Endocrine incidentalomas Challenges imposed by incidentally discovered lesions

Nature Reviews Endocrinology

Volumn 7, Issue 11, 2011, Pages 668-680

  Vassiliadi, Dimitra A ^a   Tsagarakis, Stylianos ^b  

^a NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS   (Greece)

^b EVANGELISMOS HOSPITAL   (Greece)

Author keywords

[No Author keywords available]

Indexed keywords

HYDROCORTISONE;

ADRENAL GLAND; ADRENALECTOMY; ASPIRATION BIOPSY; CANCER RISK; CONSERVATIVE TREATMENT; HORMONE RELEASE; HUMAN; HYPERCORTISOLISM; HYPOPHYSIS; INCIDENTAL FINDING; INCIDENTALOMA; MICROADENOMA; PARATHYROID ADENOMA; PRIORITY JOURNAL; REVIEW; THYROID GLAND; TUMOR VOLUME;

ADENOMA; ADRENAL GLAND NEOPLASMS; ANIMALS; HUMANS; INCIDENTAL FINDINGS; PARATHYROID NEOPLASMS; PITUITARY NEOPLASMS; THYROID NEOPLASMS;

EID: 80054903262     PISSN: 17595029     EISSN: 17595037     Source Type: Journal    
DOI: 10.1038/nrendo.2011.92     Document Type: Review

References (140)

