings, Practice Guidelines as Topic",
author = "V. Morelli and A. Scillitani and M. Arosio and I. Chiodini",
note = "Export Date: 16 February 2018 CODEN: JEIND",
year = "2017",
doi = "10.1007/s40618-016-0558-x",
language = "English",
volume = "40",
pages = "331--333",
journal = "Journal of Endocrinological Investigation",
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TY - JOUR

T1 - Follow-up of patients with adrenal incidentaloma, in accordance with the European society of endocrinology guidelines: Could we be safe?

AU - Morelli, V.

AU - Scillitani, A.

AU - Arosio, M.

AU - Chiodini, I.

N1 - Export Date: 16 February 2018 CODEN: JEIND

PY - 2017

Y1 - 2017

N2 - Recently, the European Society of Endocrinology (ESE) published new guidelines on the management of adrenal incidentalomas. At the same time Lopez and coworkers published on the Annals of Internal Medicine an important study showing that even patients with non-functioning adrenal tumors have an increased risk of incident diabetes. In consideration of previous data and of the results of the study of Lopez and coworkers, some points emerge from the ESE Guidelines that deserve attention. Firstly, it must be observed that the term “autonomous cortisol secretion,” introduced by the ESE Panel in the place of the commonly used “subclinical hypercortisolism,” seems questionable, since the guidelines do not suggest determining the adrenocorticotroph hormone levels that could give the certain proof of a truly autonomous cortisol secretion. Secondly, the ESE Guidelines suggest against repeated hormonal workup in AI patients with a normal hormonal secretion at initial evaluation, but also in those with a “possible autonomous cortisol secretion,” if in the absence of comorbidities potentially related to hypercortisolism. Thirdly, the ESE Guidelines suggest against further imaging during follow-up in patients with an adrenal mass below 4 cm in size with clear benign features on imaging studies. Considering the available literature data that are briefly summarized in this comment, we believe that no sufficient evidence is available to date for giving sharp-cutting recommendations about the uselessness of a biochemical and morphological follow-up in AI patients, even in those with initially benign and not hypersecreting adrenal adenomas. However, if a recommendation has to be given on the basis of the present evidences, we should suggest to biochemically and morphologically follow-up AI patients for at least 5 years. © 2016, Italian Society of Endocrinology (SIE).

AB - Recently, the European Society of Endocrinology (ESE) published new guidelines on the management of adrenal incidentalomas. At the same time Lopez and coworkers published on the Annals of Internal Medicine an important study showing that even patients with non-functioning adrenal tumors have an increased risk of incident diabetes. In consideration of previous data and of the results of the study of Lopez and coworkers, some points emerge from the ESE Guidelines that deserve attention. Firstly, it must be observed that the term “autonomous cortisol secretion,” introduced by the ESE Panel in the place of the commonly used “subclinical hypercortisolism,” seems questionable, since the guidelines do not suggest determining the adrenocorticotroph hormone levels that could give the certain proof of a truly autonomous cortisol secretion. Secondly, the ESE Guidelines suggest against repeated hormonal workup in AI patients with a normal hormonal secretion at initial evaluation, but also in those with a “possible autonomous cortisol secretion,” if in the absence of comorbidities potentially related to hypercortisolism. Thirdly, the ESE Guidelines suggest against further imaging during follow-up in patients with an adrenal mass below 4 cm in size with clear benign features on imaging studies. Considering the available literature data that are briefly summarized in this comment, we believe that no sufficient evidence is available to date for giving sharp-cutting recommendations about the uselessness of a biochemical and morphological follow-up in AI patients, even in those with initially benign and not hypersecreting adrenal adenomas. However, if a recommendation has to be given on the basis of the present evidences, we should suggest to biochemically and morphologically follow-up AI patients for at least 5 years. © 2016, Italian Society of Endocrinology (SIE).

KW - Adrenal incidentalomas

KW - ESE Guidelines

KW - Subclinical hypercortisolism

KW - hydrocortisone

KW - adrenal incidentaloma

KW - Article

KW - comorbidity

KW - follow up

KW - human

KW - hydrocortisone release

KW - hypercortisolism

KW - medical society

KW - practice guideline

KW - tumor volume

KW - Adrenal Gland Neoplasms

KW - endocrinology

KW - incidental finding

KW - pathology

KW - standards

KW - Endocrinology

KW - Follow-Up Studies

KW - Humans

KW - Incidental Findings

KW - Practice Guidelines as Topic

U2 - 10.1007/s40618-016-0558-x

DO - 10.1007/s40618-016-0558-x

M3 - Article

VL - 40

SP - 331

EP - 333

JO - Journal of Endocrinological Investigation

JF - Journal of Endocrinological Investigation

SN - 0391-4097

IS - 3

ER -