Información del artículo
La aplicación de técnicas de imagen de alta definición como la tomografía axial computarizada o la resonancia magnética ha hecho posible que la identificación de masas adrenales incidentales sea cada vez más frecuente. El estudio funcional de los incidentalomas adrenales permite comprobar que un porcentaje significativo de ellos se comporta de forma autónoma en lo que respecta a la secreción de cortisol, que se muestra independiente del control de las concentraciones de corticotropina. La aplicación de diferentes protocolos diagnósticos está permitiendo caracterizar mejor los incidentalomas adrenales desde el punto de vista funcional, lo que favorece la tipificación de situaciones de autonomía adrenocortical o síndrome de Cushing subclínico. Aun cuando son necesarios más estudios para establecer el impacto del hipercortisolismo subclínico sobre la esperanza de vida, existen evidencias de que se asocia con factores de riesgo cardiovascular y con el desarrollo de osteoporosis, lo que recalca la importancia de su detección, valoración y tratamiento. El desarrollo de la vía laparoscópica en el abordaje quirúrgico de las masas adrenales ofrece una opción terapéutica factible para el tratamiento de las masas adrenales hiperfuncionantes. Establecer qué casos de síndrome de Cushing subclínico son susceptibles de intervención terapéutica es uno de los retos actuales en la patología de la glándula suprarrenal.
Palabras clave:
Incidentaloma adrenal
Cushing subclínico
Autonomía adrenocortical
Masa adrenal
The use of high resolution imaging procedures has increased the identification of incidentally adrenal masses. When properly studied, adrenal incidentalomas show some biochemical features of adrenocortical autonomy in a significant number of cases, setting the basis for the diagnosis of subclinical Cushing syndrome. Recent evidences suggest that subtle glucocorticoid hypersecretion may be associated with metabolic syndrome, high cardiovascular risk and osteoporosis development. In fact, some patients with subclinical hypercortisolism due to adrenal incidentaloma get an improvement of hypertension and metabolic abnormalities following surgical treatment. These data raise several questions related to the need of evaluating and treating subclinical Cushing syndrome, specially when surgery can be performed by the less-aggressive laparoscopic approach. At present, the uniformity of diagnostic criteria, results of spontaneous follow-up and the effects of treatment of subclinical Cushing syndrome represent one of the most interesting challenges in adrenal pathology.
Key words:
Adrenal incidentaloma
Subclinical Cushing
Adrenocortical autonomy
Adrenal mass
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Bibliografía
[1.]
M. Reincke.
Subclinical Cushing's syndrome.
Endocrinol Metab Clin North Am, 29 (2000), pp. 43-56
[2.]
N.S. Ross.
Epidemiology of Cushing's syndrome and subclinical disease.
Endocrinol Metab Clin North Am, 23 (1994), pp. 539-546
[3.]
G. La Cava, A. Imperiale, C. Olianti, G.R. Gheri, C. Ladu, M. Mannelli, et al.
SPECT semiquantitative analysis of adrenocortical 131I-6â-iodomethyl-norcholesterol uptake to discriminate subclinical and preclinical functioning adrenal incidentaloma.
J Nucl Med, 44 (2003), pp. 1057-1064
[4.]
D.M. Cook, D. Lynn Loriaux.
The incidental adrenal mass.
The Endocrinologist, 6 (1996), pp. 4-9
[5.]
L. Barzon, N. Sonino, F. Fallo, G. Palu, M. Boscaro.
Prevalence and natural history of adrenal incidentalomas.
Eur J Endocrinol, 149 (2003), pp. 273-285
[6.]
H. Hedeland, C. Ostberg, B. Hokfelt.
On the prevalence of adrenocortical adenomas in autopsy material in relation to hypertension and diabetes.
Acta Med Scand, 184 (1968), pp. 211-214
[7.]
M. Terzolo, G. Osella, A. Ali, G. Boorretta, F. Cesario, P. Paccotti, et al.
Subclinical Cushing's syndrome in adrenal incidentaloma.
Clin Endocrinol, 48 (1998), pp. 89-97
[8.]
S. Tsagarakis, P. Kokkoris, C. Roboi, C. Malagari, J. Kaskarelis, V. Vlassopoulou, et al.
The low-dose dexamethasone suppression test in patients with adrenal incidentalomas: comparisons with clinical euadrenal subjects and patients with Cushing's syndrome.