1. Black, W. C. & Welch, H. G. Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy. N. Engl. J. Med. 328, 1237-1243 (1993). (Pubitemid 23115703)
2. Bailey, R. H. & Aron, D. C. The diagnostic dilemma of incidentalomas. Working through uncertainty. Endocrinol. Metab. Clin. North Am. 29, 91-105 (2000). (Pubitemid 30151891)
3. Chidiac, R. M. & Aron, D. C. Incidentalomas. A disease of modern technology. Endocrinol. Metab. Clin. North Am. 26, 233-253 (1997).
4. Turner, H. E., Moore, N. R., Byrne, J. V. & Wass, J. A. H. Pituitary, adrenal and thyroid incidentalomas. Endocr. Relat. Cancer 5, 131-150 (1998).
5. Aron, D. C. & Howlett, T. A. Pituitary incidentalomas. Endocrinol. Metab. Clin. North Am. 29, 205-221 (2000). (Pubitemid 30151897)
6. Koenig, K. & Kleerekoper, M. How common are functional incidentalomas of the parathyroid gland? Nat. Clin. Pract. Endocrinol. Metab. 2, 316-317 (2006). (Pubitemid 43885910)
7. Griffing, G. T. A I D S: the new endocrine epidemic. J. Clin. Endocrinol. Metab. 79, 1530-1531 (1994).
8. Dean, D. S. & Gharib, H. Epidemiology of thyroid nodules. Best Pract. Res. Clin. Endocrinol. Metab. 22, 901-911 (2008).
9. Ezzat, S. et al. The prevalence of pituitary adenomas: a systematic review. Cancer 101, 613-619 (2004). (Pubitemid 38970613)
10. Ezzat, S., Sarti, D. A., Cain, D. R. & Braunstein, G. D. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch. Intern. Med. 154, 1838-1840 (1994). (Pubitemid 24262001)
11. Young, W. F. Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol. Metab. Clin. North Am. 29, 159-185 (2000).
12. Molitch, M. E. Pituitary tumours: pituitary incidentalomas. Best Pract. Res. Clin. Endocrinol. Metab. 23, 667-675 (2009).
13. Chambers, E. F., Turski, P. A., LaMasters, D. & Newton, T. H. Regions of low density in the contrast-enhanced pituitary gland: normal and pathologic processes. Radiology 144, 109-113 (1982). (Pubitemid 12050823)
14. Krikorian, A. & Aron, D. Evaluation and management of pituitary incidentalomas-revisiting an acquaintance. Nat. Clin. Pract. Endocrinol. Metab. 2, 138-145 (2006).
15. Connor, S. E. & Penney, C. C. MRI in the differential diagnosis of a sellar mass. Clin. Radiol. 58, 20-31 (2003). (Pubitemid 36104939)
16. Nammour, G. M., Ybarra, J., Naheedy, M. H., Romeo, J. H. & Aron, D. C. Incidental pituitary macroadenoma: a population-based study. Am. J. Med. Sci. 314, 287-291 (1997). (Pubitemid 27481524)
17. Yue, N. C. et al. Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology 202, 41-46 (1997). (Pubitemid 27024106)
18. Chacko, A. G. & Chandy, M. J. Incidental pituitary macroadenomas. Br. J. Neurosurg. 6, 233-236 (1992).
19. Buurman, H. & Saeger, W. Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur. J. Endocrinol. 154, 753-758 (2006). (Pubitemid 43810863)
20. Kontogeorgos, G., Kovacs, K., Horvath, E. & Scheithauer, B. W. Multiple adenomas of the human pituitary. A retrospective autopsy study with clinical implications. J. Neurosurg. 74, 243-247 (1991).
21. Chong, B. W., Kucharczyk, W., Singer, W. & George, S. Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas. AJNR Am. J. Neuroradiol. 15, 675-679 (1994). (Pubitemid 24128831)
22. Hall, W. A., Luciano, M. G., Doppman, J. L., Patronas, N. J. & Oldfield, E. H. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann. Intern. Med. 120, 817-820 (1994). (Pubitemid 24140506)
23. Jeong, S. Y. et al. Incidental pituitary uptake on whole-body 18F-FDG PET/CT: a multicentre study. Eur. J. Nucl. Med. Mol. Imaging 37, 2334-2343 (2010).
24. Molitch, M. E. Clinical review 65. Evaluation and treatment of the patient with a pituitary incidentaloma. J. Clin. Endocrinol. Metab. 80, 3-6 (1995).
25. Feldkamp, J. et al. Incidentally discovered pituitary lesions: high frequency of macroadenomas and hormone-secreting adenomas-results of a prospective study. Clin. Endocrinol. (Oxf.) 51, 109-113 (1999). (Pubitemid 29339543)
26. Oyama, K., Sanno, N., Tahara, S. & Teramoto, A. Management of pituitary incidentalomas: according to a survey of pituitary incidentalomas in Japan. Semin. Ultrasound CT MR 26, 47-50 (2005). (Pubitemid 40261292)
27. Daems, T. et al. Modification of hormonal secretion in clinically silent pituitary adenomas. Pituitary 12, 80-86 (2009).
28. Fainstein Day, P. et al. Retrospective multicentric study of pituitary incidentalomas. Pituitary 7, 145-148 (2004).
