The prevalence and characteristics of non-functioning and autonomous cortisol secreting adrenal incidentaloma after patients' stratification by body mass index and age.

BACKGROUND: The escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population. It is currently unclear whether patients with obesity more likely develop AI and the current rise in the prevalence of AI could be at least partly associated with the respective rise in obesity. We compared the prevalence and characteristics of non-functional (NF) and autonomous cortisol secreting (ACS) adrenal incidentalomas (AIs) after the study population was stratified by different body mass indexes (BMI) and age groups. METHODS: Retrospective cross-sectional study comprising of 432 patients (40.6% male, 59.4% female) with NFAI (N = 290) and ACS (N = 142), of median age 63.4 (54.0-71.6) years and median BMI 28.6 (25.5-31.7) kg/m2. The data collection contained 11.132 points including demographic, anthropometric, radiologic, hormonal and metabolic parameters. RESULTS: We observed 68-87% higher prevalence of AI across different age groups in NFAI and ACS in obese/overweight compared to normal weight subjects. Patients with ACS were older (P = 0.008), with higher basal cortisol (P < 0.001), lower basal DHEAS (P = 0.001), lower suppression DHEAS (P = 0.027) and higher aldosterone (P = 0.039). AIs with ACS were larger than NFAI (P < 0.001). Interestingly, ACS group had lower body mass (P = 0.023) and did not differ in BMI, blood pressure, heart rate, lipid profile, fasting glucose and presence of diabetes mellitus type 2 when compared to NFAI., By contrast to the similarity of metabolic profiles in ACS and NFAI, some components of adverse metabolic traits were rather associated with higher BMI and older age, in particular in NFAI. CONCLUSION: The prevalence of NFAI and ACS were significantly higher in overweight/obese subgroup across the age distribution. Stratification by age and BMI displayed significant differences in some metabolic traits, in particular in NFAI.

Lower urinary tract function in patients with fracture in thoracolumbal junction: an observational study.

A fracture in the thoracolumbal junction may cause complete or incomplete damage to the spinal cord, conus medullaris or cauda equina and result in an isolated or mixed lesion of the upper and lower motor neurons causing leg weakness and urinary/bowel/sexual dysfunction. In this retrospective cross-sectional study, we aimed to describe electrodiagnostic and urodynamic findings after thoracolumbal fractures and determine potential discriminating factors. We identified 74 cases (mean age 42 years, range 16-79 years, 55 men) admitted to our institution between 2008 and 2018 for Th12, L1 or L2 vertebral fractures, and retrieved from their medical records available demographic, clinical, electrodiagnostic and urodynamic data. The most common electrodiagnostic findings in the lower limbs (n = 40) were moderate-to-severe L3-S1 (35%) and L5-S1 (40%) lesions. As to the external anal sphincter (n = 33), the most frequent findings were an incomplete cauda equina (39%) or conus medullaris (15%) lesion, followed by the combined upper and lower motor neuron lesion (12%). Only the fracture level (with peripheral damage) was statistically significantly associated with electromyography findings. Detrusor overactivity or underactivity was each present in 37 (50%) cases. Those with Th12 versus L1-L2 fractures had higher odds of exhibiting detrusor overactivity; men had higher odds of using clean intermittent catheterization for bladder emptying than women. In summary, detrusor overactivity is common after fractures at the thoracolumbal junction and urodynamic findings are essential for proper diagnosis and selection of therapeutic approach. Combining urodynamic and electrodiagnostic studies is especially valuable in the presence of L1 fracture and lower urinary tract symptoms.

Comparison of plasma metanephrines in patients with cyanotic and acyanotic congenital heart disease.

PURPOSE: The co-occurrence of cyanotic congenital heart disease (CCHD) and PHEO/PGL has been reported, but the role of the hypoxic environment in the pathogenesis of PHEO/PGL remains unclear. Our aim was to compare plasma metanephrine and normetanephrine levels between patients with CCHD and patients with acyanotic congenital heart disease (ACCHD). METHODS: We performed a cross-sectional study in a prospective cohort of 44 patients with congenital heart disease (CHD) (31 (70.5%) females) with a median age of 37.5 (31.0-55.6) years at the time of evaluation. Thirty-two (73%) patients had CCHD and 12 (27%) patients had ACCHD. Morning blood samples for plasma determination of metanephrine and normetanephrine were collected. RESULTS: Plasma normetanephrine levels were significantly higher in patients with CCHD compared to ACCHD (p = 0.002). Ten (31.3%) patients with CCHD had plasma normetanephrine levels elevated above the reference range, while all ACCHD patients had normal levels. Patients with lower oxygen saturation and higher proBNP had significantly higher normetanephrine levels (ρ = -0.444, p = 0.003 and ρ = 0.449, p = 0.002, respectively). No chromaffin cell tumors were detected. CONCLUSION: Increased plasma normetanephrine levels in patients with CCHD can be explained by the effect of hypoxia. Future research is needed to better understand the impact of chronic hypoxia in CCHD on increased sympathetic outflow, hyperplastic response of chromaffin tissue, and the role of somatic mutations in CCHD-PHEO/PGL pathogenesis related to hypoxia.

Natural history of nonfunctioning adrenal incidentalomas: a 10-year longitudinal follow-up study.

Most data on the natural history of nonfunctioning adrenal incidentalomas (NFAI) are provided by follow-ups up to 5 years. We conducted a 10.5 (9.1-11.9)-year prospective follow-up study of NFAI in 67 participants (20 (29.9%) males, 47 (70.1%) females) of mean age 57.9 (52.3-63.9) years and BMI 27.42 (24.07-30.56) kg/m2). We also evaluated the associations between baseline BMI and changes of NFAIs' characteristics at follow-up. Progression to mild autonomous cortisol excess (MACE) was observed in 15 (22 %) patients, with 14 of them having post overnight dexamethasone suppression test (ODST) cortisol between 50 and138 nmol/L and only one > 138 nmol/L. The progression rate was significantly higher in overweight and obese than in normal-weight subjects. Patients that developed MACE had a significantly higher baseline mean cortisol after 1 mg ODST. Tumor enlargement ≥10 mm occurred in 8.9% of patients. In comparison with reports of shorter observational periods, we observed a higher growth rate ≥ 10 mm and higher progression rate from NFAI to MACE, particularly in overweight and obese subjects. All tumors had persistent radiological characteristics typical for adrenal adenoma. We concluded that the duration of the follow-up period is an important factor in characterizing the natural history of NFAI. Higher baseline BMI and higher baseline cortisol after ODST might predict the long-term likelihood of progression in hormonal activity. The magnitudes of observed progressions in growth or hormonal activity were clinically insignificant. Our long-term follow-up, therefore, clearly supports the general view that a long-term monitoring of patients with NFAI is not necessary.