Incidentaloma natural history, complications and prognosis: Difference between revisions
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* In the vast majority of patients with apparently benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population (106, 107, 116). | * In the vast majority of patients with apparently benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population (106, 107, 116). | ||
* cardiac disease in 43%, malignancy in 22%, chronic obstructive pulmonary diseases in 11%, Alzheimer’s disease in 6%, cerebrovascular accident in 4%, pneumonia or sepsis in 4%, ruptured abdominal aortic aneurysm in 2.5%, diabetic renal failure in 2.5%, and other causes in 5%. Also in the series reported by Siren et al. (107), including 21 patients with adrenal | * cardiac disease in 43%, malignancy in 22%, chronic obstructive pulmonary diseases in 11%, Alzheimer’s disease in 6%, cerebrovascular accident in 4%, pneumonia or sepsis in 4%, ruptured abdominal aortic aneurysm in 2.5%, diabetic renal failure in 2.5%, and other causes in 5%. Also in the series reported by Siren et al. (107), including 21 patients with adrenal incidentaloma. | ||
* | * ACC, generally, carries a poor prognosis<sup>[12]</sup> and is unlike most tumours of the adrenal cortex, which are benign (adenomas) and only occasionally cause Cushing's syndrome. Five-year disease-free survival for a complete resection of a stage I–III ACC is approximately 30%.<sup>[12]</sup> The most important prognostic factors are age of the patient and stage of the tumor. Poor prognostic factors: mitotic activity, venous invasion, weight of 50g+; diameter of 6.5 cm+, Ki-67/MIB1 labeling index of 4%+, p53+ | ||
* the most common causes of death were related to cardiovascular disease (acute myocardial infarction, ventricular arrhythmia, cardiac failure, multi-infarct dementia, and acute cerebrovascular infarct), which occurred in seven out of nine deaths, whereas pulmonary embolism secondary to deep vein thrombosis and lung cancer occurred in two. Mean age at death was 72.8 years. | * the most common causes of death were related to cardiovascular disease (acute myocardial infarction, ventricular arrhythmia, cardiac failure, multi-infarct dementia, and acute cerebrovascular infarct), which occurred in seven out of nine deaths, whereas pulmonary embolism secondary to deep vein thrombosis and lung cancer occurred in two. Mean age at death was 72.8 years. | ||
* Whether the relatively high rate of mortality due to cardiovascular disease is related to hypercortisolism was not investigated. | * Whether the relatively high rate of mortality due to cardiovascular disease is related to hypercortisolism was not investigated. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
- The symptoms of (disease name) typically develop ___ years after exposure to ___.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- it seems that the majority of masses, classified as benign and non-hypersecreting at diagnosis, subsequently remains hormonally and morphologically unchanged (20, 53–56, 62, 64, 67, 71, 73, 87, 90, 103–108) (Table 6).
- Nonetheless, in a percentage which varies in different series, some cases develop mass enlargement and/or adrenal hyperfunction, ranging from 0 to 26% and from 0 to 11% respectively
- 9% of cases showed mass enlargement greater than 1 cm and/or the appearance of another mass in the contralateral adrenal gland.
- Mass enlargement was generally limited to 1–2 cm increase in diameter over a period of 1–3 years.
- The likelihood of malignant transformation at longterm follow-up for masses considered as benign at diagnosis is therefore minimal, and is estimated at one case
- per 1000 incidentalomas.
- Reduction or even disappearance of the adrenal mass have been reported in up to 40% (mean, 3.6%) of adrenal incidentalomas, most often in the case of cystic lesions, hematomas, or adrenal pseudotumors.
Complications
- Common complications of [disease name] include:
Prognosis
- Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
- Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
- The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
- The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
- In the vast majority of patients with apparently benign adrenal incidentalomas, death is not directly related to the adrenal mass, but to cardiovascular accidents, malignancy, and chronic disorders, as observed in the general population (106, 107, 116).
- cardiac disease in 43%, malignancy in 22%, chronic obstructive pulmonary diseases in 11%, Alzheimer’s disease in 6%, cerebrovascular accident in 4%, pneumonia or sepsis in 4%, ruptured abdominal aortic aneurysm in 2.5%, diabetic renal failure in 2.5%, and other causes in 5%. Also in the series reported by Siren et al. (107), including 21 patients with adrenal incidentaloma.
- ACC, generally, carries a poor prognosis[12] and is unlike most tumours of the adrenal cortex, which are benign (adenomas) and only occasionally cause Cushing's syndrome. Five-year disease-free survival for a complete resection of a stage I–III ACC is approximately 30%.[12] The most important prognostic factors are age of the patient and stage of the tumor. Poor prognostic factors: mitotic activity, venous invasion, weight of 50g+; diameter of 6.5 cm+, Ki-67/MIB1 labeling index of 4%+, p53+
- the most common causes of death were related to cardiovascular disease (acute myocardial infarction, ventricular arrhythmia, cardiac failure, multi-infarct dementia, and acute cerebrovascular infarct), which occurred in seven out of nine deaths, whereas pulmonary embolism secondary to deep vein thrombosis and lung cancer occurred in two. Mean age at death was 72.8 years.
- Whether the relatively high rate of mortality due to cardiovascular disease is related to hypercortisolism was not investigated.