scholarly journals Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

2018 ◽  
Vol 178 (5) ◽  
pp. 501-511 ◽  
Author(s):  
Emilia Sbardella ◽  
Marianna Minnetti ◽  
Denise D’Aluisio ◽  
Laura Rizza ◽  
Maria Rosaria Di Giorgio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arterial Stiffness ◽  
Age Distribution ◽  
Left Ventricular ◽  
Low Grade ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Asymptomatic Patients ◽  
Autonomous Cortisol Secretion ◽  
Dexamethasone Suppression

Background Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas – recently defined as possible autonomous cortisol secretion (pACS) – has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. Subjects and methods Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT 02611258). Complete anthropometric, metabolic and hormonal parameters were recorded along with full cardiac ultrasound assessment and noninvasive measurement of arterial stiffness. All patients underwent chemical-shift magnetic resonance imaging to characterize the lesions. Cardiovascular outcomes were recorded in blind. Results According to post-dexamethasone suppression cortisol values (post-DST), 34 patients had pACS and 37 non-functioning adenomas (NFA). The two groups were similar in sex, BMI, age distribution, cardiovascular risk factors and comorbidities. Left ventricular mass index (LVMIBSA) was increased in pACS compared to NFA (P = 0.006) and mildly correlated to the post-DST cortisol level (rho = 0.347; P = 0.004). The post-DST cortisol levels explained up to 13.7% of LVMIBSA variance (P = 0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; P = 0.001) and worse arterial stiffness assessed by pulse wave velocity (P = 0.033). Conclusions In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition.

scholarly journals OR25-05 Increased Overall Mortality and Cardiovascular Morbidity in Patients with Adrenal Incidentalomas and Autonomous Cortisol Secretion: Results of the ENS@T NAPACA-Outcome Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Timo Deutschbein ◽  
Giuseppe Reimondo ◽  
Guido Di Dalmazi ◽  
Irina Bancos ◽  
Henrik Falhammar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Meta Analysis ◽  
Serum Cortisol ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Survival Status ◽  
Vein Thrombosis ◽  
Randomized Intervention ◽  
Autonomous Cortisol Secretion ◽  
Overall Mortality

Abstract Objective. Several smaller studies on adrenal incidentalomas (AI) suggested an association between autonomous cortisol secretion (ACS) and mortality (Di Dalmazi Lancet Diabetes Endocrinol 2014, Debono J Clin Endocrinol Metab 2014, Patrova Endocrine 2017). However, a recent meta-analysis (9 studies, 1356 patients) could not confirm these findings (Elhassan Ann Intern Med 2019). Aim. To investigate the effects of ACS on mortality, prevalence of cardiovascular (CV) risk factors, and (CV) morbidity, in a representative cohort of AI. Design. Retrospective observational study conducted at 27 ENS@T centers from 15 countries. Methods. Inclusion criteria: AI diagnosed 1996-2015, 1 mg dexamethasone suppression test, follow-up (FU) of ≥36 months, known survival status. Exclusion criteria: clinically relevant adrenal hormone excess (i.e. Cushing’s syndrome, pheochromocytoma, primary hyperaldosteronism), known malignancy. Patient stratification: serum cortisol after dexamethasone (>5 µg/dl, ACS; 1.9-5 µg/dl, possible ACS (PACS); ≤1.8 µg/dl, non-functioning adenoma (NFA)). Definition of CV events (CVE): hospitalization due to myocardial infarction and related interventions (PTCA, surgical bypass), stroke, deep vein thrombosis, pulmonary embolism. Results. 3640 patients (57% NFA, 36% PACS, 7% ACS) were considered eligible: 64% females; median age 61 years (range 18-91); median FU 84 months (36-277) (distribution between subgroups n.s.). 352 patients died during FU. Age- and sex adjusted overall survival was significantly reduced in patients with PACS (HR 1.55; 95%CI 1.24-1.94) and ACS (1.84; 1.29-2.61). Prevalence of CV risk factors were significantly higher in PACS and ACS than in NFA (hypertension: 72, 73, 57%, p<0.0001; dyslipidemia: 42, 49, 35%, p<0.0001; diabetes: 22, 25, 17%, p<0.0001) When adjusted to relevant confounders (i.e. age, sex, CV risk factors), time to first CVE was shorter in PACS (HR 1.36; 1.07-1.73) and ACS (HR 1.62; 1.10-2.40) compared to NFA. Conclusion. PACS and ACS are associated with increased overall mortality and CV morbidity. However, to prove causality a large randomized intervention trial is required.

scholarly journals Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas

2020 ◽  
Vol 9 (10) ◽  
pp. 963-970
Author(s):  
Grethe Å Ueland ◽  
Thea Grinde ◽  
Paal Methlie ◽  
Oskar Kelp ◽  
Kristian Løvås ◽  
...  
Keyword(s):  
False Negative ◽  
High Rate ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Late Night ◽  
Urine Free Cortisol ◽  
Saliva Cortisol ◽  
Free Cortisol ◽  
Autonomous Cortisol Secretion ◽  
Dexamethasone Suppression

