메뉴 건너뛰기




Volumn 268, Issue 6, 2010, Pages 555-566

Adrenal incidentalomas and cardiometabolic morbidity: An emerging association with serious clinical implications

Author keywords

Adrenal incidentalomas; Insulin resistance; Metabolic syndrome; Nonfunctioning adrenal incidentalomas; Subclinical Cushing's syndrome

Indexed keywords

ALDOSTERONE; ANTIDIABETIC AGENT; ANTIHYPERTENSIVE AGENT; CORTICOTROPIN; D DIMER; DEXAMETHASONE; HYDROCORTISONE; INSULIN; INTERLEUKIN 6; RENIN; TUMOR NECROSIS FACTOR ALPHA; URIC ACID;

EID: 78649455481     PISSN: 09546820     EISSN: 13652796     Source Type: Journal    
DOI: 10.1111/j.1365-2796.2010.02291.x     Document Type: Review
Times cited : (39)

References (49)
  • 1
    • 33846866271 scopus 로고    scopus 로고
    • Clinical practice. The incidentally discovered adrenal mass
    • Young Jr WF. Clinical practice. The incidentally discovered adrenal mass. New Engl J Med 2007; 356: 601-10.
    • (2007) New Engl J Med , vol.356 , pp. 601-610
    • Young Jr, W.F.1
  • 3
    • 0029831066 scopus 로고    scopus 로고
    • Adrenaloma: a call for more aggressive management
    • discussion 792-3.
    • Linos DA, Stylopoulos N, Raptis SA. Adrenaloma: a call for more aggressive management. World J Surg 1996; 20: 788-92. discussion 792-3.
    • (1996) World J Surg , vol.20 , pp. 788-792
    • Linos, D.A.1    Stylopoulos, N.2    Raptis, S.A.3
  • 4
    • 56049118469 scopus 로고    scopus 로고
    • Adrenal incidentaloma: evaluation and management
    • Singh PK, Buch HN. Adrenal incidentaloma: evaluation and management. J Clin Pathol 2008; 61: 1168-73.
    • (2008) J Clin Pathol , vol.61 , pp. 1168-1173
    • Singh, P.K.1    Buch, H.N.2
  • 5
    • 0036959742 scopus 로고    scopus 로고
    • Adrenal incidentaloma: a new cause of the metabolic syndrome?
    • Terzolo M, Pia A, Alì A et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab 2002; 87: 998-1003.
    • (2002) J Clin Endocrinol Metab , vol.87 , pp. 998-1003
    • Terzolo, M.1    Pia, A.2    Alì, A.3
  • 6
    • 33847353467 scopus 로고    scopus 로고
    • Metabolic syndrome in patients with adrenocortical adenoma
    • Zhang W, Tang ZY, Wang WQ, Ning G. Metabolic syndrome in patients with adrenocortical adenoma. Zhonghua Yi Xue Za Zhi 2006; 86: 3397-400.
    • (2006) Zhonghua Yi Xue Za Zhi , vol.86 , pp. 3397-3400
    • Zhang, W.1    Tang, Z.Y.2    Wang, W.Q.3    Ning, G.4
  • 8
    • 0030447507 scopus 로고    scopus 로고
    • Adrenal incidentalomas: a manifestation of the metabolic syndrome?
    • Reincke M, Fassnacht M, Väth S, Mora P, Allolio B. Adrenal incidentalomas: a manifestation of the metabolic syndrome? Endocr Res 1996; 22: 757-61.
    • (1996) Endocr Res , vol.22 , pp. 757-761
    • Reincke, M.1    Fassnacht, M.2    Väth, S.3    Mora, P.4    Allolio, B.5
  • 10
    • 77950322356 scopus 로고    scopus 로고
    • Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas
    • Giordano R, Marinazzo E, Berardelli R et al. Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas. Eur J Endocrinol 2010; 162: 779-85.
    • (2010) Eur J Endocrinol , vol.162 , pp. 779-785
    • Giordano, R.1    Marinazzo, E.2    Berardelli, R.3
  • 11
    • 63249092692 scopus 로고    scopus 로고
    • Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study
    • Vassilatou E, Vryonidou A, Michalopoulou S et al. Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin Endocrinol (Oxf) 2009; 70: 674-9.
    • (2009) Clin Endocrinol (Oxf) , vol.70 , pp. 674-679
    • Vassilatou, E.1    Vryonidou, A.2    Michalopoulou, S.3
  • 12
    • 77950526486 scopus 로고    scopus 로고
    • Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas
    • Yener S, Ertilav S, Secil M et al. Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas. J Endocrinol Invest 2010; 33: 32-6.
