A Study of Adrenal Incidentaloma-Related Hormonal Assays After First Integration of the Diagnosis Within Primary Healthcare
Abstract
1. Introduction
Objective
2. Patients and Methods
- clinical aspects and medical records (active malignancies or malignancies under surveillance protocols; subjects under exogenous glucocorticoids exposure (current or during the previous year); suggestive endocrine phenotype for any hormonal ailment)
- radiological appearance (subjects with distinct imaging features at CT scan such as suspected/confirmed primary or secondary adrenal malignancy, adrenal cysts, or myelolipomas)
- endocrine assays consistent with a diagnosis of pheochromocytoma, Conn’s syndrome, or Cushing’s syndrome
3. Results
3.1. Baseline Clinical and Hormonal Features
3.2. Age-Decade Analysis
3.3. Correlations Between the Adrenal Incidentaloma Features
3.4. Gender Analysis
3.5. Unilateral Versus Bilateral Incidentalomas
3.6. MACS-Positive Versus MACS-Negative Profile in Adrenal Tumors
4. Discussion
4.1. Demographic Features and Clinical Picture in Subjects with Adrenal Incidentalomas
4.2. Adrenal Tumor Imaging Assessment Amid CT Scan
4.3. Hormonal Profile in Adrenal Incidentalomas: Focus on MACS
4.4. From Disease Burden to Healthcare System Integration of Patients with Adrenal Incidentalomas
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACTH | adrenocorticotropic hormone |
BMI | body mass index |
CT | computed tomography |
CI | confidence interval |
C-B | baseline morning plasma cortisol |
C-6 pm | plasma cortisol at 6 p.m. |
C-1 mg-DST | second-day plasm cortisol after 1 mg dexamethasone test |
HBP | high blood pressure |
M | median |
N | number of patients |
NFAs | nonfunctioning adrenal adenomas |
Q | quartile |
SD | standard deviation |
T2DM | type 2 diabetes mellitus |
vs. | versus |
UFC | 24-h urinary free cortisol |
Appendix A
References
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Parameter | Descriptive Statistics | Value |
---|---|---|
Female | N (%) | 47 (78.33) |
HBP | N (%) | 40 (66.67) |
T2D | N (%) | 17 (28.37) |
Age (years) | Mean ± SD | 60.72 ± 10.62 |
Median (Q1, Q3) | 63.00 (54.00, 67.00) | |
Minimum, maximum | 40.00, 82.00 | |
BMI (kg/sqm) | Mean ± SD | 30.37 ± 5.03 |
Median (Q1, Q3) | 29.85 (26.94, 32.91) | |
Minimum, maximum | 20.00, 43.63 |
Parameter | Descriptive Statistics | Value |
---|---|---|
MACS-positive | N (%) | 14 (23.33) |
Unilateral tumor | N (%) | 44 (73.33) |
Right tumor | N (%) | 18 (30.00) |
Left tumor | N (%) | 26 (43.33) |
Bilateral tumors | N (%) | 16 (26.67) |
Largest tumor diameter (mm) | Mean ± SD | 26.08 ± 8.78 |
Median (Q1, Q3) | 25.50 (19.00, 32.00) | |
