Vol 68, No 4 (2017)
Original paper
Published online: 2017-05-30

open access

Page views 1361
Article views/downloads 1451
Get Citation

Connect on Social Media

Connect on Social Media

Glucose metabolism disorders in patients with non-functioning adrenal adenomas — single-centre experience

Katarzyna Krzyżewska1, Ewa Niemczuk, Bartosz Jakub Myśliwiec, Roman Junik
Pubmed: 28585681
Endokrynol Pol 2017;68(4):416-421.


Introduction: The presence of glucose metabolism disorders and their possible correlation with degree of cortisol secretion were evaluated in patients with non-functioning adrenal incidentalomas (NFAIs).

Material and methods: The study group consisted of 131 patients with hormonally inactive adrenal incidentalomas. In each patient, besides hormonal and radiological evaluation, was assessed for fasting glucose and insulin concentrations, and the oral glucose tolerance test (OGTT) was performed in all participants without previous history of glucose disturbances. The HOMA-IR, QUICKI, and TyG indices were calculated.

Results: Diabetes was diagnosed in 30.5% of the studied group. Among glucose tolerance abnormalities, impaired fasting glucose (IFG) was found in 23.7%, impaired glucose tolerance (IGT) in 4.6%, and combined IFG and IGT in 11.5%. Normoglycaemia was recognised in 29.8% of NFAIs patients. The occurrence rate of glucose aberrations increased with age. There was a significant difference in all insulin resistance indices shown between normoglycaemic patients and those with impairments in glucose tolerance. There was no significant correlation between fasting glucose, insulin resistance indices, and adrenal tumour size or degree of cortisol secretion.

Conclusions: The prevalence of diabetes and impaired fasting glucose among NFAIs patients is much higher than in the general population. Therefore, patients with incidentally discovered adrenal tumours should be tested for glucose tolerance.


  1. Nawar R, Aron D. Adrenal incidentalomas -- a continuing management dilemma. Endocr Relat Cancer. 2005; 12(3): 585–598.
  2. Muscogiuri G, Sorice GP, Prioletta A, et al. The size of adrenal incidentalomas correlates with insulin resistance. Is there a cause-effect relationship? Clin Endocrinol (Oxf). 2011; 74(3): 300–305.
  3. Reincke M, Fassnacht M, Väth S, et al. Adrenal incidentalomas: a manifestation of the metabolic syndrome? Endocr Res. 1996; 22(4): 757–761.
  4. Terzolo M, Pia A, Alì A, et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab. 2002; 87(3): 998–1003.
  5. Gutch M, Kumar S, Razi SM, et al. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015; 19(1): 160–164.
  6. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010; 95(7): 3347–3351.
  7. Vasques AC, Novaes FS, de Oliveira Md, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract. 2011; 93(3): e98–e9e100.
  8. PTD. Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2016. Diab Klin. 2016; 5(supl. A).
  9. Association American Diabetes. Standards of Medical Care in Diabetes- 2016. Diabetes Care. 2016; 39(supl. 1).
  10. Navarro-González D, Sánchez-Íñigo L, Pastrana-Delgado J, et al. Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort. Prev Med. 2016; 86: 99–105.
  11. Lee SH, Han K, Yang HK, et al. A novel criterion for identifying metabolically obese but normal weight individuals using the product of triglycerides and glucose. Nutr Diabetes. 2015; 5: e149.
  12. Rutkowski M, Bandosz P, Czupryniak L, et al. Prevalence of diabetes and impaired fasting glucose in Poland--the NATPOL 2011 Study. Diabet Med. 2014; 31(12): 1568–1571.
  13. IDF. 2015 Diabetes Atlas. http://www.diabetesatlas.org.
  14. Tuna MM, Imga NN, Doğan BA, et al. Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis. J Endocrinol Invest. 2014; 37(8): 765–768.
  15. Fernández-Real JM, Engel WR, Simó R, et al. Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma. Clin Endocrinol (Oxf). 1998; 49(1): 53–61.
  16. Ivović M, Marina LV, Vujović S, et al. Nondiabetic patients with either subclinical Cushing's or nonfunctional adrenal incidentalomas have lower insulin sensitivity than healthy controls: clinical implications. Metabolism. 2013; 62(6): 786–792.
  17. Morelli V, Donadio F, Eller-Vainicher C, et al. Role of glucocorticoid receptor polymorphism in adrenal incidentalomas. Eur J Clin Invest. 2010; 40(9): 803–811.
  18. Midorikawa S, Sanada H, Hashimoto S, et al. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf). 2001; 54(6): 797–804.
  19. Lazúrová I, Spišáková D, Wagnerová H, et al. Clinically silent adrenal adenomas - their relation to the metabolic syndrome and to GNB3 C825T gene polymorphism. Wien Klin Wochenschr. 2011; 123(19-20): 618–622.