    • (2010) J Endocrinol Invest , vol.33 , pp. 32-36
    • Yener, S.1    Ertilav, S.2    Secil, M.3
  • 13
    • 77956947843 scopus 로고    scopus 로고
    • Insulin resistance and metabolic syndrome in patients with non-functioning adrenal incidentalomas: a cause-effect relationship?
    • Peppa M, Boutati E, Koliaki C et al. Insulin resistance and metabolic syndrome in patients with non-functioning adrenal incidentalomas: a cause-effect relationship? Metabolism 2010; 59: 1435-41.
    • (2010) Metabolism , vol.59 , pp. 1435-1441
    • Peppa, M.1    Boutati, E.2    Koliaki, C.3
  • 14
    • 0037295396 scopus 로고    scopus 로고
    • Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery
    • Bernini G, Moretti A, Iacconi P et al. Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery. Eur J Endocrinol 2003; 148: 213-9.
    • (2003) Eur J Endocrinol , vol.148 , pp. 213-219
    • Bernini, G.1    Moretti, A.2    Iacconi, P.3
  • 15
    • 14444270341 scopus 로고    scopus 로고
    • Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma
    • Fernández-Real JM, Engel WR, Simó R, Salinas I, Webb SM. Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma. Clin Endocrinol (Oxf) 1998; 49: 53-61.
    • (1998) Clin Endocrinol (Oxf) , vol.49 , pp. 53-61
    • Fernández-Real, J.M.1    Engel, W.R.2    Simó, R.3    Salinas, I.4    Webb, S.M.5
  • 16
    • 0035725369 scopus 로고    scopus 로고
    • The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection
    • Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf) 2001; 54: 797-804.
    • (2001) Clin Endocrinol (Oxf) , vol.54 , pp. 797-804
    • Midorikawa, S.1    Sanada, H.2    Hashimoto, S.3    Suzuki, T.4    Watanabe, T.5
  • 17
    • 70449732857 scopus 로고    scopus 로고
    • Hormonal and metabolic evaluation of adrenal incidentalomas
    • Wagnerova H, Dudasova D, Lazurova I. Hormonal and metabolic evaluation of adrenal incidentalomas. Neoplasma 2009; 56: 521-5.
    • (2009) Neoplasma , vol.56 , pp. 521-525
    • Wagnerova, H.1    Dudasova, D.2    Lazurova, I.3
  • 18
    • 77649228667 scopus 로고    scopus 로고
    • Two-year follow-up of thirty-two non-functional benign adrenal incidentalomas
    • Yilmaz H, Tütüncü NB, Sahin M. Two-year follow-up of thirty-two non-functional benign adrenal incidentalomas. J Endocrinol Invest 2009; 32: 913-6.
    • (2009) J Endocrinol Invest , vol.32 , pp. 913-916
    • Yilmaz, H.1    Tütüncü, N.B.2    Sahin, M.3
  • 19
    • 77649225614 scopus 로고    scopus 로고
    • Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience
    • (Epub ahead of print).
    • Comlekci A, Yener S, Ertilav S et al. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine 2009 (Epub ahead of print).
    • (2009) Endocrine
    • Comlekci, A.1    Yener, S.2    Ertilav, S.3
  • 21
    • 70149105459 scopus 로고    scopus 로고
    • Carotid intima media thickness is increased and associated with morning cortisol in subjects with non-functioning adrenal incidentaloma
    • Yener S, Genc S, Akinci B et al. Carotid intima media thickness is increased and associated with morning cortisol in subjects with non-functioning adrenal incidentaloma. Endocrine 2009; 35: 365-70.
    • (2009) Endocrine , vol.35 , pp. 365-370
    • Yener, S.1    Genc, S.2    Akinci, B.3
  • 22
    • 70349503666 scopus 로고    scopus 로고
    • Non-functioning adrenal incidentalomas are associated with elevated D-dimer levels
    • Yener S, Comlekci A, Akinci B et al. Non-functioning adrenal incidentalomas are associated with elevated D-dimer levels. J Endocrinol Invest 2009; 32: 338-43.
    • (2009) J Endocrinol Invest , vol.32 , pp. 338-343
    • Yener, S.1    Comlekci, A.2    Akinci, B.3
  • 23
    • 78649461456 scopus 로고    scopus 로고
