Concomitant alterations of metabolic parameters, cardiovascular risk factors and altered cortisol secretion in patients with adrenal incidentalomas during prolonged follow-up.

Abstract

OBJECTIVE:

Adrenal incidentalomas (AI) are associated with metabolic and hormonal abnormalities, most commonly autonomous cortisol secretion (ACS). Data regarding alterations of insulin resistance (IR) and ACS after prolonged follow-up are limited. We investigated the evolution of IR, cortisol secretion and ACS development in patients with AI during prolonged follow-up.

DESIGN:

Prospective study in a tertiary hospital.

PATIENTS AND MEASUREMENTS:

Seventy-one patients with AI [51 nonfunctioning (NFAI) and 20 ACS] and 5·54 ± 1·7 years follow-up underwent testing for ACS and oral glucose tolerance test to determine IR indices and adrenal imaging.

RESULTS:

At follow-up, 16/51 (31%) NFAI patients converted to ACS, while two with previous ACS reverted to NFAI; 21% (7/33) of patients who did not covert to ACS exhibited high urinary-free cortisol (H-UFC) levels. All AI patients developed deterioration of IR irrespective of their cortisol secretory status. Eight patients developed newly diagnosed type 2 diabetes (9·8% NFAI and 15% ACS, respectively) and 14 IR (17·6% NFAI and 25% ACS, respectively). Adenoma size increased from 2·1 ± 0·8 to 2·3 ± 0·8 cm, whereas IR correlated with postdexamethasone cortisol level and adenoma size increase. IR showed an incremental continuum trend from normal UFC (Ν-UFC), to H-UFC, C-ACS and ACS patients.

CONCLUSIONS:

New-onset ACS developed in 31% patients with NFAI, whereas 21% of NFAI patients had H-UFC levels. All AI patients as a group and the subgroups of N-UFC, H-UFC, C-ACS and ACS patients developed deterioration of metabolic parameters during follow-up that was more prominent in ACS patients.

• Authors: Labrini Papanastasiou, Krystallenia I Alexandraki, Ioannis I Androulakis, Stelios Fountoulakis, Theodora Kounadi, Athina Markou, Vaios Tsiavos, Christianna Samara, Theodoros G Papaioannou, George Piaditis, Gregory Kaltsas
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 86 Issue 4 Pg. 488-498 (04 2017) ISSN: 1365-2265 [Electronic] England
• PMID: 27992961 (Publication Type: Journal Article)
• Copyright: © 2016 John Wiley & Sons Ltd.

Chemical References

• Hydrocortisone

Topics

• Adrenal Gland Neoplasms (complications, metabolism)
• Aged
• Cardiovascular Diseases (diagnosis, etiology)
• Diabetes Mellitus, Type 2
• Disease Progression
• Female
• Follow-Up Studies
• Humans
• Hydrocortisone (metabolism)
• Insulin Resistance
• Male
• Middle Aged
• Prospective Studies
• Risk Factors