Adrenal tumors observed in 1.4% of large screening cohort in China
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A little more than 1% of adults in a general screening population who underwent a CT scan had adrenal tumors, and more than two-thirds of all tumors were nonfunctioning, according to a study published in the Annals of Internal Medicine.
“Based on our findings, we estimate that nearly two million adults in China could have adrenal tumors and one-third were with abnormal function,” Qifu Li, PhD, MD, director of the department of endocrinology at The First Affiliated Hospital of Chongqing Medical University, in Chongqing, China, told Healio. “Only a minority of people with incidentally discovered adrenal tumors are referred to an endocrinologist and undergo optimal workup to exclude functional tumors. If left undiagnosed, people with cortisol autonomy or primary aldosteronism are at risk of developing adverse cardiometabolic consequences.”
Li and colleagues recruited adults aged 18 to 78 years who underwent a health check at the community health examination center of the First Affiliated Hospital of Chongqing Medical University. The first 100 adults to receive a health check each weekday from November 2020 to November 2021 were invited to participate. CT scans of adrenal glands were performed, and tumors were diagnosed based on the detection of adrenal nodules of 1 cm or greater. Enhanced CT or MRI scans was performed on participants whose tumors had imaging characteristics suggestive of malignancy. Those with adrenal tumors underwent hormonal testing to measure aldosterone secretion, cortisol secretion, androgen secretion and plasma catecholamines.
There were 25,356 adults who enrolled in the study (mean age, 48 years; 50.2% women). Adrenal tumors were found in 1.4% of participants, with men having a higher prevalence of adrenal tumors compared with women (1.6% vs. 1.2%).
“The mean diameter of adrenal tumors in this study was 15 mm, which is smaller than in many previous studies,” the researchers wrote. “This may be due to intentional and careful assessment of adrenal tumors by radiologists leading to more smaller tumors being detected.”
Nonfunctioning adenomas common in those with tumors
Of the 351 participants with adrenal tumors, 337 had radiologically diagnosed adrenocortical adenoma. Of 212 adults with adrenocortical adenoma who completed functional assessment, 69.3% had nonfunctioning adenomas and 30.7% had tumors with steroid hormone secretion. Of those with tumors with steroid hormone secretion, 18.9% had tumors with cortisol autonomy and 11.8% had tumors with primary aldosteronism. The proportion of adults with nonfunctioning adenomas was 67% or higher across all age groups.
Compared with adults with nonfunctioning adenomas, those with primary aldosteronism had higher blood pressure, plasma aldosterone, aldosterone-to-renin ratio and 18-oxocortisol levels, and lower plasma renin levels. Adults with cortisol autonomy had higher levels of cortisol and lower levels of adrenocorticotropic hormones and adrenal androgens than participants with nonfunctioning adenomas.
Findings support universal hormonal testing
In a related editorial published in the Annals of Internal Medicine, Irina Bancos, MD, associate professor in the division of endocrinology at Mayo Clinic in Rochester, Minnesota, wrote that the researchers used a study design that minimized risks for both imaging bias and adrenal incidentaloma underreporting.
“These [adrenal prevalence] estimates have the advantage of a large sample size and minimal imaging bias because participants did not have a clinical indication that required an abdominal CT scan,” Bancos wrote. “In addition, Jing and colleagues used a stringent method of CT review by two independent radiologists with subsequent discussion of any discordant findings. Although this approach is difficult to replicate in clinical practice, it does increase the confidence around determined prevalence estimates.”
Bancos wrote that the hormonal testing findings were limited because 37% of participants with tumors did not undergo hormone testing, and that those who decline hormone testing were older and more likely to have hypertension, meaning mild autonomous cortisol secretion and primary aldosteronism may be more prevalent than what was reported.
“More than a third of patients with an adrenal incidentaloma had a previously unsuspected hormonal excess,” Bancos wrote. “Jing and colleagues’ findings support current recommendations for universal hormonal testing in any patient with an adrenal incidentaloma. Further studies are needed to improve our understanding of observed differences in the prevalence and type of hormonal excess.”
Reference:
- Bancos I. Ann Intern Med. 2022;doi:10.7326/M22-2600.
For more information:
Qifu Li, PhD, MD, can be reached at liqifu@yeah.net.
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