Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2025
Growth Kinetics of Bilateral Macronodular Adrenocortical Disease: Long-Term Imaging Follow-Up in Natural and Surgical Cohorts.
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Xu Huaijin, Zhong Feiyang, Jiao Qilong, Wang Yajing, Li Bing, Zhou Huixin, Yin Yaqi, Ma Wangtian, Gu Weijun, Mu Yiming, Lyu Zhaohui
Аннотация
OBJECTIVE: The aim of this study is to investigate the natural growth and post-unilateral total adrenalectomy changes of bilateral macronodular adrenocortical disease (BMAD).
METHODS: Retrospective analysis included BMAD patients with ≥2 computed tomography scans: 52 in the natural course cohort (median follow-up 31 months, range 7-150) and 23 in the post-unilateral adrenalectomy cohort (median follow-up 36 months, range 2-98), with their adrenal volumes measured precisely. A linear mixed-effects model was applied to longitudinal data from patients with ≥3 computed tomography scans to analyze adrenal growth patterns.
RESULTS: In BMAD patients with a natural course, total adrenal volume ranged from 5.5 to 92.8 mL. The left adrenal volume was significantly larger than the right, and males had greater volumes than females (P < 0.001). The exponential growth model best fitted volume changes, with a median volume doubling time (VDT) of 11.82 years (range: 1.72-102.70) and a median specific growth rate (SGR) of 5.87%/year (range: 0.67% to 40.41%). In post-unilateral adrenalectomy patients, contralateral adrenal volume showed a significant postoperative increase (P < .05), with exponential growth (median VDT: 9.08 years, range: 2.56-61.86; median SGR: 7.63%/year, range: 0.17% to 29.96%). Receiver operating characteristic analysis demonstrated that postoperative contralateral adrenal volume had superior diagnostic performance (area under the curve = 0.913, 95% CI: 0.813-1.000) for diagnosing autonomous cortisol secretion.
CONCLUSION: BMAD exhibits exponential growth despite variability in size and growth speed, which supports using VDT and SGR for the individualized growth assessment and imaging follow-up. Postoperative adrenal volume may help assess autonomous cortisol secretion status after unilateral adrenalectomy.
METHODS: Retrospective analysis included BMAD patients with ≥2 computed tomography scans: 52 in the natural course cohort (median follow-up 31 months, range 7-150) and 23 in the post-unilateral adrenalectomy cohort (median follow-up 36 months, range 2-98), with their adrenal volumes measured precisely. A linear mixed-effects model was applied to longitudinal data from patients with ≥3 computed tomography scans to analyze adrenal growth patterns.
RESULTS: In BMAD patients with a natural course, total adrenal volume ranged from 5.5 to 92.8 mL. The left adrenal volume was significantly larger than the right, and males had greater volumes than females (P < 0.001). The exponential growth model best fitted volume changes, with a median volume doubling time (VDT) of 11.82 years (range: 1.72-102.70) and a median specific growth rate (SGR) of 5.87%/year (range: 0.67% to 40.41%). In post-unilateral adrenalectomy patients, contralateral adrenal volume showed a significant postoperative increase (P < .05), with exponential growth (median VDT: 9.08 years, range: 2.56-61.86; median SGR: 7.63%/year, range: 0.17% to 29.96%). Receiver operating characteristic analysis demonstrated that postoperative contralateral adrenal volume had superior diagnostic performance (area under the curve = 0.913, 95% CI: 0.813-1.000) for diagnosing autonomous cortisol secretion.
CONCLUSION: BMAD exhibits exponential growth despite variability in size and growth speed, which supports using VDT and SGR for the individualized growth assessment and imaging follow-up. Postoperative adrenal volume may help assess autonomous cortisol secretion status after unilateral adrenalectomy.