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The relationship between adrenal incidentalomas and mortality risk

  • Michio TayaEmail author
  • Viktoriya Paroder
  • Eran Bellin
  • Linda B. Haramati
Urogenital

Abstract

Objective

To determine all-cause mortality risk in patients with and without adrenal incidentaloma.

Methods

Retrospective cohort study of patients with CT abdomen performed within 24 h of emergency room presentation at an academic medical center from January 1, 2005, to December 31, 2009, without history of adrenal disease, adrenal lab testing, or cancer. Incidentaloma cohort identified by database query of imaging reports followed by manual review and matched to no-nodule controls at 3:1 on age ± 1 year and exam date ± 3 months. Mortality ascertained by in-hospital deaths and National Death Index query. Survival analysis performed with Kaplan-Meier curves and Cox proportional hazards models.

Results

Among 42,575 adults with abdominal CT exams, 969 adrenal incidentaloma patients and 2907 no-nodule controls were identified. All 3876 individuals entered survival analysis with 31,182 person-years at risk (median follow-up 8.9 years [IQR, 6.9–10.7]). All-cause mortality was significantly higher among those with adrenal incidentalomas (353/969, 36.4%) compared with those without (919/2907, 31.6%; mortality difference 7.6 per 1000 person-years; multivariable-adjusted hazard ratio [aHR] 1.14; 95% CI, 1.003–1.29). Exploratory analyses, limited by missing covariates, found that adrenal incidentalomas were associated with significantly increased incidence of malignancy (aHR 1.61; 95% CI, 1.22–2.12), diabetes (aHR 1.43; 95% CI, 1.18–1.71), heart failure (aHR 1.32; 95% CI, 1.07–1.63), peripheral vascular disease (aHR 1.28; 95% CI, 1.95–1.56), renal disease (aHR 1.21; 95% CI, 1.01–1.44), and chronic pulmonary disease (aHR 1.22; 95% CI, 1.01–1.46) compared with controls.

Conclusions

Adrenal incidentalomas are associated with increased mortality and may represent a clinically valuable biomarker.

Key Points

• Adrenal incidentalomas are associated with increased mortality.

• Adrenal incidentaloma size is not predictive of mortality.

• On exploratory analyses, adrenal incidentalomas are associated with chronic illnesses.

Keywords

Adrenal gland neoplasms Incidental findings Cohort study Survival analysis Tomography, x-ray computed 

Abbreviations

AACE

American Association of Clinical Endocrinologists

AAES

American Association of Endocrine Surgeons

ACR

American College of Radiology

aHR

Adjusted hazard ratio

CI

Confidence interval

ICD-9

International Classification of Diseases Ninth Revision

IQR

Interquartile range

NDI

National Death Index

SD

Standard deviation

Notes

Acknowledgements

The preliminary findings were presented as an oral presentation at the Radiological Society of North America Annual Meeting, November 26, 2018, Chicago, IL.

Funding

This study has received funding by the Einstein Montefiore Department of Radiology and a National Institutes of Health Clinical and Translational Science Awards grant number 1UL-1TR001073 from the National Center for Advancing Translational Sciences.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Michio Taya, MD MS.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

The first author has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6202_MOESM1_ESM.docx (570 kb)
ESM 1 (DOCX 570 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterNew YorkUSA
  2. 2.Graduate Medical EducationVirginia Mason Medical CenterSeattleUSA
  3. 3.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of MedicineAlbert Einstein College of Medicine and Montefiore Medical CenterNew YorkUSA
  5. 5.Department of Epidemiology & Population HealthAlbert Einstein College of Medicine and Montefiore Medical CenterNew YorkUSA

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