29. Reincke, M., Allolio, B., Saeger, W., Menzel, J. & Winkelmann, W. The 'incidentaloma' of the pituitary gland. Is neurosurgery required? JAMA 263, 2772-2776 (1990).
30. King, J. T. Jr, Justice, A. C. & Aron, D. C. Management of incidental pituitary microadenomas: a cost-effectiveness analysis. J. Clin. Endocrinol. Metab. 82, 3625-3632 (1997). (Pubitemid 27509347)
31. Donovan, L. E. & Corenblum, B. The natural history of the pituitary incidentaloma. Arch. Intern. Med. 155, 181-183 (1995).
32. Yuen, K. C. et al. Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF 1 levels. Clin. Endocrinol. (Oxf.) 69, 292-298 (2008). (Pubitemid 352009029)
33. Arita, K. et al. Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination. J. Neurosurg. 104, 884-891 (2006). (Pubitemid 43824737)
34. Karavitaki, N. et al. What is the natural history of nonoperated nonfunctioning pituitary adenomas? Clin. Endocrinol. (Oxf.) 67, 938-943 (2007). (Pubitemid 350135140)
35. Dekkers, O. M. et al. The natural course of non-functioning pituitary macroadenomas. Eur. J. Endocrinol. 156, 217-224 (2007). (Pubitemid 46554516)
36. Kay, J. & Czirják, L. Gadolinium and systemic fibrosis: guilt by association. Ann. Rheum. Dis. 69, 1895-1897 (2010).
37. Molitch, M. E. Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol. Metab. Clin. North. Am. 37, 151-171, xi (2008).
38. Tomimori, E., Pedrinola, F., Cavaliere, H., Knobel, M. & Medeiros-Neto, G. Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid 5, 273-276 (1995).
39. Mortensen, J. D., Woolner, L. B. & Bennett, W. A. Gross and microscopic findings in clinically normal thyroid glands. J. Clin. Endocrinol. Metab. 15, 1270-1280 (1955).
40. Wang, C. & Crapo, L. M. The epidemiology of thyroid disease and implications for screening. Endocrinol. Metab. Clin. North Am. 26, 189-218 (1997). (Pubitemid 27123901)
41. Reiners, C. et al. Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14, 926-932 (2004). (Pubitemid 39612911)
42. Chu, Q. D. et al. Positron emission tomography (PET) positive thyroid incidentaloma: the risk of malignancy observed in a tertiary referral center. Am. Surg. 72, 272-275 (2006). (Pubitemid 351837710)
43. Are, C. et al. FDG-PET detected thyroid incidentalomas: need for further investigation? Ann. Surg. Oncol. 14, 239-247 (2007). (Pubitemid 44954295)
44. Kang, K. W. et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J. Clin. Endocrinol. Metab. 88, 4100-4104 (2003). (Pubitemid 37153705)
45. Minamimoto, R. et al. Performance profile of FDG-PET and PET/CT for cancer screening on the basis of a Japanese Nationwide Survey. Ann. Nucl. Med. 21, 481-498 (2007). (Pubitemid 350165651)
46. Van den Bruel, A. et al. Clinical relevance of thyroid fluorodeoxyglucose-whole body positron emission tomography incidentaloma. J. Clin. Endocrinol. Metab. 87, 1517-1520 (2002).
47. Kim, T. Y. et al. 18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 115, 1074-1078 (2005). (Pubitemid 40777005)
48. Gharib, H. & Papini, E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol. Metab. Clin. North Am. 36, 707-735 (2007). (Pubitemid 47135591)
49. Kang, H. W. et al. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid 14, 29-33 (2004). (Pubitemid 38282934)
50. Davies, L. & Welch, H. G. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA 295, 2164-2167 (2006).
51. Bernet, V. Approach to the patient with incidental papillary microcarcinoma. J. Clin. Endocrinol. Metab. 95, 3586-3592 (2010).
52. Hay, I. D. et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144, 980-987 (2008).
53. Gharib, H. et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pract. 16 (Suppl. 1), 1-43 (2010).
54. Cosgrove, D. Future prospects for SonoVue and CPS. Eur. Radiol. 14 (Suppl. 8), P116-P124 (2004). (Pubitemid 40425154)
55. Asteria, C. et al. US elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18, 523-531 (2008). (Pubitemid 351667834)
56. Cooper, D. S. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167-1214 (2009).
57. Kim, S. W. et al. BRAFV600E mutation analysis in fine-needle aspiration cytology specimens for evaluation of thyroid nodule: a large series in a BRAFV600E-prevalent population. J. Clin. Endocrinol. Metab. 95, 3693-3700 (2010).
58. Boelaert, K. The association between serum TSH concentration and thyroid cancer. Endocr. Relat. Cancer 16, 1065-1072 (2009).
59. Boelaert, K. et al. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J. Clin. Endocrinol. Metab. 91, 4295-4301 (2006). (Pubitemid 44833401)
