Global guidelines on the care of patients with adrenal tumours need up-dating, experts reported last night.
US, UK and European guidelines contradict each other about the extent of follow up and repeated imaging needed for some tumours, researchers found.
A team at Birmingham University, UK, worked with the Mayo Clinics, USA, on the study, reported in the Annals of Internal Medicine.
Dr Yasir Elhassan, a clinical lecturer in endocrinology at Birmingham University, said: "The rate at which adrenal tumours are detected is increasing due to widespread use of imaging techniques such as ultrasounds, MRI and CT scans, and it is estimated that around 5% of the global population harbours an adrenal tumour, though most do not know about it until it is discovered incidentally by a scan.
“However, while common, most adrenal tumours are benign, but it is important to determine which, if any, will develop into something more serious, such as cancer or Cushing’s syndrome."
He added: “Currently the typical approach to treating patients with adrenal tumours is to remove them surgically if there is severe hormone overproduction or suspicion of cancer. Those that are non-functioning adrenal tumours do not require surgery, however there are some reports that these evolve to adrenal cancer.
“Therefore, whether these patients should undergo long-term follow-up is debatable, because this would represent a substantial health economic burden and could increase radiation exposure if patients undergo repeated imaging.
“There is also a concern that mild autonomous cortisol excess may evolve into overt Cushing’s syndrome with all its complications, such as high blood pressure, obesity, diabetes and increased risk of death.
“However, whether these tumours should be surgically removed is controversial due to limited research evidence.”
Professor Wiebke Arlt, director of the University of Birmingham’s Institute of Metabolism and Systems Research, said: “Our findings suggest that once patients have been diagnosed with non-cancerous NFAT and MACE tumours, they should not undergo repeated follow-up imaging as the risk of NFAT and MACE tumours developing into cancer is vanishingly low and repeated imaging would expose patients unnecessarily to radiation.
“Repeated hormone testing is also not necessary as mild or absent hormone excess virtually never evolves into severe hormone excess.
“However, both patients with NFAT and those with MACE should have clinical check-ups in larger but regular intervals, paying attention to the patients’ metabolic health due to their increased risk of hypertension, type 2 diabetes, and cardiovascular disease.
“The European Society of Endocrinology clinical practice guideline currently recommends annual assessment for cortisol excess in patients with MACE, we would suggest this recommendation may need review and possibly revision in light of our findings.”
Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess; a systematic review and meta-analysis. Annals of Internal Medicine 24 June 2019; doi: 10.7326/M18-3630
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