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Attenuation Value in Adrenal Incidentalomas: A Longitudinal Study.

Filippo Ceccato1,2,3, Irene Tizianel1,2, Giacomo Voltan1,2

  • 1Department of Medicine (DIMED), University of Padova, Padova, Italy.

Frontiers in Endocrinology
|December 20, 2021
PubMed
Summary
This summary is machine-generated.

Adrenal incidentalomas show modest growth over time, with size increasing and lipid content potentially rising, especially in those with autonomous cortisol secretion (ACS). A first follow-up CT scan 5 years post-diagnosis is recommended, particularly for ACS cases.

Keywords:
Hounsfield Unitadrenal incidentalomaattenuation valueautonomous cortisol secretioncomputed tomography

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Area of Science:

  • Endocrinology and Radiology
  • Adrenal Gland Imaging and Function
  • Oncology and Endocrinology

Background:

  • Adrenal incidentalomas are frequently observed, with a known tendency for growth.
  • Long-term data on attenuation values, indicative of lipid content, are lacking for these tumors.
  • Understanding changes in size and lipid content is crucial for managing adrenal incidentalomas.

Purpose of the Study:

  • To longitudinally assess radiological changes in adrenal incidentalomas using computed tomography (CT).
  • To compare baseline imaging characteristics with long-term follow-up data, focusing on diameter and attenuation value.
  • To investigate the relationship between tumor characteristics, growth, and endocrine function, particularly autonomous cortisol secretion (ACS).

Main Methods:

  • A longitudinal study evaluated 277 patients with 355 adrenal incidentalomas from January 2002 to June 2020.
  • Follow-up imaging was performed on 181 patients with 234 adenomas (12-175 months post-baseline).
  • Computed tomography (CT) was used to measure diameter (mm) and attenuation value (Hounsfield units, HU); endocrine function was assessed via the 1-mg dexamethasone suppression test (DST).

Main Results:

  • Over time, adrenal incidentaloma size increased (mean diameter +2 mm after ≥60 months), and attenuation value decreased (mean -4 HU), suggesting increased lipid content.
  • Lipid-poor adenomas (>10 HU) showed reduced cortisol suppression, increased size, and the most significant decrease in attenuation value during follow-up.
  • Patients with autonomous cortisol secretion (ACS) had higher baseline attenuation values and showed a greater reduction in attenuation during follow-up.

Conclusions:

  • Adrenal incidentaloma growth is clinically modest, supporting a first follow-up CT scan approximately 5 years after baseline, especially for ACS cases.
  • A decrease in mean attenuation value during follow-up suggests an increase in lipid content in all adrenal adenomas, particularly those with ACS.
  • Changes in density and size correlate with endocrine function, highlighting the importance of integrated radiological and functional assessment.