{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T08:53:52Z","timestamp":1789894432221,"version":"4.0.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,12]]},"abstract":"\nObjective<\/jats:title>\nRecently, the European Society of Endocrinology (ESE), in collaboration with the European Network for the Study of Adrenal Tumors (ENSAT), asserted that adrenal incidentalomas (AIs) <4\u2009cm and \u226410 Hounsfield units (HU) do not require further follow-up imaging. To validate the clinical application of the follow-up strategies suggested by the 2016 ESE-ENSAT guidelines, we explored the clinical characteristics and natural course of AIs in a single center over 13 years.<\/jats:p><\/jats:sec>\n\nDesign and methods<\/jats:title>\nThis retrospective cohort study included a total of 1149 patients diagnosed with AIs between 2000 and 2013 in a single tertiary center. Hormonal examination and radiological evaluations were performed at the initial diagnosis of AI and during the follow-up according to the appropriate guidelines.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThe mean age at diagnosis was 54.2 years, and the majority of AIs (68.0%) were nonfunctional lesions. Receiver operating curve analysis was used to discriminate malignant from benign lesions; the optimal cut-off value for mass size was 3.4\u2009cm (sensitivity: 100%; specificity: 95.0%), and that for the pre-contrast HU was 19.9 (sensitivity: 100%; specificity: 67.4%). The majority of nonfunctional lesions did not change in size during the 4-year follow-up period. Applying a cut-off value of 1.8\u2009\u03bcg\/dL after a 1-mg overnight dexamethasone suppression test, 28.0% of all nonfunctional AIs progressed to autonomous cortisol secretion during the follow-up period. However, we observed no development of overt Cushing\u2019s syndrome in the study.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nWe advocate that no follow-up imaging is required if the detected adrenal mass is <4\u2009cm and has clear benign features. However, prospective studies with longer follow-up are needed to confirm the appropriate follow-up strategies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-17-0372","type":"journal-article","created":{"date-parts":[[2017,9,5]],"date-time":"2017-09-05T00:25:33Z","timestamp":1504571133000},"page":"475-483","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":67,"title":["Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice"],"prefix":"10.1093","volume":"177","author":[{"given":"A Ram","family":"Hong","sequence":"first","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"},{"name":"2Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyeong Seon","family":"Park","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyong Young","family":"Kim","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"},{"name":"3Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hye","family":"Kong","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seo Young","family":"Lee","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Soo","family":"Shin","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Wan","family":"Kim","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"},{"name":"2Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea"},{"name":"3Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref31","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1530\/EJE-09-0234","article-title":"Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; 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