{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:32:47Z","timestamp":1788449567950,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,1,25]],"date-time":"2017-01-25T00:00:00Z","timestamp":1485302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Adrenal incidentalomas (<jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content>) are associated with metabolic and hormonal abnormalities, most commonly autonomous cortisol secretion (<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>). Data regarding alterations of insulin resistance (<jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> after prolonged follow\u2010up are limited. We investigated the evolution of <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content>, cortisol secretion and <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> development in patients with <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> during prolonged follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective study in a tertiary hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and measurements<\/jats:title><jats:p>Seventy\u2010one patients with <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> [51 nonfunctioning (<jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content>) and 20 <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>] and 5\u00b754\u00a0\u00b1\u00a01\u00b77\u00a0years follow\u2010up underwent testing for ACS and oral glucose tolerance test to determine <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content> indices and adrenal imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At follow\u2010up, 16\/51 (31%) <jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content> patients converted to <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>, while two with previous <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> reverted to <jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content>; 21% (7\/33) of patients who did not covert to <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> exhibited high urinary\u2010free cortisol (H\u2010<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content>) levels. All <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> patients developed deterioration of <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content> irrespective of their cortisol secretory status. Eight patients developed newly diagnosed type 2 diabetes (9\u00b78% <jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content> and 15% <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>, respectively) and 14 <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content> (17\u00b76% <jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content> and 25% <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>, respectively). Adenoma size increased from 2\u00b71\u00a0\u00b1\u00a00\u00b78 to 2\u00b73\u00a0\u00b1\u00a00\u00b78\u00a0cm, whereas <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content> correlated with postdexamethasone cortisol level and adenoma size increase. <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content> showed an incremental continuum trend from normal <jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content> (\u039d\u2010<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content>), to H\u2010<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content>, C\u2010<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>New\u2010onset <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> developed in 31% patients with <jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content>, whereas 21% of <jats:styled-content style=\"fixed-case\">NFAI<\/jats:styled-content> patients had H\u2010<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content> levels. All <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> patients as a group and the subgroups of N\u2010<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content>, H\u2010<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content>, C\u2010<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> patients developed deterioration of metabolic parameters during follow\u2010up that was more prominent in <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13294","type":"journal-article","created":{"date-parts":[[2016,12,19]],"date-time":"2016-12-19T23:03:15Z","timestamp":1482188595000},"page":"488-498","source":"Crossref","is-referenced-by-count":46,"title":["Concomitant alterations of metabolic parameters, cardiovascular risk factors and altered cortisol secretion in patients with adrenal incidentalomas during prolonged follow\u2010up"],"prefix":"10.1111","volume":"86","author":[{"given":"Labrini","family":"Papanastasiou","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystallenia \u0399.","family":"Alexandraki","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, Laikon Hospital National and Kapodistrian University of Athens Medical School Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis I.","family":"Androulakis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stelios","family":"Fountoulakis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora","family":"Kounadi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athina","family":"Markou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaios","family":"Tsiavos","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christianna","family":"Samara","sequence":"additional","affiliation":[{"name":"Department of Radiology \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros G.","family":"Papaioannou","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology Hippokration Hospital National and Kapodistrian University of Athens Medical School Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Piaditis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Center \u2018G Gennimatas\u2019 General Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Kaltsas","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, Laikon Hospital National and Kapodistrian University of Athens Medical School Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,1,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2002-0031"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03344099"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.4.1440"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-10-1147"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03551.x"},{"key":"e_1_2_6_7_1","first-page":"637","article-title":"A survey on adrenal incidentaloma in Italy. 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