Bleier Jonathan, Pickovsky Jana, Apter Sara, Fishman Boris, Dotan Zohar, Tirosh Amir, Shlomai Gadi
Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Clin Endocrinol (Oxf). 2022 Mar;96(3):311-318. doi: 10.1111/cen.14651. Epub 2021 Dec 7.
Autonomous cortisol secretion (ACS) is common in patients with adrenal incidentalomas (AI). ACS is associated with increased cardiovascular morbidity and mortality. Data regarding the association between radiological characteristics of adrenal adenomas, their hormonal functionality and metabolic outcomes, are scarce and inconclusive. In this study, we aim to delineate the association between radiological characteristics of AI, ACS and metabolic status.
A cross-sectional study of 77 patients with AI who underwent a comprehensive hormonal evaluation. Radiological assessments were performed by an independent radiologist blinded to the clinical and hormonal phenotype of each case. Linear regression models were used to evaluate the association between post dexamethasone suppression test (DST) cortisol levels, metabolic indices and radiological measurements.
Mean maximal adenoma diameter was greater in patients with versus without ACS (20.35 ± 6 vs. 27.09 ± 9.3 mm, respectively, p < .01). Maximal adenoma diameter was found to be positively and linearly correlated with post-DST morning cortisol levels across their entire range (R = .474, p < .01). Linear correlations between maximal adenoma diameter and indices of glycemic control showed a correlation coefficient (R) of .481 and .463 for fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c), respectively, p < .01. When analysis included only patients with ACS, an R = .584 and R = .565 was observed for FPG and HbA1c, respectively (p < .01 for both). The association between maximal adenoma diameter and both FPG and post-DST morning cortisol intensified in patients with metabolic syndrome.
There is a quantitative positive mild correlation between AI size and both cortisol autonomy and metabolic parameters.
自主性皮质醇分泌（ACS）在肾上腺偶发瘤（AI）患者中很常见。ACS与心血管发病率和死亡率增加相关。关于肾上腺腺瘤的放射学特征、其激素功能和代谢结果之间关联的数据很少且尚无定论。在本研究中，我们旨在描述AI的放射学特征、ACS和代谢状态之间的关联。
对77例接受全面激素评估的AI患者进行横断面研究。由一名对每个病例的临床和激素表型不知情的独立放射科医生进行放射学评估。使用线性回归模型评估地塞米松抑制试验（DST）后皮质醇水平、代谢指标和放射学测量之间的关联。
有ACS的患者与无ACS的患者相比，腺瘤平均最大直径更大（分别为20.35±6与27.09±9.3mm，p<.01）。发现腺瘤最大直径在其整个范围内与DST后早晨皮质醇水平呈正线性相关（R=.474，p<.01）。腺瘤最大直径与血糖控制指标之间的线性相关性显示，空腹血糖（FPG）和糖化血红蛋白（HbA1c）的相关系数（R）分别为.481和.463，p<.01。当分析仅包括有ACS的患者时，FPG和HbA1c的R分别为.584和.565（两者p<.01）。在代谢综合征患者中，腺瘤最大直径与FPG和DST后早晨皮质醇之间的关联增强。
AI大小与皮质醇自主性和代谢参数之间存在定量的轻度正相关。