    • Is there an association between non-functioning adrenal adenoma and endothelial dysfunction?
    • (Epub ahead of print).
    • Yener S, Baris M, Secil M, Akinci B, Comlekci A, Yesil S. Is there an association between non-functioning adrenal adenoma and endothelial dysfunction? J Endocrinol Invest 2010 (Epub ahead of print).
    • (2010) J Endocrinol Invest
    • Yener, S.1    Baris, M.2    Secil, M.3    Akinci, B.4    Comlekci, A.5    Yesil, S.6
  • 24
    • 0034456839 scopus 로고    scopus 로고
    • Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features
    • Rossi R, Tauchmanova L, Luciano A et al. Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 2000; 85: 1440-8.
    • (2000) J Clin Endocrinol Metab , vol.85 , pp. 1440-1448
    • Rossi, R.1    Tauchmanova, L.2    Luciano, A.3
  • 25
    • 64549126078 scopus 로고    scopus 로고
    • Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study
    • Sereg M, Szappanos A, Toke J et al. Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study. Eur J Endocrinol 2009; 160: 647-55.
    • (2009) Eur J Endocrinol , vol.160 , pp. 647-655
    • Sereg, M.1    Szappanos, A.2    Toke, J.3
  • 26
    • 33745232750 scopus 로고    scopus 로고
    • Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: usefulness of adrenocortical scintigraphy
    • Izaki H, Fukumori T, Takahashi M et al. Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: usefulness of adrenocortical scintigraphy. Int J Urol 2006; 13: 677-81.
    • (2006) Int J Urol , vol.13 , pp. 677-681
    • Izaki, H.1    Fukumori, T.2    Takahashi, M.3
  • 27
    • 70449427859 scopus 로고    scopus 로고
    • High prevalence of autonomous cortisol and aldosterone secretion from adrenal adenomas
    • Piaditis GP, Kaltsas GA, Androulakis II et al. High prevalence of autonomous cortisol and aldosterone secretion from adrenal adenomas. Clin Endocrinol (Oxf) 2009; 71: 772-8.
    • (2009) Clin Endocrinol (Oxf) , vol.71 , pp. 772-778
    • Piaditis, G.P.1    Kaltsas, G.A.2    Androulakis, I.I.3
  • 28
    • 0028167734 scopus 로고
    • Augmented 17 alpha-hydroxyprogesterone response to ACTH stimulation as evidence of decreased 21-hydroxylase activity in patients with incidentally discovered adrenal tumours ('incidentalomas')
    • Seppel T, Schlaghecke R. Augmented 17 alpha-hydroxyprogesterone response to ACTH stimulation as evidence of decreased 21-hydroxylase activity in patients with incidentally discovered adrenal tumours ('incidentalomas'). Clin Endocrinol (Oxf) 1994; 41: 445-51.
    • (1994) Clin Endocrinol (Oxf) , vol.41 , pp. 445-451
    • Seppel, T.1    Schlaghecke, R.2
  • 29
    • 0036278187 scopus 로고    scopus 로고
    • Coexistence of 21-hydroxylase and 11 beta-hydroxylase deficiency in adrenal incidentalomas and in subclinical Cushing's syndrome
    • Dall'Asta C, Barbetta L, Libé R, Passini E, Ambrosi B. Coexistence of 21-hydroxylase and 11 beta-hydroxylase deficiency in adrenal incidentalomas and in subclinical Cushing's syndrome. Horm Res 2002; 57: 192-6.
    • (2002) Horm Res , vol.57 , pp. 192-196
    • Dall'Asta, C.1    Barbetta, L.2    Libé, R.3    Passini, E.4    Ambrosi, B.5
  • 30
    • 0028986264 scopus 로고
    • Increased 17 alpha-hydroxyprogesterone response to ACTH in silent adrenal adenoma: cause or effect?
    • Del Monte P, Bernasconi D, Bertolazzi L et al. Increased 17 alpha-hydroxyprogesterone response to ACTH in silent adrenal adenoma: cause or effect? Clin Endocrinol (Oxf) 1995; 42: 273-7.
    • (1995) Clin Endocrinol (Oxf) , vol.42 , pp. 273-277
    • Del Monte, P.1    Bernasconi, D.2    Bertolazzi, L.3
  • 31
    • 2442533133 scopus 로고    scopus 로고
    • Subclinical Cushing's syndrome in adrenal incidentalomas
