Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis
Abstract Background Increased detection of non-functioning adrenal incidentalomas (NFAI) due to widespread abdominal imaging may underestimate associated metabolic risks. To examine NFAI's impact on metabolic comorbidities and evaluate outcomes in surgical and non-surgical management, including...
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2025-04-01
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| Series: | BMC Endocrine Disorders |
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| Online Access: | https://doi.org/10.1186/s12902-025-01923-2 |
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| author | Xiaolan Li Huiyu Lan Xinying Lin Huibin Huang Junping Wen Gang Chen Wei Lin |
| author_facet | Xiaolan Li Huiyu Lan Xinying Lin Huibin Huang Junping Wen Gang Chen Wei Lin |
| author_sort | Xiaolan Li |
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| description | Abstract Background Increased detection of non-functioning adrenal incidentalomas (NFAI) due to widespread abdominal imaging may underestimate associated metabolic risks. To examine NFAI's impact on metabolic comorbidities and evaluate outcomes in surgical and non-surgical management, including changes in NFAI characteristics during follow-up. Methods Meta-analysis of studies from PubMed, Embase, Cochrane Library, and Web of Science (January 2000 to May 2024). Studies focusing on patients with serum cortisol levels ≤ 50 nmol/L after 1 mg dexamethasone suppression test (DST). Prevalence of hypertension, diabetes, obesity, and lipid disorders before and after follow-up. Tumor growth (> 10 mm increase) and functional changes (1 mg DST retest) were assessed. Results Eighteen studies met inclusion criteria (n = 2,059). In the non-surgical group, diabetes (RR: 1.33, 95% CI: 1.07–1.65) and lipid disorders (RR: 1.22, 95% CI: 1.07–1.38) increased significantly, while hypertension (RR: 1.07, 95% CI: 0.99–1.16) and obesity (RR: 1.05, 95% CI: 0.91–1.21) showed no significant change. Surgical intervention significantly improved hypertension (RR: 0.67, 95% CI: 0.52–0.86). During mean follow-up of 46.1 months, 4% (95% CI: 2%- 8%) of NFAI enlarged > 10 mm, while 8% (95% CI: 5%- 14%) became functional during 45.1 months of follow-up. Conclusions In patients with NFAI, subtle hormone secretion may exist despite current diagnostic criteria suggesting non-functionality. Such tumors show significant associations with metabolic disorders, particularly diabetes mellitus and dyslipidemia. Future research should focus on developing more sensitive diagnostic methods and establishing evidence-based surgical intervention criteria through prospective studies. |
| format | Article |
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| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Endocrine Disorders |
| spelling | doaj-art-6f7212f2e9b74fee895aa0aa1e7b82d92025-08-20T02:16:06ZengBMCBMC Endocrine Disorders1472-68232025-04-0125111210.1186/s12902-025-01923-2Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysisXiaolan Li0Huiyu Lan1Xinying Lin2Huibin Huang3Junping Wen4Gang Chen5Wei Lin6Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalAbstract Background Increased detection of non-functioning adrenal incidentalomas (NFAI) due to widespread abdominal imaging may underestimate associated metabolic risks. To examine NFAI's impact on metabolic comorbidities and evaluate outcomes in surgical and non-surgical management, including changes in NFAI characteristics during follow-up. Methods Meta-analysis of studies from PubMed, Embase, Cochrane Library, and Web of Science (January 2000 to May 2024). Studies focusing on patients with serum cortisol levels ≤ 50 nmol/L after 1 mg dexamethasone suppression test (DST). Prevalence of hypertension, diabetes, obesity, and lipid disorders before and after follow-up. Tumor growth (> 10 mm increase) and functional changes (1 mg DST retest) were assessed. Results Eighteen studies met inclusion criteria (n = 2,059). In the non-surgical group, diabetes (RR: 1.33, 95% CI: 1.07–1.65) and lipid disorders (RR: 1.22, 95% CI: 1.07–1.38) increased significantly, while hypertension (RR: 1.07, 95% CI: 0.99–1.16) and obesity (RR: 1.05, 95% CI: 0.91–1.21) showed no significant change. Surgical intervention significantly improved hypertension (RR: 0.67, 95% CI: 0.52–0.86). During mean follow-up of 46.1 months, 4% (95% CI: 2%- 8%) of NFAI enlarged > 10 mm, while 8% (95% CI: 5%- 14%) became functional during 45.1 months of follow-up. Conclusions In patients with NFAI, subtle hormone secretion may exist despite current diagnostic criteria suggesting non-functionality. Such tumors show significant associations with metabolic disorders, particularly diabetes mellitus and dyslipidemia. Future research should focus on developing more sensitive diagnostic methods and establishing evidence-based surgical intervention criteria through prospective studies.https://doi.org/10.1186/s12902-025-01923-2Adrenal incidentaloma (AI)Non-functioning adrenal incidentalomaMetabolic comorbiditiesSurgical managementNon-surgical management |
| spellingShingle | Xiaolan Li Huiyu Lan Xinying Lin Huibin Huang Junping Wen Gang Chen Wei Lin Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis BMC Endocrine Disorders Adrenal incidentaloma (AI) Non-functioning adrenal incidentaloma Metabolic comorbidities Surgical management Non-surgical management |
| title | Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis |
| title_full | Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis |
| title_fullStr | Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis |
| title_full_unstemmed | Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis |
| title_short | Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis |
| title_sort | metabolic complications and clinical outcomes of non functioning adrenal incidentalomas a systematic review and meta analysis |
| topic | Adrenal incidentaloma (AI) Non-functioning adrenal incidentaloma Metabolic comorbidities Surgical management Non-surgical management |
| url | https://doi.org/10.1186/s12902-025-01923-2 |
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