Clin Endocrinol, 48 (1998), pp. 627-633
[9.]
R. Rossi, L. Tauchmanova, A. Luciano, M. Di Martino, C. Battista, L. Del Viscovo, et al.
Subclinical Cushing' syndrome in patients with adrenal incidentaloma: clinical and biochemical features.
J Clin Endocrinol Metab, 85 (2000), pp. 1440-1448
[10.]
N. Valli, B. Catargi, N. Ronci, V. Vergnot, F. Leccia, J.M. Ferriere, et al.
Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas.
Eur J Endocrinol, 144 (2001), pp. 401-408
[11.]
M. Morioka, T. Fujii, T. Matsuki, Y. Jo, T. Kobayashi, H. Tanaka, et al.
Preclinical Cushing's syndrome: report on seven cases and review of the literature.
Int J Urol, 7 (2000), pp. 126-132
[12.]
E. Grossrubatscher, F. Vignati, M. Possa, P. Loli.
The natural history of incidentally discovered adrenocortical adenomas: a retrospective evaluation.
J Endocrinol Invest, 24 (2001), pp. 846-855
[13.]
D. Hadjidakis, S. Tsagarakis, C. Roboti, M. Sfakianakis, V. Iconomidou, S.A. Raptis, et al.
Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas?.
Clin Endocrinol, 58 (2003), pp. 72-77
[14.]
F. Mantero, M. Terzolo, G. Arnaldi, G. Osella, A.M. Masini, A. Ali, et al.
A survey on adrenal incidentaloma in Italy.
J Clin Endocrinol Metab, 85 (2000), pp. 637-644
[15.]
L. Barzon, F. Fallo, N. Sonino, M. Boscaro.
Development of overt Cushing's syndrome in patients with adrenal incidentaloma.
Eur J Endocrinol, 146 (2002), pp. 61-66
[16.]
M. Torlontano, I. Chiodini, M. Pileri, G. Guglielmi, M. Cammisa, S. Modoni, et al.
Altered bone mass and turnover in female patients with adrenal incidentaloma: the effect of subclinical hypercortisolism.
J Clin Endocrinol Metab, 84 (1999), pp. 2381-2385
[17.]
M. Reincke, J. Nieke, G. Krestin, W. Saeger, B. Allolio, W. Winkelmann.
Preclinical Cushing's syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing's syndrome.
J Clin Endocrinol Metab, 75 (1992), pp. 826-832
[18.]
D. Hirano, Y. Okada, H. Ishida, K. Okada.
Electron microscopic study to compare preclinical Cushing's syndrome with overt Cushing's syndrome.
Int J Urol, 9 (2002), pp. 193
[19.]
J. Bertherat, H. Mosnier-Pudar, X. Bertagna.
Adrenal incidentalomas.
Curr Opin Oncol, 14 (2002), pp. 58-63
[20.]
R.T. Kloos, M.D. Gross, I.R. Francis, M. Korobkin, B. Shapiro.
Incidentally discovered adrenal masses.
Endocr Rev, 16 (1995), pp. 460-484
[21.]
T. Takao, T. Mimoto, M. Yamamoto, K. Hashimoto.
Preclinical Cushing disease.
Arch Intern Med, 161 (2001), pp. 892-893
[22.]
S. Jaresch, E. Kornely, H.K. Kley, R. Schlaghecke.
Adrenal incidentaloma and patients with homozygous or heterozygous congenital adrenal hyperplasia.
J Clin Endocrinol Metab, 74 (1992), pp. 685-689
[23.]
M. Bondanelli, M. Campo, G. Trasforini, et al.
Evaluation of hormonal function in a series of incidentally discovered adrenal masses.
Metabolism, 46 (1997), pp. 107-113
[24.]
L. Groussin, K. Perlemoine, V. Contesse, H. Lefebvre, A. Tabarin, P. Thieblot, et al.
The ectopic expression of the gastric inhibitory polypeptide receptor is frequent in adrenocorticotropinindependent bilateral macronodular adrenal hyperplasia, but rare in unilateral tumors.
J Clin Endocrinol Metab, 87 (2002), pp. 1980-1985
[25.]
