ORIGINAL ARTICLE

The Association Between Thyroid Volume and Insulin Resistance in Patients with Non-Functional Adrenal Incidentaloma
Non-Fonksiyonel Adrenal İnsidentalomalı Hastalarda İnsülin Direnci ve Tiroid Volümü Arasındaki İlişki
Received Date : 27 Jun 2020
Accepted Date : 25 Aug 2020
Available Online : 30 Sep 2020
Doi: 10.25179/tjem.2020-77502 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:261-269
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: This study aimed to investigate the association between insulin resistance (IR) and thyroid volume (TV) along with thyroid nodule in patients with nonfunctional adrenal incidentaloma (NFAI). Material and Methods: Fortyfive NFAI patients with a mean age of 59.00±7.00 and 43 healthy controls of comparable age and body mass index (BMI) were included. Sociodemographic data, fasting plasma glucose (FPG), alanine aminotransferase (ALT), insulin, lipid, and hormonal parameters, TV, nodule frequency, and adrenal mass dimensions were retrospectively recorded in all the patients. Resuls: Triglyceride (TG), insulin, HOMA-IR, basal cortisol, and cortisol levels after dexamethasone suppression test (DST) were significantly higher in the patient group (p<0.05). Although the frequency of thyroid nodules was higher in the patient group than in the control group, this finding was statistically insignificant (64.4% and 53.5%, respectively, p=0.296). TV was significantly higher in the NFAI group (13.30±5.95 and 5.99±3.04, respectively p<0.001). After grouping the participants according to insulin resistance; BMI, FPG, triglyceride, and fasting insulin levels were significantly higher in the IR group (p<0.05). Though the frequency of thyroid nodules was higher in those with IR, it was not statistically significant (62.2% and 56.9%, p=0.617).TV was significantly higher in participants with IR (11.23±7.15cm) compared to those without IR (8.64±4.77) (p=0.045). Conclusion: Increased insulin resistance was observed in patients with NFAI. It may play a role in increasing the TV and nodule formation, besides subclinical cortisol secretion.
ÖZET
Amaç: Non-fonksiyone adrenal insidentalomalı (NFAI) hastalarda insülin direnci (IR) ile tiroid volümü (TV) ve tiroid nodülleri arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Endokrinoloji ve Metabolizma Hastalıkları polikliniğine başvuran ortalama yaşları 59,00±7,00 olan 45 NFAI olan hasta ile benzer yaş ve vücut kitle indeksi (VKİ)’ye sahip 43 sağlıklı kontrolalındı. Çalışmaya alınan bireylerinsosyodemografik verileri, açlık plazma glukoz (APG), alaninaminotransferaz (ALT), açlık insülinseviyesi, lipid ve hormonal parametreleri, TV, nodül sıklığı, adrenal kitle boyutları retrospektif olarak dosyadan kaydedildi. Bulgular: Hasta grubu (n=45) ve kontrol grubu (n=43) karşılaştırıldığında hasta grubunda trigliserid, insülin, HOMA-IR, kortizol ve deksametazonsupresyon testi (DST) sonrası kortizol seviyesi anlamlı düzeyde daha yüksek saptandı (p<0,05). Tiroid nodül sıklığı, hasta grubunda kontrol grubuna göre anlamlı olmamakla birlikte daha yüksek (%64,4 ve %53,5, p=0,296), TV ise hasta grubunda anlamlı seviyede daha yüksekti (13,30±5,95 ve 5,99±3,04, sırasıyla, p<0,001). Katılımcılar IR’ye göre gruplandırıldıklarında IR olanlarda; VKİ, APG, trigliserid ve açlık insülin seviyeleri anlamlı düzeyde daha yüksek saptandı (p<0,05).Tiroid nodül sıklığı, IR olanlarda daha yüksek olmakla birlikte istatistiksel olarak anlamlı değildi (%62,2 ve %56,9, p=0,617). TV ise, IR olanlarda (11,23±7,15 cm) olmayanlara (8,64±4,77) göre anlamlı derecede daha yüksekti (p=0,045). Sonuç: NFAI’lı hastalarda IR artmıştır ve TV artışı ile nodül oluşumunda etkili olabilir. Ayrıca subklinikkortizolsekresyonu da etkili diğer faktör olarak görünmektedir.
