Endocrinology Department, Ramón y Cajal University Hospital, Madrid, Spain.
Endocrinology Department, Salamanca Clinical University Hospital, Salamanca, Spain.
Endocrine. 2019 Dec;66(3):650-659. doi: 10.1007/s12020-019-02066-w. Epub 2019 Aug 31.
To study the differences in the cardiometabolic profile between patients with non-functioning adrenal incidentalomas (NFAI) and incidentalomas with autonomous cortisol secretion (ACS).
A total of 149 patients with adrenal incidentalomas were retrospectively evaluated and followed-up for a mean time of 34.6 months at Departments of Endocrinology and Metabolic Diseases Units of four tertiary Spanish hospitals. Patients were grouped as NFAI or ACS adenomas based on two cutoffs in the dexamethasone suppression test (DST): 3.0 µg/dl (NFAI or ACS) and 1.8 µg/dl (ACS and NFAI).
The mean age of both groups was 62.0 (10.31) and was similar in ACS and NFAI. The prevalence of diabetes, high blood pressure, cardiovascular, and cerebrovascular disease was higher in ACS than in NFAI, but differences only reached statistical significance for cerebrovascular disease using the 3.0 µg/dl cutoff (15.8% vs 2.3%, p = 0.01) and for diabetes using the 1.8 µg/dl cutoff (38.0% vs 22.0%, p = 0.04). No differences were found in the prevalence of dyslipidemia. The prevalence of obesity was lower in patients with ACS than in NFAI 26.3% vs 39.2%, p = 0.18 (NFAI vs ACS) and 32.1% vs 40.6%, p = 0.56 (ACS vs NFAI), but the differences did not reach statistical significance. Maximum adenoma diameter (R-squared = 0.15, p < 0.001) and cerebrovascular disease (OR = 1.59, p = 0.04) were the only parameters that could be predicted by the DST. The DST was an inadequate predictor of clinical (systolic and diastolic blood pressure, body mass index), hormonal (DHEAS, ACTH, UFC, and basal serum cortisol), biochemical (glucose, cholesterol, LDL, HDL, and triglycerides), and other radiological (laterality, lipid content) parameters. Throughout the follow-up, patients did not develop overt Cushing's Syndrome; three NFAI developed ACS, eight NFAI developed ACS, and one NFAI progressed to ACS. In both groups (NFAI and ACS) the metabolic profile remained stable.
Our data suggest higher prevalence of diabetes and cerebrovascular disease in ACS patients compared with NFAI. However, probably because of the small sample size, the differences only reached statistical significance using the cutoffs of 1.8 µg/dl for diabetes and 3.0 µg/dl for cerebrovascular disease. Patients with ACS and NFAI rarely progress to more aggressive forms of hypercortisolism, and the metabolic profile usually remains stable during the follow-up.
研究无功能性肾上腺意外瘤（NFAI）和具有自主皮质醇分泌功能的意外瘤（ACS）患者的心脏代谢特征差异。
对四家西班牙三级医院内分泌和代谢疾病科的 149 名肾上腺意外瘤患者进行回顾性评估，并平均随访 34.6 个月。根据地塞米松抑制试验（DST）的两个截止值（3.0μg/dl[NFAI 或 ACS]和 1.8μg/dl[ACS 和 NFAI]），将患者分为 NFAI 或 ACS 腺瘤。
两组的平均年龄均为 62.0（10.31），ACS 和 NFAI 之间的年龄相似。ACS 患者的糖尿病、高血压、心血管和脑血管疾病的患病率高于 NFAI，但仅在使用 3.0μg/dl 截止值时脑血管疾病（15.8% vs 2.3%，p=0.01）和使用 1.8μg/dl 截止值时糖尿病（38.0% vs 22.0%，p=0.04）的差异有统计学意义。两组血脂异常的患病率无差异。ACS 患者的肥胖患病率低于 NFAI（26.3% vs 39.2%，p=0.18[NFAI 与 ACS]和 32.1% vs 40.6%，p=0.56[ACS 与 NFAI]），但差异无统计学意义。最大腺瘤直径（R 平方=0.15，p<0.001）和脑血管疾病（OR=1.59，p=0.04）是 DST 唯一可预测的参数。DST 不能充分预测临床（收缩压和舒张压、体重指数）、激素（DHEAS、ACTH、UFC 和基础血清皮质醇）、生化（葡萄糖、胆固醇、LDL、HDL 和甘油三酯）和其他影像学（侧位、脂质含量）参数。在整个随访期间，患者未出现明显的库欣综合征；3 例 NFAI 发展为 ACS，8 例 NFAI 发展为 ACS，1 例 NFAI 进展为 ACS。在两组（NFAI 和 ACS）中，代谢特征均保持稳定。
我们的数据表明，ACS 患者的糖尿病和脑血管疾病的患病率高于 NFAI。然而，可能由于样本量小，仅在糖尿病的 1.8μg/dl 和脑血管疾病的 3.0μg/dl 截止值时差异才具有统计学意义。ACS 和 NFAI 患者很少进展为更具侵袭性的皮质醇增多症，且代谢特征在随访期间通常保持稳定。
