Contribution of tomographic findings of the contralateral adrenal gland in the diagnosis of Mild Autonomous Cortisol Secretion (MACS)

• Grant number: 23/17788-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: March 01, 2024
• End date: February 28, 2025
• Field of knowledge: Health Sciences - Medicine - Medical Radiology
• Principal Investigator: Valdair Francisco Muglia
• Grantee: Matheus Bitencourt de Toledo
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

The adrenal incidentaloma, an adrenal mass of 1 cm or more discovered incidentally, has become common due to the increased use of high-resolution imaging. This study aims to address the need to differentiate these masses found during diagnostic exams, considering their potential malignancy and hormonal activity. With an incidence of approximately 5% in the population, this occurrence increases with age, reaching 10% in individuals aged 70 and above. Determining whether an adrenal mass is malignant or hormonally active is crucial for guiding appropriate clinical management.Malignancy is diagnosed in 5% to 8% of adrenal tumors, with the size of the lesion being a significant predictor of adrenocortical carcinoma. Non-secreting adenomas have historically been prevalent, but recently, adenomas with mild autonomous cortisol secretion (MACS) have been diagnosed in up to 30% to 50% of patients. These conditions, although not exhibiting the evident stigmas of Cushing's syndrome, are associated with fragility and an increased burden of cardiometabolic morbidities, including hyperglycemia, hypertension, dyslipidemia, and obesity.The evaluation of autonomous cortisol secretion in patients with adrenal incidentalomas is crucial. The test of choice is suppression with 1mg dexamethasone, with specific criteria for the diagnosis of MACS and "definitive" hypercortisolism. This research proposes a detailed radiological analysis of these masses, considering the relationship between lesion volume and contralateral adrenal gland characteristics.Computed tomography is the primary imaging modality to assess these lesions, and while it can differentiate benign from malignant tumors, studies on the diagnosis of autonomous adrenal hypercortisolism from radiological phenotyping are limited. This project aims to fill this gap, using two-dimensional and volumetric analysis to compare characteristics in patients with different cortisol secretion levels.The retrospective study will include 200 patients with adrenal incidentalomas, undergoing clinical, biochemical, and radiological evaluations. The statistical analysis will encompass specific tests to relate adrenal volume to cortisol secretion. The data management plan ensures confidentiality and proper preservation.In summary, this project aims to enhance the understanding and diagnosis of adrenal incidentalomas, offering significant contributions to clinical practice and improving the management of these common yet clinically challenging lesions.