Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy.
Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5519-5528. doi: 10.1210/jc.2019-00365.
Steroid profiling by mass spectrometry has shown implications for diagnosis and subtyping of adrenal tumors.
To investigate steroid profiles and their cardiovascular correlates in a large cohort of patients with nonsecreting (NS) adrenal incidentalomas and autonomous cortisol secretion (ACS).
Cohort study.
University hospital.
Patients (n = 302) with incidentally discovered adrenal masses, divided into unilateral adenoma and hyperplasia with ACS (n = 46 and n = 52, respectively) and NS (n = 120 and n = 84, respectively). Post-dexamethasone suppression test (DST) cortisol <50 or >50 nmol/L defined NS and ACS, respectively.
Analysis of 10-steroid panel by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and clinical data (mean follow-up 39 months).
Difference in baseline and post-DST steroid profiles between groups. Correlation with cardiovascular profile.
Patients with unilateral adenomas and ACS showed higher cortisol, 11-deoxycortisol, and corticosterone and lower dehydroepiandrosterone than those with NS adenomas. Patients with ACS hyperplasia showed higher cortisol and lower androgens in women than those with NS. Patients with ACS had reduced suppression of post-DST cortisol, 11-deoxycortisol, and corticosterone, irrespective of adrenal morphology. Post-DST cortisol and corticosterone were associated with higher prevalence of severe/resistant hypertension. Patients with ACS unilateral adenomas showed higher incidence of worsening of hypertensive disease and novel cardiovascular events than those with NS, with post-DST cortisol [hazard ratio (HR) 1.02; 95% CI, 1.01 to 1.03; P < 0.001] and baseline corticosterone (HR 1.06; 95% CI, 1.01 to 1.12; P = 0.031) among the main predictors.
Patients with adrenal incidentalomas showed different steroid profiles, depending on functional status and adrenal morphology, with implications for their cardiovascular status.
质谱类固醇分析对肾上腺肿瘤的诊断和亚型具有重要意义。
在一个大型的无分泌（NS）肾上腺意外瘤和自主皮质醇分泌（ACS）患者队列中，研究类固醇谱及其与心血管的相关性。
队列研究。
大学医院。
患有偶然发现的肾上腺肿块的患者（n=302），分为单侧腺瘤和伴有 ACS（n=46 和 n=52）和 NS（n=120 和 n=84）的增生。地塞米松抑制后（DST）皮质醇<50 或>50 nmol/L 分别定义为 NS 和 ACS。
通过液相色谱-串联质谱（LC-MS/MS）和临床数据（平均随访 39 个月）分析 10-类固醇组。
组间基线和 DST 后类固醇谱的差异。与心血管特征的相关性。
单侧腺瘤和 ACS 的患者皮质醇、11-脱氧皮质醇和皮质酮水平较高，脱氢表雄酮水平较低，而 NS 腺瘤患者则较低。ACS 增生的女性患者皮质醇水平较高，雄激素水平较低。无论肾上腺形态如何，ACS 患者 DST 后皮质醇、11-脱氧皮质醇和皮质酮的抑制作用均降低。DST 后皮质醇和皮质酮与严重/难治性高血压的患病率较高有关。与 NS 患者相比，ACS 单侧腺瘤患者高血压病恶化和新发心血管事件的发生率更高，DST 后皮质醇（危险比[HR]1.02；95%置信区间，1.01 至 1.03；P<0.001）和基线皮质酮（HR 1.06；95%置信区间，1.01 至 1.12；P=0.031）是主要预测因素。
肾上腺意外瘤患者的类固醇谱因功能状态和肾上腺形态而异，这对其心血管状况有影响。
