The Prevalence of Second Neoplasms in Patients with Non-Aldosterone Producing Adrenocortical Lesions

TL;DR

This study finds that a significant portion of patients with non-aldosterone adrenal tumors also have second benign or malignant neoplasms.

Contribution

The study identifies a correlation between cortisol levels and the presence of second neoplasms in non-aldosterone adrenal tumor patients.

Findings

35.4% of NAPACA patients had a second neoplasm (benign or malignant).

Cortisol levels after dexamethasone suppression were higher in patients without second neoplasms.

ACTH/F-ODS levels were significantly higher in patients with second malignancies.

Abstract

Over the last few decades, due to improvement in imaging techniques, the increased detection of adrenal incidentalomas is observed. Non-aldosterone producing adrenal adenomas (NAPACAs) often co-exist with second benign or malignant lesions. In the present study, we aimed to assess the presence of second neoplasms, both benign and malignant, in patients with NAPACAs, and to investigate possible correlations with clinical parameters, hormonal characteristics and the emergence of comorbidities. A total of 130 NAPACA patients were included in this single-center retrospective study. In this cohort, 35.4% of NAPACA patients carried any second neoplasm (either benign or malignant) whereas, 26.9% had a second malignant neoplasm. Cortisol levels after 1 mg overnight dexamethasone suppression test (F-ODS) were significantly higher in patients without a second neoplasm (p = 0.02), and this finding was consistent even when categorizing patients with and without malignancies (p = 0.02). In line with this observation, ACTH/F-ODS levels were significantly higher in patients with second malignancies (p < 0.05). Interestingly, the presence of mild autonomous cortisol secretion tended to be lower in patients with second malignancies (p = 0.08). No remarkable differences in the comorbidities of NAPACA patients with and without a second neoplasm were documented. Further prospective studies will be needed to elucidate the role of mild hypercortisolemia on the development of these second tumors in NAPACA patients.

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