S. Tsagarakis, C. Tsigos, V. Vassiliou, P. Tsiotra, H. Pratsinis, D. Kletsas, et al.
Food-dependent androgen and cortisol secretion by a gastric inhibitory polypeptide-receptor expressive adrenocortical adenoma leading to hirsutism and subclinical Cushing's syndrome: in vivo and in vitro studies.
J Clin Endocrinol Metab, 86 (2001), pp. 583-589
[26.]
A. Lacroix, N. N'Diaye, J. Tremblay, P. Hamet.
Ectopic and abnormal hormone receptors in adrenal Cushing's syndrome.
Endocr Rev, 22 (2001), pp. 75-110
[27.]
I. Bourdeau, P. D'Amour, P. Hamet, J.M. Boutin, A. Lacroix.
Aberrant membrane hormone receptors in incidentally discovered bilateral macronodular adrenal hyperplasia with subclinical Cushing's syndrome.
J Clin Endocrinol Metab, 86 (2001), pp. 5534-5540
[28.]
J.M. Fernandez Real, W. Ricart Engel, R. Simo, I. Salinas, S.M. Webb.
and the study group of Incidental Adrenal Adenoma. Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours.
Clin Endocrinol, 49 (1998), pp. 53-61
[29.]
G.G.M. Garrapa, P. Pantanetti, G. Arnaldi, F. Mantero, E. Faloia.
Body composition and metabolic features in women with adrenal incidentaloma or Cushing's syndrome.
J Clin Endocrinol Metab, 86 (2001), pp. 5301-5306
[30.]
G. Bernini, A. Moretti, P. Iacconi, P. Miccoli, R. Nami, B. Lucani, et al.
Anthropometric, hemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery.
Eur J Endocrinol, 148 (2003), pp. 213-219
[31.]
L. Tauchmanova, R. Rossi, B. Biondi, M. Pulcrano, V. Nuzzo, E.A. Palmieri, et al.
Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk.
J Clin Endocrinol Metab, 87 (2002), pp. 4872-4878
[32.]
A. Faggiano, R. Pivonello, S. Spiezia, M.C. De Martino, M. Filipella, C. Di Somma, et al.
Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing's disease during active disease and 1 year after disease remission.
J Clin Endocrinol Metab, 88 (2003), pp. 2527-2533
[33.]
J.A. Whitworth, G.J. Mangos, J.J. Kelly.
Cushing, cortisol and cardiovascular disease.
Hypertension, 36 (2000), pp. 912-916
[34.]
M. Terzolo, A. Pia, A. Ali, G. Osella, G. Reimondo, S. Bovio, et al.
Adrenal incidentaloma: a new cause of the metabolic syndrome?.
J Clin Endocrinol Metab, 87 (2002), pp. 998-1003
[35.]
B. Catargi, V. Rigalleau, A. Poussin, N. Ronci-Chaix, V. Bex, V. Vergnot, et al.
Occult Cusing's syndrome in type-2 diabetes.
J Clin Endocrinol Metab, 88 (2003), pp. 5808-5813
[36.]
C.M. Francucci, P. Pantanetti, G.G. Garrapa, F. Massi, G. Arnaldi, F. Mantero.
Bone metabolism and mass in women with Cushing's syndrome and adrenal incidentaloma.
Clin Endocrinol, 57 (2002), pp. 587-593
[37.]
I. Chiodini, M. Torlontano, V. Carnevale, G. Guglielmi, M. Cammisa, V. Trischitta, et al.
Bone loss rate in adrenal incidentalomas: a longitudinal study.
J Clin Endocrinol Metab, 86 (2001), pp. 5337-5341
[38.]
L. Tauchmanova, R. Rossi, V. Nuzzo, 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 (2001), pp. 241-247
[39.]
I. Chiodini, L. Tauchmanova, M. Torlontano, C. Battista, G. Guglielmi, M. Cammisa, et al.
Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism.
J Clin Endocrinol Metab, 87 (2002), pp. 5491-5494
[40.]
A. Sartorio, A. Conti, S. Ferrero, S. Giambona, T. Re, E. Passini, et al.
Evaluation of markers of bone and collagen turnover in patients with active and preclinical Cushing's syndrome and in patients with adrenal incidentaloma.