KAYNAKLAR
  1. Reimondo G, Castellano E, Grosso M, Priotto R, Puglisi S, Pia A, Pellegrino M, Borretta G, Terzolo M. Adrenal incidentalomas are tied to increased risk of diabetes: findings from a prospective study. J Clin Endocrinol Metab. 2020;105:dgz284. [Crossref]  [PubMed] 
  2. Cawood TJ, Hunt PJ, O'Shea D, Cole D, Soule S. 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; time for a rethink? Eur J Endocrinol. 2009;161:513-527. [Crossref]  [PubMed] 
  3. Muscogiuri G, De Martino MC, Negri M, Pivonello C, Simeoli C, Orio F, Pivonello R, Colao A. Adrenal mass: insight into pathogenesis and a common link with insulin resistance. Endocrinology. 2017;158:1527-1532. [Crossref]  [PubMed] 
  4. Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, Niepomniszcze H. Introducing the thyroid gland as another victim of the insulin resistance syndrome. Thyroid. 2008;18:461-464. [Crossref]  [PubMed] 
  5. Vella V, Sciacca L, Pandini G, Mineo R, Squatrito S, Vigneri R, Belfiore A. The IGF system in thyroid cancer: new concepts. Mol Pathol. 2001;54:121-124. [Crossref]  [PubMed]  [PMC] 
  6. Arduc A, Isik S, Ozuguz U, Tutuncu YA, Kucukler FK, Ozcan HN, Berker D, Guler S. Relationship between thyroid nodules and non-functioning adrenal incidentalomas and their association with insulin resistance. Endocr Res. 2014;39:99-104. [Crossref]  [PubMed] 
  7. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:1889-1916. [Crossref]  [PubMed] 
  8. Hegedüs L. Thyroid ultrasound. Endocrinol Metab Clin North Am. 2001;30:339-360. [Crossref]  [PubMed] 
  9. Akkus G, Evran M, Sert M, Tetiker T. Adipocytokines in non-functional adrenal incidentalomas and relation with insulin resistance parameters. Endocr Metab Immune Disord Drug Targets. 2019;19:326-332. [Crossref]  [PubMed] 
  10. Sydney GI, Ioakim KJ, Paschou SA. Insulin resistance and adrenal incidentalomas: a bidirectional relationship. Maturitas. 2019;121:1-6. [Crossref]  [PubMed] 
  11. Angelousi A, Kyriakopoulos G, Nasiri-Ansari N, Karageorgou M, Kassi E. The role of epithelial growth factors and insulin growth factors in the adrenal neoplasms. Ann Transl Med. 2018;6:253. [Crossref]  [PubMed]  [PMC] 
  12. Bahadir CT, Ecemis GC, Atmaca H. Does IGF-1 play a role in the etiopathogenesis of non-functioning adrenocortical adenoma? J Endocrinol Invest. 2018;41:1317-1323. [Crossref]  [PubMed] 
  13. Ribeiro TC, Jorge AA, Montenegro LR, Almeida MQ, Ferraz-de-Souza B, Nishi MY, Mendonca BB, Latronico AC. Effects of Type 1 insulin-like growth factor receptor silencing in a human adrenocortical cell line. Horm Metab Res. 2016;48:484-488. [Crossref]  [PubMed] 
  14. Emral R, Aydoğan Bİ, Köse AD, Demir Ö, Çorapçıoğlu D. Could a nonfunctional adrenal incidentaloma be a risk factor for increased carotid intima-media thickness and metabolic syndrome. Endocrinol Diabetes Nutr. 2019;66:402-409. [Crossref]  [PubMed] 
  15. Evran M, Akkuş G, Berk Bozdoğan İ, Gök M, Deniz A, Sert M, Tetiker T. Carotid intima-media thickness as the cardiometabolic risk indicator in patients with nonfunctional adrenal mass and metabolic syndrome screening. Med Sci Monit. 2016;22:991-997. [Crossref]  [PubMed]  [PMC] 
