Berkel, D.G.M. (2014) Onderzoek naar diagnostiek en beleid bij bijnierincidentalomen, subklinisch hypercortisolisme en adrenocorticale carcinomen. thesis, Medicine.
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Abstract
Background/aims: The prevalence of adrenal incidentalomas (AI) has increased. The diagnostic challenge in patients with unexpected adrenal tumors is to distinguish benign lesions from malignant masses and nonfunctioning incidentalomas from hormonally active tumors. The required diagnostic assessment is often cumbersome or potentially harmful. Therefore, there is an increasing demand for simple and safe screening methods, like salivary cortisol level for the diagnosis of subclinical hypercortisolism and urine steroid profile for detecting malignancy. Unfortunately, the diagnostic accuracy of these tests are not well employed. Therefore, the aim of this study was to evaluate the validity of late-night salivary cortisol levels and urine steroid profile in patients with AI. Additionally, the clinical characteristics and follow-up findings of patients with AI from the MST and ZGT were investigated. Methods: A retrospective and prospective cohort study of patients with AI in the MST and ZGT was carried out. The retrospective study was performed examining the tumor characteristics, demographic and management data of patients with an AI from 01-01-2008 to 01-10-2013. The prospective enrolled patients were evaluated using the current protocol and were followed-up for 5 months. ROC analysis was used to calculate the diagnostic value for the salivary cortisol level. Quantification of the adrenal steroids was carried out by gas chromatography/mass spectrometry in 24-h urine samples. Results: 16 patients were included prospectively. 264 patients were enrolled retrospectively. 5% of these masses found to be functioning, 2.6% was malign. The diagnostic and therapeutic management of AI deviated from the guidelines. The quality of radiology reports with regard to AI appeared to be suboptimal. Surgeons referred a considerably part of AI patients not to the internist. No difference in salivary cortisol levels in patients with subclinical hypercortisolism compared with patients without subclinical hypercortisolism was observed. The prevalence of metabolic alternations was not higher in patients with subclinical hypercortisolism. An aberrant urine steroid excretion confirmed the presence of an adrenalcortical carcinoma. However, insufficient patients with adrenalcortical carcinoma were enrolled to investigate the diagnostic value of the urine steroid profile. Conclusions: The vast majority of the incidentalomas were nonfunctioning, benign adrenal lesions. The clinician compliance of the AI guideline should be increased. Radiology reports should be improved and surgeons should be encouraged to refer AI patients to internists. The salivary cortisol level is not the first choice screening tool for subclinical hypercortisolism in patients with AI. In patients with AI and subclinical hypercortisolism, surgery should be performed only in patients who display metabolic diseases. Further prospective studies are needed to evaluate the possible use of urine steroid profile in order to differentiate benign from malignant adrenal tumors.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Legdeur, dr. |
| Supervisor name: | Pouwels, dr. and Locatie: Medisch Spectrum Twente and Afdeling: Interne Geneeskunde |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1566 |
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