NASHVILLE, Tenn. — Performing a hormonal evaluation to explore the clinical relevance of incidental adrenal enlargement found on computed tomography (CT) scan may be best in some cases, according to a new study presented at the American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress.
Adrenal enlargement appears to be more common in those with higher BMI, hypertension, electrolyte abnormalities, and it also correlates with both visceral and subcutaneous fat, according to the researchers’ findings. However, it also appears to be underreported and under-evaluated.
“Over the years, there has been an increase in the use of imaging modalities, including MRI and CT scans. With this we are now seeing a rise in the number of incidental findings, and we are faced with the decision of what to do next in terms of management. One of these issues is adrenal enlargement. There are clear guidelines set forth for adrenal incidentalomas, but not adrenal enlargement,” said lead study investigator Michael Marchese, MD, who is an endocrinology fellow at Albany Medical Center in New York.
He said a recent study looked at more than 500 patients and found that the prevalence of bilateral adrenal enlargement may be as high as 11%. Unfortunately, the study demonstrated that only 14% of these patients actually had these enlargements recorded on the CT reports.
Marchese believes there are two main reasons for the underreporting.
“First, there are no clear guidelines on the management of this problem, and second, there are not enough studies completed. Our study was the first to my knowledge to be completed in the U.S. or in a VA population,” Marchese told Endocrinology Advisor.
In their study, Marchese and his colleagues examined whether adrenal enlargement is being overlooked and underdiagnosed and, more importantly, what the prevalence of adrenal enlargement actually is.
The researchers retrieved the records at a Veterans Affairs (VA) medical center and reviewed 338 CT scans performed between January 2012 and December 2013. Marchese said 158 records were excluded because they did not meet the criteria. The majority of the patients were men, and the mean age was 66 years. The mean BMI was 29.5.
Of 50 patients with adrenal enlargement, 39 had bilateral enlargement and 11 had unilateral enlargement.
The researchers found that 14.8% of patients had adrenal enlargement, and only 22% were actually documented on CT reports. They also found a significant positive correlation between incidental adrenal enlargement and BMI (P<.01), visceral fat (P<.01) and subcutaneous fat (P<.01).
Additionally, those with adrenal enlargement had a higher prevalence of hypertension (P<.001) and electrolyte abnormalities (P<.001).
“Even after adjusting for depression, alcoholism and medication use, which can all cause pseudo-Cushing’s, we found similar findings. This will hopefully raise awareness of the fact that it is being overlooked and that it should be looked at more closely,” said Marchese.
He and his colleagues are now planning a prospective study looking at these patients and completing a hormonal evaluation for subclinical Cushing’s syndrome, primary hyperaldosteronism or pheochromocytoma.
A recent study by Le Le Li in Beijing, China, also showed a prevalence of about 13.5% of adrenal enlargement. Those investigators performed hormonal testing and found about 15% to 16% of patients had subclinical Cushing’s syndrome and about another 5% to 6% of patients had primary hyperaldosteronism.
- Marchese M et al. Abstract #101. Presented at: American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.