Minimum, maximum | 10.00, 51.00 | |
ACTH (pg/mL) (7.20–63.30) | Mean ± SD | 19.19 ± 12.44 |
Median (Q1, Q3) | 14.50 (11.44, 21.00) | |
Minimum, maximum | 8.00, 62.44 | |
C-B (μg/dL) (6.24–18.00) | Mean ± SD | 14.55 ± 5.07 |
Median (Q1, Q3) | 13.90 (10.68, 18.00) | |
Minimum, maximum | 5.73, 34.20 | |
C-6 pm (μg/dL) (2.69–10.40) | Mean ± SD | 5.09 ± 2.34 |
Median (Q1, Q3) | 4.83 (3.20, 6.62) | |
Minimum, maximum | 1.30, 11.50 | |
C-1 mg-DST (μg/dL) (<1.8) | Mean ± SD | 1.94 ± 2.16 |
Median (Q1, Q3) | 1.32 (0.10, 1.79) | |
Minimum, maximum | 0.67, 14.50 | |
UFC (μg/24 h) (11.50–102.00) | Mean ± SD | 38.53 ± 27.51 |
Median (Q1, Q3) | 34.70 (21.60, 45.85) | |
Minimum, maximum | 9.50, 148.80 |
Age Group (Years) | N (%) | Largest Tumor Diameter (mm) Mean ± SD | 95% CI | p-Value |
---|---|---|---|---|
40–49 | 10 (16.66) | 28.00 ± 11.72 | 19.62–36.38 | 0.535 |
50–59 | 15 (25.00) | 25.09 ± 6.05 | 21.75–28.44 | |
60–69 | 24 (40.00) | 26.43 ± 8.54 | 22.83–30.04 | |
70–79 | 8 (13.33) | 27.38 ± 11.19 | 18.02–36.73 | |
80–89 | 3 (5.00) | 18.33 ± 0.58 | 16.90–19.77 |
Age Group (Years) | Bilateral Tumors N (%) | Right Adrenal Tumor N (%) | Left Adrenal Tumor N (%) | p-Value |
---|---|---|---|---|
40–49 | 2 (20.00) | 4 (40.00) | 4 (40.00) | 0.735 |
50–59 | 7 (46.67) | 3 (20.00) | 5 (33.33) | |
60–69 | 5 (20.83) | 8 (33.33) | 11 (45.83) | |
70–79 | 1 (12.50) | 2 (25.00) | 5 (62.50) | |
80–89 | 1 (33.33) | 1 (33.33) | 1 (33.33) |
Age Group (Years) | N (%) | MACS N (%) | Non-MACS N (%) | p-Value |
---|---|---|---|---|
40–49 | 10 (16.66) | 2 (20.00) | 8 (80.00) | 0.330 |
50–59 | 15 (25.00) | 4 (26.67) | 11 (73.33) | |
60–69 | 24 (40.00) | 4 (16.67) | 20 (83.33) | |
70–79 | 8 (13.33) | 4 (50.00) | 4 (50.00) | |
80–89 | 3 (5.00) | 0 (0.00) | 3 (100.00) |
Largest Tumor Diameter (mm) | ACTH (pg/mL) | C-B (μg/dL) | C-6 pm (μg/dL) | C-1 mg-DST (μg/dL) | UFC (μg/24 h) | |
---|---|---|---|---|---|---|
Age (years) | p = 0.677 r = −0.038 | p = 0.365 r = 0.019 | p = 0.107 r = −0.145 | p = 0.275 r = −0.098 | p = 0.759 r = 0.028 | p = 0.341 r = 0.086 |
BMI (kg/sqm) | p = 0.583 r = 0.049 | p = 0.481 r = 0.147 | p = 0.030 r = −0.193 | p = 0.515 r = −0.058 | p = 0.198 r = −0.114 | p = 0.038 r = −0.185 |
Largest tumor diameter (mm) | p = 0.415 r = 0.183 | p = 0.627 r = 0.044 | p = 0.325 r = 0.088 | p = 0.007 r = 0.241 | p = 0.999 r = 0.000 | |
ACTH (pg/mL) | p = 0.415 r = 0.183 | p = 0.255 r = 0.069 | p = 0.194 r = −0.043 | p = 0.135 r = −0.030 | p = 0.520 r = −0.171 | |
C-B (μg/dL) | p = 0.627 r = 0.044 | p = 0.255 r = 0.069 | p < 0.001 r = 0.320 | p = 0.623 r = −0.043 | p = 0.011 r = 0.226 | |
