Related Experiment Video
Updated: Mar 27, 2026
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Cardiometabolic Risk in Bilateral versus Unilateral Nonfunctioning Adrenal Incidentalomas: Evidence From a Large
Elisa Febbraro1, Matteo Procopio1, Sara Napoli1
1Arterial Hypertension and Cardiovascular Endocrinology Laboratory, Division of Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Objective:
The cardiometabolic risk associated with nonfunctioning adrenal incidentalomas (NFAIs) remains controversial. This study aimed to compare cardiovascular risk and related complications in patients with bilateral versus unilateral NFAIs.
Methods:
This is a retrospective cross-sectional study including outpatients from a tertiary referral center. The cardiovascular risk was assessed using validated scores, and data about the presence of cardiometabolic complications and organ damage were collected.
Results:
We included 906 patients with NFAIs in primary cardiovascular prevention (820 unilateral, 86 bilateral), diagnosed and treated in our center between 2000 and 2024. Multivariable linear regressions showed that bilateral NFAIs are associated with higher cardiovascular risk, compared to unilateral NFAI, when calculated using the Framingham score (P = .006), the CUORE Project (P < .001), the SCORE (P < .001), and the SCORE-2 (P = .035). While multivariable logistic regressions revealed that patients with bilateral NFAIs are associated with the presence of type 2 diabetes mellitus (OR 2.36, 95% CI 1.18-4.72; P = .015) and with the presence of organ damage (OR 2.09, 95% CI 1.00-4.37; P = .050), after adjusting for age, male sex, body mass index, smoking habit, arterial hypertension and number of antihypertensive drugs; estimated glomerular filtration rate was additionally included as a covariate in the model predicting type 2 diabetes mellitus.
Conclusions:
Bilateral NFAIs are independently associated with greater cardiometabolic risk and complications compared to unilateral lesions. These findings support the concept of bilaterality as a distinct clinical phenotype and suggest that patients with bilateral NFAIs may benefit from closer cardiometabolic monitoring.
Related Concept Videos
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:17Anatomy of the Adrenal Glands
These glands possess a distinctive yellow tinge due to the stored cholesterol and fatty acids required for hormone synthesis. They are encased in a fibrous capsule and cushioned by fat.
The adrenal gland comprises two distinct...
01:31Hormones of the Adrenal Glands
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and...
01:21External Anatomy of the Kidney
The kidneys are located in the retroperitoneal space on either side of the vertebral column, protected posteriorly by the 11th and 12th ribs. The right kidney sits slightly lower than the left owing to the presence of the liver...
01:27Sympathetic Pathways: Collateral Ganglia and Adrenal Medulla
Collateral Ganglia
Sympathetic preganglionic axons reach the collateral ganglia along the route of splanchnic nerves. These nerves bypass the sympathetic trunk and communicate with sympathetic postganglionic neurons housed in the prevertebral ganglia. These ganglia supply the organs of the abdominopelvic cavity.
The greater splanchnic nerve, formed by the...
01:26Adrenergic Receptors: β Subtype
Isoprenaline > Adrenaline > Noradrenaline
Neurotransmitter binding to these receptors causes activation of adenylyl cyclase resulting in increased concentrations of cAMP and modulation of calcium ion channels within the cell. They are further classified into β1, β2, and β3 subtypes.
β1-adrenoceptors: β1-adrenoceptors...