Skåne University Hospital and Lund University, Lund, Sweden (A.K., O.L., M.L., H.O.).
Skåne University Hospital, Lund, Sweden (S.P.).
Ann Intern Med. 2021 Aug;174(8):1041-1049. doi: 10.7326/M20-7946. Epub 2021 May 25.
Autonomous cortisol secretion in patients with adrenal incidentalomas is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available.
To measure the association between mortality and levels of autonomous cortisol secretion in patients with adrenal incidentalomas.
Retrospective cohort study. (ClinicalTrials.gov: NCT03919734).
Two hospitals in southern Sweden.
Consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 and were followed for up to 14 years. Outcome data were collected from national registers.
Patients were grouped according to plasma cortisol level after a 1-mg dexamethasone suppression test (cortisol; <50, 50 to 82, 83 to 137, or ≥138 nmol/L).
During a median follow-up of 6.4 years, 170 of 1048 patients died. Compared with a cortisol less than 50 nmol/L, a cortisol of 50 to 82 nmol/L was not associated with increased mortality (hazard ratio [HR], 1.15 [95% CI, 0.78 to 1.70]). However, a cortisol of 83 to 137 nmol/L ( = 119) had an HR of 2.30 (CI, 1.52 to 3.49), and a cortisol of 138 nmol/L or higher ( = 82) had an HR of 3.04 (CI, 1.86 to 4.98). Analyses using restricted cubic splines indicated that the association between cortisol and mortality was linear up to a cortisol of 200 nmol/L.
The results are not based on verified autonomous cortisol secretion; thus, the association may be underestimated.
The association between mortality and cortisol increased linearly until cortisol reached 200 nmol/L. A cortisol of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisol of 138 nmol/L or higher was associated with a 3-fold increase in mortality. Additional studies should be done, and until those studies are completed some clinicians may consider these findings when deciding which patients to recommend for surgery.
Lisa and Johan Grönberg Foundation and Gyllenstiernska Krapperup Foundation.
肾上腺意外瘤患者的自主皮质醇分泌与死亡率增加有关，但关于与自主皮质醇分泌特定水平相关的风险的详细信息尚不清楚。
测量肾上腺意外瘤患者的死亡率与自主皮质醇分泌水平之间的关系。
回顾性队列研究。（ClinicalTrials.gov：NCT03919734）。
瑞典南部的两家医院。
2005 年至 2015 年间确诊为肾上腺意外瘤并随访长达 14 年的连续患者。通过国家登记册收集结果数据。
根据 1 毫克地塞米松抑制试验后血浆皮质醇水平（皮质醇；<50、50-82、83-137 或≥138 nmol/L）将患者分组。
在中位数为 6.4 年的随访期间，1048 例患者中有 170 例死亡。与皮质醇<50 nmol/L 相比，皮质醇为 50-82 nmol/L 与死亡率增加无关（风险比 [HR]，1.15 [95%CI，0.78 至 1.70]）。然而，皮质醇为 83-137 nmol/L（n=119）的 HR 为 2.30（CI，1.52 至 3.49），皮质醇为 138 nmol/L 或更高（n=82）的 HR 为 3.04（CI，1.86 至 4.98）。使用限制立方样条的分析表明，皮质醇与死亡率之间的关联呈线性关系，直到皮质醇达到 200 nmol/L。
结果并非基于已验证的自主皮质醇分泌；因此，关联可能被低估。
死亡率与皮质醇之间的关联呈线性增加，直至皮质醇达到 200 nmol/L。皮质醇为 83-137 nmol/L 与死亡率增加 2 倍相关，皮质醇为 138 nmol/L 或更高与死亡率增加 3 倍相关。应进行更多研究，在这些研究完成之前，一些临床医生在决定推荐哪些患者进行手术时可能会考虑这些发现。
Lisa 和 Johan Grönberg 基金会和 Gyllenstiernska Krapperup 基金会。
