The relationship between adrenal incidentalomas and mortality risk

Michio Taya, Viktoriya Paroder, Eran Y. Bellin, Linda B. Haramati

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalEuropean Radiology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Mortality
Survival Analysis
Chronic Disease
Peripheral Vascular Diseases
Adrenal incidentaloma
Hospital Mortality
Proportional Hazards Models
Abdomen
Lung Diseases
Hospital Emergency Service
Neoplasms
Cohort Studies
Heart Failure
Retrospective Studies
Biomarkers
Databases
Kidney
Incidence

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

The relationship between adrenal incidentalomas and mortality risk. / Taya, Michio; Paroder, Viktoriya; Bellin, Eran Y.; Haramati, Linda B.

In: European Radiology, 01.01.2019.

Research output: Contribution to journalArticle

@article{9104316ee5604976b8fe0d76ce97edd7,
title = "The relationship between adrenal incidentalomas and mortality risk",
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, Cohort study, Incidental findings, Survival analysis, Tomography, x-ray computed",
author = "Michio Taya and Viktoriya Paroder and Bellin, {Eran Y.} and Haramati, {Linda B.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00330-019-06202-y",
language = "English (US)",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - The relationship between adrenal incidentalomas and mortality risk

AU - Taya, Michio

AU - Paroder, Viktoriya

AU - Bellin, Eran Y.

AU - Haramati, Linda B.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Adrenal gland neoplasms

KW - Cohort study

KW - Incidental findings

KW - Survival analysis

KW - Tomography, x-ray computed

UR - http://www.scopus.com/inward/record.url?scp=85064595842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064595842&partnerID=8YFLogxK

U2 - 10.1007/s00330-019-06202-y

DO - 10.1007/s00330-019-06202-y

M3 - Article

C2 - 30993434

AN - SCOPUS:85064595842

JO - European Radiology

JF - European Radiology

SN - 0938-7994

ER -