Departments of Experimental MedicineSapienza University of Rome, Rome, Italy.
Departments of Internal MedicineSapienza University of Rome, Rome, Italy.
Eur J Endocrinol. 2018 May;178(5):501-511. doi: 10.1530/EJE-17-0986. Epub 2018 Mar 6.
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.
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.
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 (LVMI) was increased in pACS compared to NFA ( = 0.006) and mildly correlated to the post-DST cortisol level (rho = 0.347; = 0.004). The post-DST cortisol levels explained up to 13.7% of LVMI variance ( = 0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; = 0.001) and worse arterial stiffness assessed by pulse wave velocity ( = 0.033).
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.
患有肾上腺意外瘤的患者中，出现低级别不完全的地塞米松后皮质醇抑制 - 最近被定义为可能的自主皮质醇分泌（pACS） - 与心血管事件和死亡率的增加有关。然而，缺乏这些患者心脏异常的前瞻性研究。
在 2016 年 7 月至 2017 年 9 月期间，通过地塞米松抑制试验（NCT 02611258）对 71 例连续的肾上腺病变患者进行了前瞻性筛查，以检测皮质醇增多症。记录了完整的人体测量、代谢和激素参数，以及全面的心脏超声评估和动脉僵硬度的无创测量。所有患者均接受化学位移磁共振成像以确定病变特征。在盲法下记录心血管结局。
根据地塞米松抑制后皮质醇值（post-DST），34 例患者为 pACS，37 例为无功能腺瘤（NFA）。两组在性别、BMI、年龄分布、心血管危险因素和合并症方面相似。与 NFA 相比，pACS 的左心室质量指数（LVMI）升高（= 0.006），且与 post-DST 皮质醇水平轻度相关（rho = 0.347；= 0.004）。post-DST 皮质醇水平可解释高达 13.7%的 LVMI 变异（= 0.002）。与 NFA 相比，pACS 患者舒张功能障碍的患病率更高（35.1%对 82.6%；= 0.001），脉搏波速度评估的动脉僵硬度更差（= 0.033）。
在无明显症状的患者中，轻度自主皮质醇分泌可维持早期心脏和血管重塑，独立于其他危险因素。在 pACS 中观察到的形态和功能心血管变化强调需要进一步研究，以正确定义这种相对常见情况的长期管理。