  16. Sasaki N, Ozono R, Higashi Y, Maeda R, Kihara Y. Association of insulin resistance, plasma glucose level, and serum insulin level with hypertension in a population with different stages of ımpaired glucose metabolism. J Am Heart Assoc. 2020;9:e015546. [Crossref]  [PubMed]  [PMC] 
  17. Ribeiro Cavalari EM, de Paula MP, Arruda M, Carraro N, Martins A, de Souza K, Coelho MC, de Oliveira E Silva de Morais NA, Moraes AB, Vieira Neto L. Nonfunctioning adrenal incidentaloma: a novel predictive factor for metabolic syndrome. Clin Endocrinol (Oxf). 2018;89:586-595. [Crossref]  [PubMed] 
  18. Imga NN, Topcuoglu C, Berker D, Turhan T. Serum amyloid A, paraoxonase-1 activity, and apolipoprotein concentrations as biomarkers of subclinical atherosclerosis risk in adrenal incidentaloma patients. Arch Med Res. 2018;49:182-190. [Crossref]  [PubMed] 
  19. Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf). 2001;54:797-804. [Crossref]  [PubMed] 
  20. Arruda M, Mello Ribeiro Cavalari E, Pessoa de Paula M, Fernandes Cordeiro de Morais F, Furtado Bilro G, Alves Coelho MC, de Oliveira E Silva de Morais NA, Choeri D, Moraes A, Vieira Neto L. The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test. J Hum Hypertens. 2017;32:3-11. [Crossref]  [PubMed] 
  21. Yener S, Genc S, Akinci B, Secil M, Demir T, Comlekci A, Ertilav S, Yesil S. Carotid intima media thickness is increased and associated with morning cortisol in subjects with non-functioning adrenal incidentaloma. Endocrine. 2009;35:365-370. [Crossref]  [PubMed] 
  22. Androulakis II, Kaltsas GA, Kollias GE, Markou AC, Gouli AK, Thomas DA, Alexandraki KI, Papamichael CM, Hadjidakis DJ, Piaditis GP. Patients with apparently nonfunctioning adrenal incidentalomas may be at increased cardiovascular risk due to excessive cortisol secretion. J Clin Endocrinol Metab. 2014;99:2754-2762. [Crossref]  [PubMed] 
  23. Karakose M, Karbek B, Sahin M, Arslan MS, Topaloglu O, Erden G, Demirci T, Calıskan M, Delibasi T. The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance. Arch Endocrinol Metab. 2015;59:42-46. [Crossref]  [PubMed] 
  24. Vardanian AJ, Hines OJ, Farrell JJ, Yeh MW. Incidentally discovered tumors of the endocrine glands. Future Oncol. 2007;3:463-474. [Crossref]  [PubMed] 
  25. Kushchayeva YS, Kushchayev SV, Startzell M, Cochran E, Auh S, Dai Y, Lightbourne M, Skarulis M, Brown RJ. Thyroid Abnormalities in Patients With Extreme Insulin Resistance Syndromes. J Clin Endocrinol Metab. 2019;104:2216-2228. [Crossref]  [PubMed]  [PMC] 
  26. Sahin M, Demircioglu D, Oguz A, Tuzun D, Sarica MA, Inanc E, Gul K. Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome? Arch Endocrinol Metab. 2017;61:145-151. [Crossref]  [PubMed] 
  27. Suzuki S, Midorikawa S, Fukushima T, Shimura H, Ohira T, Ohtsuru A, Abe M, Shibata Y, Yamashita S, Suzuki S; Thyroid Examination Unit of the Radiation Medical Science Center for the Fukushima Health Management Survey. Systematic determination of thyroid volume by ultrasound examination from infancy to adolescence in Japan: the Fukushima Health Management Survey. Endocr J. 2015;62:261-268. [Crossref]  [PubMed] 
  28. Erdoğan MF, Ağbaht K, Altunsu T, Ozbaş S, Yücesan F, Tezel B, Sargin C, Ilbeğ I, Artik N, Köse R, Erdoğan G. Current iodine status in Turkey. J Endocrinol Invest. 2009;32:617-622. [Crossref]  [PubMed]