    • Sippel RS, Chen H. Subclinical Cushing's syndrome in adrenal incidentalomas. Surg Clin North Am 2004; 84: 875-85.
    • (2004) Surg Clin North Am , vol.84 , pp. 875-885
    • Sippel, R.S.1    Chen, H.2
  • 32
    • 28144445147 scopus 로고    scopus 로고
    • Metabolism of glucocorticoids and mineralocorticoids in patients with adrenal incidentalomas
    • Maser-Gluth C, Reincke M, Allolio B, Schulze E. Metabolism of glucocorticoids and mineralocorticoids in patients with adrenal incidentalomas. Eur J Clin Invest 2000; 30(Suppl 3): 83-6.
    • (2000) Eur J Clin Invest , vol.30 , Issue.SUPPL. 3 , pp. 83-86
    • Maser-Gluth, C.1    Reincke, M.2    Allolio, B.3    Schulze, E.4
  • 34
    • 0034990327 scopus 로고    scopus 로고
    • Analysis of cortisol secretion in hormonally inactive adrenocortical incidentalomas: study of in vitro steroid secretion and immunohistochemical localization of steroidogenic enzymes
    • Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T, Sasano H. Analysis of cortisol secretion in hormonally inactive adrenocortical incidentalomas: study of in vitro steroid secretion and immunohistochemical localization of steroidogenic enzymes. Endocr J 2001; 48: 167-74.
    • (2001) Endocr J , vol.48 , pp. 167-174
    • Midorikawa, S.1    Sanada, H.2    Hashimoto, S.3    Suzuki, T.4    Watanabe, T.5    Sasano, H.6
  • 35
    • 0034118742 scopus 로고    scopus 로고
    • Oral glucose tolerance testing but not intravenous glucose administration uncovers hyper-responsiveness of hypothalamo-pituitary-adrenal axis in patients with adrenal incidentalomas
    • Beuschlein F, Borgemeister M, Schirra J et al. Oral glucose tolerance testing but not intravenous glucose administration uncovers hyper-responsiveness of hypothalamo-pituitary-adrenal axis in patients with adrenal incidentalomas. Clin Endocrinol (Oxf) 2000; 52: 617-23.
    • (2000) Clin Endocrinol (Oxf) , vol.52 , pp. 617-623
    • Beuschlein, F.1    Borgemeister, M.2    Schirra, J.3
  • 36
    • 34147159267 scopus 로고    scopus 로고
    • Adipokine levels and cardiovascular risk in patients with adrenal incidentaloma
    • Ermetici F, Malavazos AE, Corbetta S et al. Adipokine levels and cardiovascular risk in patients with adrenal incidentaloma. Metabolism 2007; 56: 686-92.
    • (2007) Metabolism , vol.56 , pp. 686-692
    • Ermetici, F.1    Malavazos, A.E.2    Corbetta, S.3
  • 37
    • 0033671097 scopus 로고    scopus 로고
    • Possible function of IL-6 and TNF as intraadrenal factors in the regulation of adrenal steroid secretion
    • Judd AM, Call GB, Barney M et al. Possible function of IL-6 and TNF as intraadrenal factors in the regulation of adrenal steroid secretion. Ann N Y Acad Sci 2000; 917: 628-37.
    • (2000) Ann N Y Acad Sci , vol.917 , pp. 628-637
    • Judd, A.M.1    Call, G.B.2    Barney, M.3
  • 38
    • 77649206787 scopus 로고    scopus 로고
    • The relation of adiponectin and tumor necrosis factor alpha levels between endothelial nitric oxide synthase, angiotensin-converting enzyme, transforming growth factor beta and tumor necrosis factor alpha gene polymorphism in adrenal incidentalomas
    • Harman E, Karadeniz M, Biray C et al. The relation of adiponectin and tumor necrosis factor alpha levels between endothelial nitric oxide synthase, angiotensin-converting enzyme, transforming growth factor beta and tumor necrosis factor alpha gene polymorphism in adrenal incidentalomas. J Endocrinol Invest 2009; 32: 881-8.
    • (2009) J Endocrinol Invest , vol.32 , pp. 881-888
    • Harman, E.1    Karadeniz, M.2    Biray, C.3
  • 39
    • 0034454579 scopus 로고    scopus 로고
    • A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology
    • Mantero F, Terzolo M, Arnaldi G et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000; 85: 637-44.
