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The following is a summary of “Metabolic complications and clinical outcomes of non-functioning adrenal incidentalomas: a systematic review and meta-analysis,” published in the April 2025 issue of BMC Endocrine Disorders by Li et al. 

Widespread abdominal imaging led to increased detection of non-functioning adrenal incidentalomas (NFAI), potentially underestimating associated metabolic risks.  

Researchers conducted a retrospective study to analyze the impact of NFAI on metabolic comorbidities and compare outcomes between surgical and non-surgical management, including changes in NFAI characteristics during follow-up.  

They performed a meta-analysis using studies from PubMed, Embase, Cochrane Library, and Web of Science (January 2000 to May 2024). The analysis included individuals with serum cortisol levels ≤ 50 nmol/L following a 1 mg dexamethasone suppression test (DST). The prevalence of hypertension, diabetes, obesity, and lipid disorders was analyzed before and after follow-up. Tumor growth (>10 mm increase) and functional changes were analyzed using a 1 mg DST retest.  

The results showed that 18 studies met the inclusion criteria (n = 2,059). In the non-surgical group, diabetes increased significantly (relative risk [RR]: 1.33, 95% CI: 1.07–1.65), as did lipid disorders (RR: 1.22, 95% CI: 1.07–1.38), while hypertension (RR: 1.07, 95% CI: 0.99–1.16) and obesity (RR: 1.05, 95% CI: 0.91–1.21) showed no significant change. Surgical intervention significantly improved hypertension (RR: 0.67, 95% CI: 0.52–0.86). During a mean follow-up of 46.1 months, 4% (95% CI: 2%–8%) of NFAI increased in size by more than 10 mm, while 8% (95% CI: 5%–14%) became functional over 45.1 months.  

Investigators concluded that subtle hormone secretion might occur in patients with NFAI despite current diagnostic criteria, and these tumors were significantly associated with metabolic disorders like diabetes mellitus and dyslipidemia, necessitating more sensitive diagnostic tools and prospective studies to establish surgical guidelines. 

Source: bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-025-01923-2