C-6 pm (μg/dL) | p = 0.325 r = 0.088 | p = 0.194 r = −0.043 | p < 0.001 r = 0.320 | p = 0.010 r = 0.229 | p = 0.108 r = 0.143 | |
C-1 mg-DST (μg/dL) | p = 0.007 r = 0.241 | p = 0.135 r = −0.030 | p = 0.632 r = −0.043 | p = 0.010 r = 0.229 | p = 0.326 r = 0.087 | |
UFC (μg/24 h) | p = 0.999 r = 0.000 | p = 0.520 r = −0.171 | p = 0.011 r = 0.226 | p = 0.108 r = 0.143 | p = 0.326 r = 0.087 |
Parameter | Descriptive Statistics | Female (N = 47, 78.33%) | Male (N = 13, 21.67%) | p-Value |
---|---|---|---|---|
HBP | N (%) | 30 (63.82) | 10 (76.92) | 0.902 |
T2D | N (%) | 13 (27.66) | 4 (30.77) | 0.826 |
Age (years) | Mean ± SD | 62.40 ± 10.47 | 54.62 ± 9.11 | 0.018 |
Median (Q1, Q3) | 65.00 (55.00, 69.00) | 58.00(50.00, 61.00) | ||
Minimum, maximum | 44.00, 82.00 | 40.00, 66.00 | ||
BMI (kg/sqm) | Mean ± SD | 30.77 ± 5.29 | 28.94 ± 3.76 | 0.249 |
Median (Q1, Q3) | 30.00 (27.80, 34.36) | 28.08 (25.60, 32.50) | ||
Minimum, maximum | 20.00, 43.63 | 22.85, 34.60 |
Parameter | Descriptive Statistics | Female (N = 47, 78.33%) | Male (N = 13, 21.67%) | p-Value |
---|---|---|---|---|
MACS-positive | N (%) | 11 (23.40) | 3 (23.08) | 0.980 |
Unilateral tumor | N (%) | 34 (72.34) | 10 (76.92) | 0.741 |
Right tumor | N (%) | 13 (27.66) | 5 (38.46) | |
Left tumor | N (%) | 21 (44.68) | 5 (38.46) | |
Bilateral tumors | N (%) | 13 (27.66) | 3 (23.08) | |
Largest tumor diameter (mm) | Mean ± SD | 26.63 ± 9.16 | 24.08 ± 7.23 | 0.357 |
Median (Q1, Q3) | 26.00 (19.00, 32.50) | 25.00 (20.00, 28.00) | ||
Minimum, maximum | 13.00, 51.00 | 10.00, 35.00 | ||
ACTH (pg/mL) (7.20–63.30) | Mean ± SD | 20.47 ± 10.53 | 18.92 ± 11.28 | 0.444 |
Median (Q1, Q3) | 21.20 (13.50, 29.17) | 25.06 (15.10, 32.00) | ||
Minimum, maximum | 11.36, 53.80 | 8.00, 50.37 | ||
C-B (μg/dL) (6.24–18.00) | Mean ± SD | 14.44 ± 5.41 | 14.95 ± 3.74 | 0.755 |
Median (Q1, Q3) | 13.60 (10.30, 18.00) | 14.60 (13.00, 17.30) | ||
Minimum, maximum | 5.73, 34.20 | 8.90, 20.50 | ||
C-6 pm (μg/dL) (2.69–10.40) | Mean ± SD | 5.19 ± 2.54 | 4.71 ± 1.42 | 0.377 |
Median (Q1, Q3) | 4.87 (3.17, 6.86) | 4.63 (4.20, 5.31) | ||
Minimum, maximum | 1.30, 11.50 | 2.21, 7.58 | ||
C-1 mg-DST (μg/dL) (<1.8) | Mean ± SD | 1.99 ± 2.41 | 1.76 ± 0.84 | 0.093 |
Median (Q1, Q3) | 1.20 (0.90, 1.79) | 1.56 (1.34, 1.70) | ||
Minimum, maximum | 0.67, 14.50 | 1.04, 4.33 | ||
UFC (μg/24 h) (11.50–102.00) | Mean ± SD | 40.40 ± 30.04 | 31.75 ± 14.04 | 0.590 |
Median (Q1, Q3) | 34.70 (21.60, 46.55) | 34.70 (22.10, 39.30) | ||
Minimum, maximum | 10.60, 148.80 | 9.50, 57.30 |
Parameter | Descriptive Statistics | Unilateral (N = 44, 73.33%) | Bilateral (N = 16, 26.67%) | p-Value |
---|---|---|---|---|
Female | N (%) | 34 (77.27) | 13 (81.25) | 0.741 |