60. Fiore, E. et al. Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocr. Relat. Cancer 16, 1251-1260 (2009).
61. Valle, L. A. & Kloos, R. T. The prevalence of occult medullary thyroid carcinoma at autopsy. J. Clin. Endocrinol. Metab. 96, E109-E113 (2011).
62. Wilhelm, S. M., Robinson, A. V., Krishnamurthi, S. S. & Reynolds, H. L. Evaluation and management of incidental thyroid nodules in patients with another primary malignancy. Surgery 142, 581-586 (2007).
63. Ohba, K. et al. High incidence of thyroid cancer in focal thyroid incidentaloma detected by 18F-fluorodexyglucose positron emission tomography in relatively young healthy subjects: results of 3 year follow-up. Endocr. J. 57, 395-401 (2010).
64. Shroff, P., McGrath, G. A. & Pezzi, C. M. Incidentalomas of the parathyroid gland: multiple presentations, variable function, and review of the literature. Endocr. Pract. 11, 363-369 (2005).
65. Katz, A. D. & Kong, L. B. Incidental preclinical hyperparathyroidism identified during thyroid operations. Am. Surg. 58, 747-749 (1992). (Pubitemid 23004439)
66. Kwak, J. Y. et al. Parathyroid incidentalomas detected on routine ultrasound-directed fine-needle aspiration biopsy in patients referred for thyroid nodules and the role of parathyroid hormone analysis in the samples. Thyroid 19, 743-748 (2009).
67. Akerström, G. et al. Histologic parathyroid abnormalities in an autopsy series. Hum. Pathol. 17, 520-527 (1986). (Pubitemid 16077188)
68. Yu, N., Donnan, P. T. & Leese, G. P. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: The Parathyroid Epidemiology and Audit Research Study (PEARS). Clin. Endocrinol. (Oxf.) doi:10.1111/j.1365-2265.2010.03958.x.
69. Bilezikian, J. P., Khan, A. A. & Potts, J. T. Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J. Clin. Endocrinol. Metab. 94, 335-339 (2009).
70. Barzon, L., Sonino, N., Fallo, F., Palu, G. & Boscaro, M. Prevalence and natural history of adrenal incidentalomas. Eur. J. Endocrinol. 149, 273-285 (2003). (Pubitemid 37304697)
71. Kloos, R. T., Gross, M. D., Francis, I. R., Korobkin, M. & Shapiro, B. Incidentally discovered adrenal masses. Endocr. Rev. 16, 460-484 (1995).
72. Spain, D. M. & Weinsaft, P. Solitary adrenal cortical adenoma in elderly female; frequency. Arch. Pathol. 78, 231-233 (1964).
73. Dévényi, I. Possibility of normokalaemic primary aldosteronism as reflected in the frequency of adrenal cortical adenomas. J. Clin. Pathol. 20, 49-51 (1967).
74. Dobbie, J. W. Adrenocortical nodular hyperplasia: the ageing adrenal. J. Pathol. 99, 1-18 (1969).
75. Bovio, S. et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J. Endocrinol. Invest. 29, 298-302 (2006). (Pubitemid 43905318)
76. Bülow, B. et al. Adrenal incidentaloma-follow-up results from a Swedish prospective study. Eur. J. Endocrinol. 154, 419-423 (2006).
77. Kasperlik-Zeluska, A. A. et al. Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients. Clin. Endocrinol. (Oxf.) 46, 29-37 (1997).
78. Barzon, L. et al. Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J. Clin. Endocrinol. Metab. 83, 55-62 (1998). (Pubitemid 28498310)
79. Caplan, R. H., Strutt, P. J. & Wickus, G. G. Subclinical hormone secretion by incidentally discovered adrenal masses. Arch. Surg. 129, 291-296 (1994). (Pubitemid 24103322)
80. Herrera, M. F., Grant, C. S., van Heerden, J. A., Sheedy, P. F. & Ilstrup, D. M. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 110, 1014-1021 (1991).
81. Cawood, T. J., Hunt, P. J., O'Shea, D., Cole, D. & Soule, S. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur. J. Endocrinol. 161, 513-527 (2009).
82. Buurman, H. & Saeger, W. Abnormalities in incidentally removed adrenal glands. Endocr. Pathol. 17, 277-282 (2006). (Pubitemid 46279675)
83. Funder, J. W. et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93, 3266-3281 (2008).
84. Mantero, F. et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J. Clin. Endocrinol. Metab. 85, 637-644 (2000). (Pubitemid 32273647)
85. Bernini, G. P. et al. Frequency of pheochromocytoma in adrenal incidentalomas and utility of the glucagon test for the diagnosis. J. Endocrinol. Invest. 20, 65-71 (1997). (Pubitemid 27192836)
86. Tsagarakis, S., Vassiliadi, D. & Thalassinos, N. Endogenous subclinical hypercortisolism: Diagnostic uncertainties and clinical implications. J. Endocrinol. Invest. 29, 471-482 (2006). (Pubitemid 44043366)
