Clinic of Endocrinology, Diabetology, and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
Department of Imaging, Provincial Specialist Hospital in Olsztyn, Olsztyn, Poland.
Endokrynol Pol. 2023;74(6). doi: 10.5603/ep.95139. Epub 2023 Nov 23.
Adrenal incidentaloma (AI) secreting small amounts of glucocorticoids may cause morphological and functional changes in the blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with AI. But it is unclear whether the nonfunctional adrenal incidentalomas (NFAI) may also be a risk factor for cardiovascular diseases. The aim of this study was to determine the relationship between NFAI, carotid intima-media thickness (CIMT), and cardiovascular risk (CVR) based on Systematic Coronary Risk Evaluation (SCORE) prediction models for Europe.
This study from a single centre in Poland included 48 NFAI patients and 44 individuals in the control group matched for age, sex, and body mass index (BMI). All participants underwent adrenal imaging, biochemical evaluation, measurement of CIMT, and assessment of the 10-year risk of cardiovascular mortality based on the SCORE algorithm. Hormonal evaluation was conducted in AI patients.
The NFAI group showed significantly higher sodium (p = 0.02) and glucose levels in the 2-h oral glucose tolerance test (OGTT) (p = 0.04), a higher CIMT (p < 0.01), and a higher CVR calculated according to the SCORE algorithm (p = 0.03). The estimated glomerular filtration rate (eGFR) was higher in the NFAI group (p = 0.015). Hypertension (p < 0.01) and IGT (p = 0.026) were more common in the NFAI group. Statistically significant positive correlations were found between CIMT and age (r = 0.373, p = 0.003), waist circumference (r = 0.316, p = 0.029), diastolic blood pressure (r = 0.338, p = 0.019), and CVR based on the SCORE algorithm (r = 0.43, p = 0.004). There was a statistically significant positive correlation between CIMT and serum cortisol levels after 1 mg dexamethasone suppression test (r = 0.33, p = 0.02).
Non-functional adrenal adenomas are associated with increased CIMT and CVR. Early stages of cardiovascular remodelling can be observed in asymptomatic NFAI patients.
分泌少量糖皮质激素的肾上腺偶发瘤（AI）可能导致血管的形态和功能发生变化。在无症状的 AI 患者中可能会观察到心血管重塑的早期阶段。但目前尚不清楚无功能性肾上腺偶发瘤（NFAI）是否也是心血管疾病的危险因素。本研究旨在根据欧洲的系统性冠状动脉风险评估（SCORE）预测模型，确定 NFAI、颈动脉内膜中层厚度（CIMT）和心血管风险（CVR）之间的关系。
这项来自波兰一个中心的研究纳入了 48 名 NFAI 患者和 44 名年龄、性别和体重指数（BMI）匹配的对照组个体。所有参与者均接受了肾上腺影像学、生化评估、CIMT 测量以及基于 SCORE 算法评估 10 年心血管死亡率风险。在 AI 患者中进行了激素评估。
NFAI 组的血清钠（p = 0.02）和口服葡萄糖耐量试验（OGTT）2 小时后血糖水平（p = 0.04）显著升高，CIMT 更高（p < 0.01），根据 SCORE 算法计算的 CVR 更高（p = 0.03）。NFAI 组的估计肾小球滤过率（eGFR）更高（p = 0.015）。NFAI 组更常见高血压（p < 0.01）和 IGT（p = 0.026）。CIMT 与年龄（r = 0.373，p = 0.003）、腰围（r = 0.316，p = 0.029）、舒张压（r = 0.338，p = 0.019）和基于 SCORE 算法的 CVR（r = 0.43，p = 0.004）呈显著正相关。地塞米松 1mg 抑制试验后血清皮质醇水平与 CIMT 呈显著正相关（r = 0.33，p = 0.02）。
无功能性肾上腺腺瘤与 CIMT 和 CVR 增加有关。在无症状的 NFAI 患者中可能会观察到心血管重塑的早期阶段。