HBP | N (%) | 28 (63.64) | 12 (75.00) | 0.409 |
T2D | N (%) | 13 (29.55) | 4 (25.00) | 0.730 |
Age (years) | Mean ± SD | 61.41 ± 10.57 | 58.81 ± 10.86 | 0.407 |
Median (Q1, Q3) | 63.00 (53.00, 67.50) | 57.00 (54.50, 65.00) | ||
Minimum, maximum | 44.00, 82.00 | 40.00, 80.00 | ||
BMI (kg/sqm) | Mean ± SD | 30.64 ± 4.71 | 29.63 ± 5.92 | 0.494 |
Median (Q1, Q3) | 30.05 (27.80, 33.30) | 28.92 (24.90, 32.91) | ||
Minimum, maximum | 22.60, 42.50 | 20.00, 43.63 |
Parameter | Descriptive Statistics | Unilateral (N = 44, 73.33%) | Bilateral (N = 16, 26.67%) | p-Value |
---|---|---|---|---|
MACS-positive | N (%) | 9 (20.46) | 5 (31.25) | 0.382 |
Largest tumor diameter (mm) | Mean ± SD | 25.51 ± 9.25 | 27.65 ± 7.38 | 0.408 |
Median (Q1, Q3) | 25.00 (18.00, 30.50) | 29.00 (23.00, 33.20) | ||
Minimum, maximum | 13.00, 51.00 | 10.00, 36.00 | ||
ACTH (pg/mL) (7.20–63.30) | Mean ± SD | 19.55 ± 10.96 | 22.67 ± 13.03 | 0.517 |
Median (Q1, Q3) | 20.59 (12.06, 28.54) | 25.00 (11.32, 36.03) | ||
Minimum, maximum | 13.85, 62.44 | 12.60, 50.53 | ||
C-B (μg/dL) (6.24–18.00) | Mean ± SD | 14.20 ± 4.49 | 15.53 ± 6.46 | 0.373 |
Median (Q1, Q3) | 13.85 (11.20, 17.60) | 14.60 (10.22, 18.20) | ||
Minimum, maximum | 5.73, 24.60 | 8.29, 34.20 | ||
C-6 pm (μg/dL) (2.69–10.40) | Mean ± SD | 4.69 ± 1.98 | 6.18 ± 2.94 | 0.075 |
Median (Q1, Q3) | 4.65 (3.10, 5.90) | 6.00 (3.50, 8.05) | ||
Minimum, maximum | 1.30, 9.86 | 2.21, 11.50 | ||
C-1 mg-DST (μg/dL) (<1.8) | Mean ± SD | 1.65 ± 1.10 | 2.73 ± 3.74 | 0.867 |
Median (Q1, Q3) | 1.33 (1.00, 1.75) | 1.21 (0.92, 2.49) | ||
Minimum, maximum | 0.67, 5.80 | 0.71, 14.50 | ||
UFC (μg/24 h) (11.50–102.00) | Mean ± SD | 37.79 ± 26.53 | 40.56 ± 30.86 | 0.953 |
Median (Q1, Q3) | 34.80 (21.60, 44.40) | 32.45 (20.30, 46.10) | ||
Minimum, maximum | 9.50, 148.80 | 11.40, 134.40 |
Parameter | Descriptive Statistics | MACS (N = 14, 23.33%) | Non-MACS (N = 46, 76.67%) | p-Value |
---|---|---|---|---|
Female | N (%) | 11 (78.57) | 36 (78.36) | 0.980 |
HBP | N (%) | 9 (64.29) | 31 (67.4) | 0.625 |
T2D | N (%) | 1 (7.14) | 16 (34.78) | 0.044 |
Age (years) | Mean ± SD | 60.21 ± 9.76 | 60.87 ± 10.97 | 0.842 |
Median (Q1, Q3) | 62.00 (51.00, 70.00) | 63.00 (54.00, 67.00) | ||
Minimum, maximum | 44.00, 74.00 | 40.00, 82.00 | ||
BMI (kg/sqm) | Mean ± SD | 28.07 ± 4.83 | 31.07 ± 4.92 | 0.049 |
Median (Q1, Q3) | 27.64 (25.09, 30.21) | 30.05 (27.90, 33.80) | ||
Minimum, maximum | 20.00, 36.41 | 22.85, 43.63 |
Parameter | Descriptive Statistics | MACS (N = 14, 23.33%) | Non-MACS (N = 46, 76.67%) | p-Value |
---|---|---|---|---|
Unilateral tumor | N (%) | 9 (64.29) | 35 (76.09) | 0.382 |
Right tumor | N (%) | 5 (35.71) | 13 (28.26) | |
