TY - THES A1 - Morell, Sarah T1 - Klinische Charakteristika und Mortalität von Nebennieren-Inzidentalomen mit Fokus auf Nicht-Aldosteron-produzierende adrenokortikale Adenome: eine retrospektive Studie mit dem Patientenkollektiv des Universitätsklinikums Würzburg von 1998 bis 2017 T1 - Clinical characteristics and mortality of adrenal incidentalomas focussing on non-aldosterone-producing adrenocortical adenomas: a retrospective study with the patient collective of the University Hospital Würzburg from 1998 to 2017 N2 - Nebennieren-Inzidentalome werden durch den zunehmenden Einsatz von bildgebenden Methoden immer häufiger zufällig entdeckt. Hierbei liegen vorrangig klinisch unauffällige Nicht-Aldosteron-produzierende adrenokortikale Adenome (NAPACA) vor, wobei Nicht-funktionelle Adenome (NFA) von Tumoren mit (möglicher) autonomen Cortisol-Sekretion (MACS und ACS) zu differenzieren sind. Der Verlauf und die Prognose dieser Patienten werden teilweise noch kontrovers diskutiert. Die wesentlichen Fragestellungen dieser Arbeit lauteten, welche Dynamik Nebennieren-Inzidentalome (und hierbei insbesondere die NAPACA) hinsichtlich Hormonsekretion und Malignitätspotential aufweisen und welchen Einfluss sie auf das Gesamtüberleben der Betroffenen ausüben. In dieser Studie wurde hierfür das Patientenkollektiv des Universitätsklinikums Würzburg zwischen 1998 und 2017 retrospektiv untersucht. Die Zuordnung zu Entitäten und die Interpretation der Daten erfolgte dabei anhand der Empfehlungen der aktuellen Europäischen Leitlinie zum Management von Nebennieren-Inzidentalomen. Für diese Arbeit wurden 357 Patienten mit einem Nebennieren-Inzidentalom identifiziert, von denen 263 (73,7 %) der NAPACA-Gruppe zuzuordnen waren. Im Verlauf kam es bei 39 (10,9 %) der Patienten zu relevanten Veränderungen der endokrinen Aktivität und bei 4 (1,1 %) auch der Dignität, wodurch die Zuordnung zu einer anderen Tumorentität notwendig wurde. In den Mortalitätsanalysen stellten Hormonaktivität und Malignität relevante prognostische Einflüsse bei Patienten mit Nebennieren-Inzidentalom dar. Speziell Patienten mit MACS und ACS wiesen eine höhere Gesamtmortalität auf als solche mit NFA, wobei das Serumcortisol im Dexamethason-Suppressionstest für die multivariaten Cox-Regressionsanalysen als kontinuierliche und nicht kategoriale Variable betrachtet wurde. NAPACA-Patienten starben vorrangig an malignen, kardiovaskulären und infektiösen Ursachen. Zusammenfassend weisen Patienten mit Nebennieren-Inzidentalom im Allgemeinen und mit NAPACA im Speziellen im Verlauf eine geringe endokrinologische und maligne Dynamik auf. Ihr Gesamtüberleben wird maßgeblich von Hormonaktivität und Dignität bzw. von der Höhe des Serumcortisols im Dexamethason-Hemmtest beeinflusst. N2 - Incidental discoveries of adrenal tumors are increasing due to the rising use of imaging. Clinically inapparent non-aldosterone-producing adrenocortical adenomas (NAPACA) are most common, although non-functional adenomas (NFA) should be differentiated from tumors with (possible) autonomous cortisol secretion (MACS and ACS). To what extent the prognosis of patients with adrenal incidentaloma is affected is still a controversial matter. The main questions addressed were the dynamics of adrenal incidentalomas (and in particular NAPACA) with regard to hormone secretion and malignancy potential and what influence they have on the overall survival of those affected. In this study, patients of the University Hospital of Würzburg were retrospectively examined between 1998 and 2017. The workup and interpretation of data was based on the recommendations of the current European guidelines for the management of adrenal incidentalomas. For this work, 357 patients with an adrenal incidentaloma were identified, of which 263 (73.7%) were assigned to the NAPACA group. During the study, relevant changes in endocrine activity occurred in 39 (10.9%) patients and in dignity in 4 (1.1%) patients, which made assignment to a different tumor entity necessary. In the mortality analyses, hormone activity and malignancy were relevant prognostic influences in patients with adrenal incidentaloma. Patients with MACS and ACS in particular had a higher overall mortality than those with