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Predictive model for autonomous cortisol secretion development in non-functioning adrenal incidentalomas

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Abstract

Purpose

We aimed to develop a predictive model able to stratify patients with non-functioning adrenal incidentalomas (AIs), according to their risk for developing autonomous cortisol secretion (ACS) during follow-up.

Methods

This was a retrospective study of patients with non-functioning AIs consecutively evaluated at a single institution between 2013 and 2019 in whom hormonal follow-up information was available for at least 1 year. Clinical, biochemical, and radiological features were used to build a multivariate Cox regression model using the estimation of all possible equations.

Results

We included 331 patients with non-functioning AIs. ACS (post-dexamethasone suppression test (DST) serum cortisol > 1.8 µg/dL) developed in 73 patients during a median follow-up time of 35.7 months [range 12.8–165.4]. The best predictive model for ACS development during follow-up combined age, post-DST serum cortisol, and bilaterality at presentation and showed good diagnostic accuracy (AUC-ROC 0.70 [95% CI 0.65–0.75]). The lowest risk for ACS development was found among patients < 50 years old with cortisol post-DST values < 0.45 µg/dL and with unilateral tumors (risk 2.42%). Baseline post-DST serum cortisol levels at diagnosis were the most important factor for the development of ACS during follow-up (hazard ratio 3.56 for each µg/dL, p < 0.001). The rate of ACS development was associated with post-DST cortisol levels, being 19.2, 32.3, and 68.1 cases/10,000 person-years for patients with baseline post-DST cortisol < 0.9 µg/dL, 0.9–1.3 µg/dL, and > 1.3 µg/dL, respectively.

Conclusion

After ruling out malignancy, follow-up visits for patients < 50 years old with unilateral non-functioning AIs and post-DST serum cortisol < 0.45 µg/dL are considered unnecessary given the low risk of developing ACS during follow-up.

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Acknowledgements

Val Fernández. Bioinformatics Unit, IRYCIS, Hospital Ramón y Cajal, Madrid; Ángel del Rey. Bioinformatics Unit, IRYCIS, Hospital Ramón y Cajal, Madrid.

Funding

SENDIMAD: BECA SENDIMAD de Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019. IRYCIS: Convocatoria intramural de ayudas a proyectos de investigación de investigadores noveles, investigadores clínicos asociados y/o grupos emergentes del Hospital Universitario Ramón y Cajal 2019.

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Authors and Affiliations

  1. Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

    Marta Araujo-Castro, Héctor F. Escobar-Morreale & Pablo Valderrabano

  2. Universidad de Alcalá, Madrid, Spain

    Marta Araujo-Castro & Héctor F. Escobar-Morreale

  3. Department of Biochemistry, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

    Ana M. García Cano

  4. Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain

    Héctor F. Escobar-Morreale

Authors
  1. Marta Araujo-Castro
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  2. Ana M. García Cano
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  3. Héctor F. Escobar-Morreale
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  4. Pablo Valderrabano
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Corresponding authors

Correspondence to Marta Araujo-Castro or Pablo Valderrabano.

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Ethical approval

All the procedures performed in the participants of the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study has been approved by the Ethical Committee of the Hospital Universitario La Princesa and Hospital Ramón y Cajal University Hospital, Madrid, Spain.

Informed consent

Due to the retrospective nature of the study, the Ethical Committee approved the need for informed consent only in those patients who continued follow-up in our center.

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The authors declare no competing interests.

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Araujo-Castro, M., García Cano, A.M., Escobar-Morreale, H.F. et al. Predictive model for autonomous cortisol secretion development in non-functioning adrenal incidentalomas. Hormones 22, 51–59 (2023). https://doi.org/10.1007/s42000-022-00406-6

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