Eur J Endocrinol, 1388 (1998), pp. 146-152
[41.]
G. Osella, M. Terzolo, G. Reimondo, A. Piovesan, A. Pia, A. Termine, 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 (1997), pp. 3303-3307
[42.]
G. Osella, G. Reimondo, P. Peretti, A. Ali, P. Paccotti, A. Angeli, et al.
The patients with incidentally discovered adrenal adenoma (incidentaloma) are not at increased risk of osteoporosis.
J Clin Endocrinol Metab, 86 (2001), pp. 604-607
[43.]
M. Terzolo, S. Bosoni, A. Ali, M. Doga, G. Reimondo, G. Milani, et al.
Growth hormone (GH) responses to GH-releasing hormone alone or combined with arginine in patients with adrenal incidentaloma: evidence for enhanced somatostatinergic tone.
J Clin Endocrinol Metab, 85 (2000), pp. 1310-1315
[44.]
S. Ozmen, R. Yavuzer, I. Yazici, O. Laftoglu.
Adrenal incidentaloma as a cause of postoperative exaggerated ecchymosis.
Ann Plast Surg, 46 (2001), pp. 82-83
[45.]
S. Midorikawa, H. Sanada, S. Hashimoto, T. Suzuki, T. Watanabe.
The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection.
Clin Endocrinol, 54 (2001), pp. 797-804
[46.]
G. Luisetto, M. Zangari, V. Camozzi, M. Boscaro, N. Sonino, F. Fallo.
Recovery of bone mineral density after surgical cure, but not by ketoconazole treatment in Cushing's syndrome.
Osteoporos Int, 12 (2001), pp. 956-960
[47.]
S. Tsagarakis, C. Roboti, P. Kokkoris, V. Vasiliou, C. Alevizaki, N. Thalassinos.
Elevated post-dexamethasone suppression cortisol concentrations correlate with hormonal alterations of the hypothalamo-pituitary adrenal axis in patients with adrenal incidentalomas.
Clin Endocrinol, 49 (1998), pp. 165-171
[48.]
M. Terzolo, G. Osella, A. Ali, G. Borretta, G.P. Magro, A. Termine, et al.
Different patterns of steroid secretion in patients with adrenal incidentaloma.
J Clin Endocrinol Metab, 81 (1996), pp. 740-744
[49.]
Z. Bencsik, I. Szabolcs, Z. Kovacs, A. Ferencz, A. Voros, I. Kaszas, et al.
Low dehydroepiandrosterone sulfate (DHEA-S) level is not a good predictor of hormonal activity in nonselected patients with incidentally detected adrenal tumors.
J Clin Endocrinol Metab, 81 (1996), pp. 1726-1729
[50.]
M.D. Gross, B. Shapiro, I.R. Francis, G.M. Glazer, R.L. Bree, M.A. Arcomano, et al.
Scintigraphic evaluation of clinically silent adrenal masses.
J Nucl Med, 35 (1994), pp. 1145-1152
[51.]
L. Barzon, C. Scaroni, N. Sonino, F. Fallo, M. Gregianin, C. Macri, et al.
Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates.
J Clin Endocrinol Metab, 83 (1998), pp. 55-62
[52.]
S. Bardet, V. Rohmer, A. Murat, C. Guillemot, R. Marechaud, M. Chupin, et al.
131I-6β-iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas.
Clin Endocrinol, 44 (1996), pp. 587-596
[53.]
R. Libe, C. Dall'Asta, L. Barbetta, A. Baccarelli, P. Beck-Peccoz, B. Ambrosi.
Long-term follow-up study of patients with adrenal incidentalomas.
Eur J Endocrinol, 147 (2002), pp. 489-494
[54.]
L. Barzon, C. Scaroni, N. Sonino, F. Fallo, A. Paoletta, M. Boscaro.
Risk factors and long-term follow-up of adrenal incidentalomas.
J Clin Endocrinol Metab, 84 (1999), pp. 5220-5226
[55.]
S. Minowada, T. Fujimura, N. Takahashi, H. Kishi, K. Hasuo, M. Minami.
Computed tomography-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenoma.
J Clin Endocrinol Metab, 88 (2003), pp. 5814-5817
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