NFA, when the serum cortisol in the dexamethasone suppression test was examined as a continuous variable in the multivariate Cox regression analysis. NAPACA patients died primarily from malignant, cardiovascular, and infectious causes. In summary, patients with adrenal incidentaloma in general and with NAPACA in particular show little endocrinological and malignant potentials over the course of the disease. The overall survival is significantly influenced by hormone activity and malignancy or in NAPACA by the level of serum cortisol in the dexamethasone suppression test. KW - Nebenniere KW - Sterblichkeit KW - Tumor KW - Inzidentalom KW - Mortalität KW - Incidentaloma Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-291784 ER - TY - JOUR A1 - Remde, Hanna A1 - Kranz, Stefanie A1 - Morell, Sarah Maria A1 - Altieri, Barbara A1 - Kroiss, Matthias A1 - Detomas, Mario A1 - Fassnacht, Martin A1 - Deutschbein, Timo T1 - Clinical course of patients with adrenal incidentalomas and cortisol autonomy BT - a German retrospective single center cohort study JF - Frontiers in Endocrinology N2 - Background Adrenal incidentalomas with cortisol autonomy are associated with increased cardiovascular morbidity and mortality. Specific data on the clinical and biochemical course of affected patients are lacking. Methods Retrospective study from a tertiary referral centre in Germany. After exclusion of overt hormone excess, malignancy and glucocorticoid medication, patients with adrenal incidentalomas were stratified according to serum cortisol after 1 mg dexamethasone: autonomous cortisol secretion (ACS), >5.0; possible ACS (PACS), 1.9-5.0; non-functioning adenomas (NFA), ≤1.8 µg/dl. Results A total of 260 patients were enrolled (147 women (56.5%), median follow-up 8.8 (2.0-20.8) years). At initial diagnosis, median age was 59.5 (20-82) years, and median tumour size was 27 (10-116) mm. Bilateral tumours were more prevalent in ACS (30.0%) and PACS (21.9%) than in NFA (8.1%). Over time, 40/124 (32.3%) patients had a shift of their hormonal secretion pattern (NFA to PACS/ACS, n=15/53; PACS to ACS, n=6/47; ACS to PACS, n=11/24; PACS to NFA, n=8/47). However, none of the patients developed overt Cushing’s syndrome. Sixty-one patients underwent adrenalectomy (NFA, 17.9%; PACS, 24.0%; ACS, 39.0%). When non-operated patients with NFA were compared to PACS and ACS at last follow-up, arterial hypertension (65.3% vs. 81.9% and 92.0%; p<0.05), diabetes (23.8% vs. 35.6% and 40.0%; p<0.01), and thromboembolic events (PACS: HR 3.43, 95%-CI 0.89-13.29; ACS: HR 5.96, 95%-CI 1.33-26.63; p<0.05) were significantly less frequent, along with a trend towards a higher rate of cardiovascular events in case of cortisol autonomy (PACS: HR 2.23, 95%-CI 0.94-5.32; ACS: HR 2.60, 95%-CI 0.87-7.79; p=0.1). Twenty-five (12.6%) of the non-operated patients died, with higher overall mortality in PACS (HR 2.6, 95%-CI 1.0-4.7; p=0.083) and ACS (HR 4.7, 95%-CI 1.6-13.3; p<0.005) compared to NFA. In operated patients, prevalence of arterial hypertension decreased significantly (77.0% at diagnosis to 61.7% at last follow-up; p<0.05). The prevalence of cardiovascular events and mortality did not differ significantly between operated and non-operated patients, whereas thromboembolic events were significantly less frequent in the surgical treatment group. Conclusion Our study confirms relevant cardiovascular morbidity in patients with adrenal incidentalomas (especially those with cortisol autonomy). These patients should therefore be monitored carefully, including adequate treatment of typical cardiovascular risk factors. Adrenalectomy was associated with a significantly decreased prevalence of hypertension. However, more than 30% of patients required reclassification according to repeated dexamethasone suppression tests. Thus, cortisol autonomy should ideally be confirmed before making any relevant treatment decision (e.g. adrenalectomy). KW - adrenal imaging KW - adrenal tumours KW - autonomous cortisol secretion KW - cardiovascular events KW - cardiovascular risk factors KW - dexamethasone suppression test KW - morbidity KW - mortality Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-316793 SN - 1664-2392 VL - 14 ER -