87. Vassilatou, E. et al. Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin. Endocrinol. (Oxf.) 70, 674-679 (2009).
88. Nieman, L. K. Approach to the patient with an adrenal incidentaloma. J. Clin. Endocrinol. Metab. 95, 4106-4113 (2010).
89. Pantalone, K. M. et al. Change in adrenal mass size as a predictor of a malignant tumor. Endocr. Pract. 16, 577-587 (2010).
90. Johnson, P. T., Horton, K. M. & Fishman, E. K. Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radiographics 29, 1333-1351 (2009).
91. Ilias, I., Sahdev, A., Reznek, R. H., Grossman, A. B. & Pacak, K. The optimal imaging of adrenal tumours: a comparison of different methods. Endocr. Relat. Cancer 14, 587-599 (2007). (Pubitemid 350074049)
92. Yun, M. et al. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J. Nucl. Med. 42, 1795-1799 (2001). (Pubitemid 34016347)
93. Kopetschke, R. et al. Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. Eur. J. Endocrinol. 161, 355-361 (2009).
94. Pacak, K. et al. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat. Clin. Pract. Endocrinol. Metab. 3, 92-102 (2007). (Pubitemid 46146962)
95. Vierhapper, H. Determination of the aldosterone/renin ratio in 269 patients with adrenal incidentaloma. Exp. Clin. Endocrinol. Diabetes 115, 518-521 (2007). (Pubitemid 350056764)
96. Nieman, L. K. et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 93, 1526-1540 (2008). (Pubitemid 351656485)
97. Tsagarakis, S. et al. Elevated post-dexamethasone suppression cortisol concentrations correlate with hormonal alterations of the hypothalamo-pituitary adrenal axis in patients with adrenal incidentalomas. Clin. Endocrinol. (Oxf.) 49, 165-171 (1998). (Pubitemid 28372643)
98. Terzolo, M. et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma. Eur. J. Endocrinol. 153, 307-315 (2005). (Pubitemid 41167489)
99. Fernández-Real, J. M., Engel, W. R., Simó, R., Salinas, I. & Webb, S. M. Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma. Clin. Endocrinol. (Oxf.) 49, 53-61 (1998). (Pubitemid 28338043)
100. Young, W. F. Jr. Clinical practice. The incidentally discovered adrenal mass. N. Engl. J. Med. 356, 601-610 (2007). (Pubitemid 46220820)
101. Zeiger, M. A. et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr. Pract. 15, 450-453 (2009).
102. Nunes, M. L. et al. Late-night salivary cortisol for diagnosis of overt and subclinical Cushing's syndrome in hospitalized and ambulatory patients. J. Clin. Endocrinol. Metab. 94, 456-462 (2009).
103. Fagour, C. et al. Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study. Eur. J. Endocrinol. 160, 257-264 (2009).
104. Bardet, S. et al. 131I 6 beta-iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas. Clin. Endocrinol. (Oxf.) 44, 587-596 (1996).
105. [No authors listed] Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP publication 53). Ann. ICRP 28, 1-126 (1998).
106. Chiodini, I. et al. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemicalhypercortisolism. J. Clin. Endocrinol. Metab. 95, 2736-2745 (2010).
107. Stewart, P. M. Is subclinical Cushing's syndrome an entity or a statistical fallout from diagnostic testing? Consensus surrounding the diagnosis is required before optimal treatment can be defined. J. Clin. Endocrinol. Metab. 95, 2618-2620 (2010).
108. Rossi, R. et al. Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J. Clin. Endocrinol. Metab. 85, 1440-1448 (2000). (Pubitemid 32289484)
109. Tauchmanovà, L. et al. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J. Clin. Endocrinol. Metab. 87, 4872-4878 (2002). (Pubitemid 35316318)
110. Bernini, G. et al. Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery. Eur. J. Endocrinol. 148, 213-219 (2003). (Pubitemid 36305687)
111. Toniato, A. et al. Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study. Ann. Surg. 249, 388-391 (2009).
112. Tsuiki, M., Tanabe, A., Takagi, S., Naruse, M. & Takano, K. Cardiovascular risks and their long-term clinical outcome in patients with subclinical Cushing's syndrome. Endocr. J. 55, 737-745 (2008).
113. Eller-Vainicher, C. et al. Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery? Eur. J. Endocrinol. 162, 91-99 (2010).
114. Kasperlik-Zaluska, A. A. et al. Incidentally discovered adrenal tumors: a lesson from observation of 1,444 patients. Horm. Metab. Res. 40, 338-341 (2008). (Pubitemid 351859445)