Objective: Autonomous cortisol secretion (ACS) is a condition with ACTH-independent cortisol overproduction from adrenal incidentalomas (AI) or adrenal hyperplasia. The hypercortisolism is often mild, and most patients lack typical clinical features of overt Cushing’s syndrome (CS). ACS is not well defined and diagnostic tests lack validation. Methods: Retrospective study of 165 patients with AI evaluated clinically and by assay of morning plasma ACTH, late-night saliva cortisol, serum DHEA sulphate (DHEAS), 24-h urine-free cortisol, and cortisol after dexamethasone suppression. Results: Patients with AI (n = 165) were diagnosed as non-functioning incidentalomas (NFI) (n = 82) or ACS (n = 83) according to current European guidelines. Late-night saliva cortisol discriminated poorly between NFI and ACS, showing a high rate of false-positive (23/63) and false-negative (38/69) results. The conventional low-dose dexamethasone suppression test (LDDST) did not improve the diagnostic specificity, compared with the 1 mg overnight DST. Receiver operating characteristic curve analysis of DHEAS in the two cohorts demonstrated an area under the curve of 0.76 (P < 0.01) with a sensitivity for ACS of 58% and a specificity of 80% using the recommended cutoff at 1.04 µmol/L (40 µg/dL). Conclusion: We here demonstrate in a large retrospective cohort of incidentaloma patients, that neither DHEAS, late-night saliva cortisol nor 24-h urine free cortisol are useful to discriminate between non-functioning adrenal incidentalomas and ACS. The conventional LDDST do not add further information compared with the 1 mg overnight DST. Alternative biomarkers are needed to improve the diagnostic workup of ACS.

THE QUANTITATIVE RELATIONSHIP BETWEEN AUTONOMOUS CORTISOL SECRETION, DYSGLYCEMIA AND THE METABOLIC SYNDROME

2020 ◽  
Vol 26 (9) ◽  
pp. 974-982
Author(s):  
Jonathan Bleier ◽  
Gadi Shlomai ◽  
Boris Fishman ◽  
Zohar Dotan ◽  
Barak Rosenzweig ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Plasma Glucose ◽  
Hemoglobin A1c ◽  
Dexamethasone Suppression Test ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Continuous Parameter ◽  
Suppression Test ◽  
Autonomous Cortisol Secretion ◽  
Dexamethasone Suppression

Objective: Autonomous cortisol secretion (ACS) is the most common endocrine abnormality in the evaluation of adrenal incidentalomas. The categorization of ACS is derived from a 1 mg dexamethasone suppression test (DST). Impaired DST is associated with several metabolic derangements. In this study we analyzed the association between post-DST cortisol level, analyzed as a continuous parameter, and indices of glycemic metabolism. Methods: We prospectively collected data of 1,976 patients evaluated for adrenal incidentalomas in a large tertiary medical center between December 1, 2017, and August 31, 2019. Seventy-three patients completed the evaluation process. Post-DST cortisol levels were analyzed for correlation with various metabolic parameters, including fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) among the general cohort and for subgroups stratified by the number of metabolic syndrome (MS) criteria. Results: Post-DST cortisol demonstrated a linear association with FPG and HbA1c across its entire cortisol range ( R = 0.51 and 0.41, respectively; P≤.01). The association between post-DST cortisol and FPG was strengthened with an increased number of metabolic syndrome criteria. Patients with 4 MS criteria show a stronger association ( R = 0.92) compared to patients with only a single criterion ( R = 0.509). Furthermore, mean post-DST cortisol levels increased as the number of MS criteria accumulated. Conclusion: Post-DST cortisol should be viewed as a continuous parameter in risk stratification algorithms for the development of MS and particularly dysglycemia. Abbreviations: ACS = autonomous cortisol secretion; AI = adrenal incidentaloma; BMI = body mass index; BP = blood pressure; DM = diabetes mellitus; DST = dexamethasone suppression test; FPG = fasting plasma glucose; HbA1c = hemoglobin A1c; HDL = high-density lipoprotein; MS = metabolic syndrome; TG = triglycerides; WHR = waist-to-hip ratio

Risk estimator for autonomous cortisol secretion in adrenal incidentalomas. Retrospective study of 100 cases

2018 ◽  
Author(s):  
Marta Araujo Castro ◽  
Miguel Sampedro Nunez ◽  
Elena Fernandez Gonzalez ◽  
Nerea Aguire Moreno ◽  
Monica Marazuela Azpiroz
Keyword(s):  
Retrospective Study ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Autonomous Cortisol Secretion ◽  
Risk Estimator

Autonomous cortisol secretion in adrenal incidentalomas

2019 ◽  
Author(s):  
Alexander Greene ◽  
Dushyant Sharma ◽  
Tejpal Purewal ◽  
Pallavi Hegde
Keyword(s):  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Autonomous Cortisol Secretion
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