Left tumor | N (%) | 4 (28.57) | 22 (47.83) | |
Bilateral tumors | N (%) | 5 (35.71) | 11 (23.91) | |
Largest tumor diameter (mm) | Mean ± SD | 30.14 ± 6.81 | 24.84 ± 9.00 | 0.047 |
Median (Q1, Q3) | 32.00 (24.75, 36.00) | 25.00 (18.00, 30.00) | ||
Minimum, maximum | 18.00, 40.00 | 10.00, 51.00 | ||
ACTH (pg/mL) (7.20–63.30) | Mean ± SD | 19.98 ± 9.12 | 21.30 ± 13.02 | 0.371 |
Median (Q1, Q3) | 22.63 (17.03, 31.19) | 25.06 (17.90, 34.62) | ||
Minimum, maximum | 13.59, 49.99 | 12.68, 50.94 | ||
C-B (μg/dL) (6.24–18.00) | Mean ± SD | 15.69 ± 6.81 | 14.21 ± 4.44 | 0.342 |
Median (Q1, Q3) | 13.95 (10.90, 18.10) | 13.90 (9.83, 17.90) | ||
Minimum, maximum | 8.29, 34.20 | 5.73, 21.50 | ||
C-6 pm (μg/dL) (2.69–10.40) | Mean ± SD | 6.40 ± 2.40 | 4.69 ± 2.20 | 0.015 |
Median (Q1, Q3) | 5.81 (4.98, 7.56) | 4.26 (2.98, 5.98) | ||
Minimum, maximum | 2.55, 11.50 | 1.30, 9.86 | ||
C-1 mg-DST (μg/dL) (<1.8) | Mean ± SD | 4.38 ± 3.53 | 1.19 ± 0.33 | <0.001 |
Median (Q1, Q3) | 2.90 (2.23, 5.45) | 1.19 (0.89, 1.45) | ||
Minimum, maximum | 1.88, 14.50 | 0.67, 1.79 | ||
UFC (μg/24 h) (11.50–102.00) | Mean ± SD | 43.41 ± 31.20 | 37.04 ± 26.48 | 0.479 |
Median (Q1, Q3) | 35.20 (26.30, 52.60) | 33.25 (21.60, 45.00) | ||
Minimum, maximum | 10.60, 128.40 | 9.50, 148.80 |
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Sima, O.-C.; Costachescu, M.; Valea, A.; Stanciu, M.; Lebada, I.C.; Nistor, T.V.I.; Ciobica, M.-L.; Nistor, C.; Carsote, M. A Study of Adrenal Incidentaloma-Related Hormonal Assays After First Integration of the Diagnosis Within Primary Healthcare. Diseases 2025, 13, 169. https://doi.org/10.3390/diseases13060169
Sima O-C, Costachescu M, Valea A, Stanciu M, Lebada IC, Nistor TVI, Ciobica M-L, Nistor C, Carsote M. A Study of Adrenal Incidentaloma-Related Hormonal Assays After First Integration of the Diagnosis Within Primary Healthcare. Diseases. 2025; 13(6):169. https://doi.org/10.3390/diseases13060169
Chicago/Turabian StyleSima, Oana-Claudia, Mihai Costachescu, Ana Valea, Mihaela Stanciu, Ioana Codruta Lebada, Tiberiu Vasile Ioan Nistor, Mihai-Lucian Ciobica, Claudiu Nistor, and Mara Carsote. 2025. "A Study of Adrenal Incidentaloma-Related Hormonal Assays After First Integration of the Diagnosis Within Primary Healthcare" Diseases 13, no. 6: 169. https://doi.org/10.3390/diseases13060169
APA StyleSima, O.-C., Costachescu, M., Valea, A., Stanciu, M., Lebada, I. C., Nistor, T. V. I., Ciobica, M.-L., Nistor, C., & Carsote, M. (2025). A Study of Adrenal Incidentaloma-Related Hormonal Assays After First Integration of the Diagnosis Within Primary Healthcare. Diseases, 13(6), 169. https://doi.org/10.3390/diseases13060169