115. Reincke, M. et al. Preclinical Cushing's syndrome in adrenal "incidentalomas": comparison with adrenal Cushing's syndrome. J. Clin. Endocrinol. Metab. 75, 826-832 (1992).
116. Emral, R. et al. Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes. Endocr. J. 50, 399-408 (2003). (Pubitemid 37129032)
117. Comlekci, A. et al. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine 37, 40-46 (2010).
118. Morelli, V. et al. Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects. Clin. Endocrinol. (Oxf.) 73, 161-166 (2010).
119. Giordano, R. et al. Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas. Eur. J. Endocrinol. 162, 779-785 (2010).
120. Fernández-Real, J. M., Gonzalbez, J. & Ricart, W. Metabolic abnormalities in patients with adrenal incidentaloma. J. Clin. Endocrinol. Metab. 86, 950-952 (2001). (Pubitemid 32207530)
121. Tauchmanovà, L. et al. Bone loss determined by quantitative ultrasonometry correlates inversely with disease activity in patients with endogenous glucocorticoid excess due to adrenal mass. Eur. J. Endocrinol. 145, 241-247 (2001). (Pubitemid 32825656)
122. Chiodini, I. et al. Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effects of subclinical hypercortisolism and gonadal status. J. Clin. Endocrinol. Metab. 89, 2237-2241 (2004). (Pubitemid 38619858)
123. Chiodini, I. et al. Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann. Intern. Med. 147, 541-548 (2007). (Pubitemid 351664501)
124. Chiodini, I. et al. Bone mineral density, prevalence of vertebral fractures, and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian multicenter study. J. Clin. Endocrinol. Metab. 94, 3207-3214 (2009).
125. Chiodini, I. et al. Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism. J. Clin. Endocrinol. Metab. 87, 5491-5494 (2002). (Pubitemid 36034349)
126. Chiodini, I. et al. Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures. Clin. Endocrinol. (Oxf.) 70, 208-213 (2009).
127. Osella, G. et al. Serum markers of bone and collagen turnover in patients with Cushing's syndrome and in subjects with adrenal incidentalomas. J. Clin. Endocrinol. Metab. 82, 3303-3307 (1997). (Pubitemid 27419076)
128. Bardet, S. et al. Bone mineral density and biological markers of bone repair in patients with adrenal incidentaloma: effect of subclinical hypercortisolism [French]. Rev. Med. Interne 23, 508-517 (2002). (Pubitemid 34650751)
129. Hadjidakis, D. et al. Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas? Clin. Endocrinol. (Oxf.) 58, 72-77 (2003). (Pubitemid 36098851)
130. Torlontano, M. et al. Altered bone mass and turnover in female patients with adrenal incidentaloma: the effect of subclinical hypercortisolism. J. Clin. Endocrinol. Metab. 84, 2381-2385 (1999).
131. Sereg, M. 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. 160, 647-655 (2009).
132. Erbil, Y. et al. Cardiovascular risk in patients with nonfunctional adrenal incidentaloma: myth or reality? World J. Surg. 33, 2099-2105 (2009).
133. Yilmaz, H., Tütüncü, N. B. & Sahin, M. Two-year follow-up of thirty-two non-functional benign adrenal incidentalomas. J. Endocrinol. Invest. 32, 913-916 (2009).
134. Erbil, Y. et al. Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery. World J. Surg. 30, 1665-1671 (2006). (Pubitemid 44411221)
135. Vasiliadi, D. et al. Glucocortidoid sensitivity assessed in peripheral blood cells do not correlate with the feedback sensitivity of the hypothalamo-pituitary adrenal axis. Hormones (Athens) 1, 233-238 (2002).
136. Huizenga, N. A. et al. Interperson variability but intraperson stability of baseline plasma cortisol concentrations, and its relation to feedback sensitivity of the hypothalamo pituitary adrenal axis to a low dose of dexamethasone in elderly individuals. J. Clin. Endocrinol. Metab. 83, 47-54 (1998). (Pubitemid 28498309)
137. Mitchell, I. C. et al. "Subclinical Cushing's syndrome" is not subclinical: improvement after adrenalectomy in 9 patients. Surgery 142, 900-905 (2007). (Pubitemid 350184118)
138. Lindholm, J. et al. Incidence and late prognosis of cushing's syndrome: a population-based study. J. Clin. Endocrinol. Metab. 86, 117-123 (2001). (Pubitemid 32111743)
139. 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.) 54, 797-804 (2001). (Pubitemid 34208891)
140. Guerrieri, M. et al. Primary adrenal hypercortisolism: minimally invasive surgical treatment or medical therapy? A retrospective study with long-term follow-up evaluation. Surg. Endosc. 24, 2542-2546 (2010).