    • (2000) J Clin Endocrinol Metab , vol.85 , pp. 637-644
    • Mantero, F.1    Terzolo, M.2    Arnaldi, G.3
  • 40
    • 74549213609 scopus 로고    scopus 로고
    • Subclinical Cushing's syndrome in adrenal incidentaloma: a common problem or an artefact of current diagnostic testing?
    • Gagliardi L, Torpy DJ. Subclinical Cushing's syndrome in adrenal incidentaloma: a common problem or an artefact of current diagnostic testing? Clin Endocrinol (Oxf) 2010; 72: 277-8.
    • (2010) Clin Endocrinol (Oxf) , vol.72 , pp. 277-278
    • Gagliardi, L.1    Torpy, D.J.2
  • 41
    • 33745904717 scopus 로고    scopus 로고
    • Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications
    • Tsagarakis S, Vassiliadi D, Thalassinos N. Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications. J Endocrinol Invest 2006; 29: 471-82.
    • (2006) J Endocrinol Invest , vol.29 , pp. 471-482
    • Tsagarakis, S.1    Vassiliadi, D.2    Thalassinos, N.3
  • 42
    • 0036847434 scopus 로고    scopus 로고
    • Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk
    • Tauchmanovà L, Rossi R, Biondi B et al. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 2002; 87: 4872-8.
    • (2002) J Clin Endocrinol Metab , vol.87 , pp. 4872-4878
    • Tauchmanovà, L.1    Rossi, R.2    Biondi, B.3
  • 43
    • 0141703517 scopus 로고    scopus 로고
    • Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes
    • Emral R, Uysal AR, Asik M et al. Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes. Endocr J 2003; 50: 399-408.
    • (2003) Endocr J , vol.50 , pp. 399-408
    • Emral, R.1    Uysal, A.R.2    Asik, M.3
  • 44
    • 33748778766 scopus 로고    scopus 로고
    • Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery
    • Erbil Y, Ademoǧlu E, Ozbey N et al. Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery. World J Surg 2006; 30: 1665-71.
    • (2006) World J Surg , vol.30 , pp. 1665-1671
    • Erbil, Y.1    Ademoǧlu, E.2    Ozbey, N.3
  • 45
    • 77954866654 scopus 로고    scopus 로고
    • Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects
    • Morelli V, Masserini B, Salcuni AS et al. Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects. Clin Endocrinol (Oxf) 2010; 73: 161-6.
    • (2010) Clin Endocrinol (Oxf) , vol.73 , pp. 161-166
    • Morelli, V.1    Masserini, B.2    Salcuni, A.S.3
  • 46
    • 69749104546 scopus 로고    scopus 로고
    • Surgical excision of subclinical cortisol secreting incidentalomas: impact on blood pressure, BMI and glucose metabolism
    • Mauclère-Denost S, Duron-Martinaud S, Nunes ML et al. Surgical excision of subclinical cortisol secreting incidentalomas: impact on blood pressure, BMI and glucose metabolism. Ann Endocrinol (Paris) 2009; 70: 211-7.
    • (2009) Ann Endocrinol (Paris) , vol.70 , pp. 211-217
    • Mauclère-Denost, S.1    Duron-Martinaud, S.2    Nunes, M.L.3
  • 47
    • 63449112671 scopus 로고    scopus 로고
    • Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study
    • Toniato A, Merante-Boschin I, Opocher G, Pelizzo MR, Schiavi F, Ballotta E. Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study. Ann Surg 2009; 249: 388-91.
    • (2009) Ann Surg , vol.249 , pp. 388-391
    • Toniato, A.1    Merante-Boschin, I.2    Opocher, G.3    Pelizzo, M.R.4    Schiavi, F.5    Ballotta, E.6
  • 48
    • 77954476416 scopus 로고    scopus 로고
    • Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism
    • Chiodini I, Morelli V, Salcuni AS et al. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism. J Clin Endocrinol Metab 2010; 95: 2736-45.
    • (2010) J Clin Endocrinol Metab , vol.95 , pp. 2736-2745
    • Chiodini, I.1    Morelli, V.2    Salcuni, A.S.3


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.