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Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study

Departments of¹ , Endocrinology² Nuclear Medicine, University Hospital of Bordeaux, Hôpital Haut Leveque, Avenue de Magellan, 33600 Pessac, France³ Department of Nuclear Medicine, Centre François Baclesse, 14076 Caen, France⁴ Department of Endocrinology, University Hospital of Angers, 49033 Angers, France⁵ Department of Pharmacology, INSERM U 657, University of Bordeaux 2, Bordeaux 33000, France⁶ Department of Endocrinology, University Hospital of Tours, 37044 Tours Cedex 9, France

(Correspondence should be addressed to A Tabarin; Email: antoine.tabarin{at}chu-bordeaux.fr)

Objectives: Prognostic factors for progression of benign adrenocortical adenomas (AI) remain poorly known. We assessed the usefulness of ¹³¹I-6-β-iodomethylnorcholesterol scintigraphy (IMS) to predict the occurrence of adrenal hyperfunction or mass enlargement.

Design: Fifty-one consecutive inpatients with unilateral AI and normal 24-h urinary free cortisol (UFC) were enrolled in a multicenter observational prospective study to investigate the relationship between the scintigraphic pattern and the progression of biological abnormalities of the hypothalamo-pituitary–adrenal axis or tumor size.

Results: Biochemically defined ‘subclinical’ Cushing's syndrome (SCS) was found at baseline in 47% of patients. Unilateral uptake (UU) was significantly associated with SCS (P<0.05). During the follow-up (4.3±1.6-year): 53% of patients showed unchanged hormonal evaluation, 29% displayed intermittent SCS and 18% showed definitive hormonal progression of SCS but without overt biochemical hypercortisolism. UU was associated with persistence of SCS and hormonal progression (P<0.01). In multivariate analysis, UU and impaired 1 mg dexamethasone suppression were independently associated with hormonal progression. Three patients with UU developed clinical CS despite persistently normal UFC. Tumor size increased in 10% patients and was not associated with any scintigraphic pattern.

Conclusion: Evolution of SCS toward overt biochemical CS in patients with AI is a rare event during a 4-year follow-up. UU is predictive for the occurrence of SCS, its persistence and progression within the spectrum of SCS. Further studies aiming to establish the clinical consequences of SCS are needed to recommend IMS as a complementary evaluation in patients with AI and biochemical SCS.