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Nonfunctioning adrenal incidentalomas with cortisol post-dexamethasone suppression test >0.9 µg/dL have a higher prevalence of cardiovascular disease than those with values ≤0.9 µg/dL

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Abstract

Purpose

To analyze the differences in the cardiometabolic profile in patients with nonfunctioning adrenal incidentalomas (NFAI) with post-dexamethasone suppression test (DST) cortisol ≤1.4 µg/dL (NFAI ≤ 1.4) and those with post-DST cortisol >1.4 µg/dL (NFAI > 1.4) and between NFAI with post-DST cortisol ≤0.9 µg/dL (NFAI ≤ 0.9) and those with levels >0.9 µg/dL (NFAI > 0.9).

Methods

Multicenter retrospective observational study of patients with NFAIs. NFAI was defined as an adrenal incidentaloma with negative hormonal study (including metanephrines, post-DST cortisol ≤1.8 µg/dL and aldosterone/renin ratio when screening was indicated). Autonomous cortisol secretion (ACS) development was defined as an NFAIs in which post-DST serum cortisol >1.8 µg/dL were evidenced during hormonal follow-up evaluation.

Results

A total of 593 NFAI were included. Based on the 1.4 µg/dL threshold in the DST, most of the NFAI were classified as NFAI ≤ 1.4 (74.5%). Patients in the NFAI > 1.4 group were older than those in the NFAI ≤ 1.4 group, but there was no difference in the cardiometabolic profile after adjusting for age. A total of 69.5% of the patients had DST > 0.9 µg/dl. They were older and had a higher prevalence of cardiovascular disease than NFAI ≤ 0.9, even after adjusting by age (adjusted OR = 2.23 [1.10–4.53]). Patients in the NFAI > 1.4 group developed ACS more commonly than the NFAI ≤ 1.4 group (23.5% vs. 7.44%, P < 0.001). However, when the threshold of 0.9 µg/dL was considered, no difference was found between NFAI ≤ 0.9 and NFAI > 0.9 (P = 0.126).

Conclusion

The threshold of 1.4 µg/dL in the DST is useful to predict which patients with NFAI had a higher risk of ACS development during follow-up; and the threshold of 0.9 µg/dL to identify those patients with NFAI with a higher cardiovascular risk.

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Funding

SENDIMAD: BECA SENDIMAD de Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019. IRYCIS (Convocatoria intramural de ayudas aproyectos de investigación deinvestigadores noveles, investigadoresclínicos asociados y/o grupos emergentesdel Hospital Universitario Ramón y Cajal2019).

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Authors and Affiliations

  1. Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Marta Araujo-Castro

  2. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

    Marta Araujo-Castro

  3. University of Alcalá, Madrid, Spain

    Marta Araujo-Castro

  4. Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain

    Paola Parra Ramírez & Patricia Martín Rojas-Marcos

  5. Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain

    Rogelio García Centeno

  6. Endocrinology & Nutrition Department, Hospital Royo Villanueva, Zaragoza, Spain

    Paola Gracia Gimeno

  7. Endocrinology & Nutrition Department, Hospital Universitario Puerto Real, Cadiz, Spain

    Mariana Tomé Fernández-Ladreda

  8. Endocrinology & Nutrition Department., Hospital Universitario de La Princesa, Madrid, Spain

    Miguel Antonio Sampedro Núñez

  9. Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain

    Cecilia Higueruela & Cristina Robles Lázaro

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  1. Marta Araujo-Castro
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Correspondence to Marta Araujo-Castro.

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The authors declare no competing interests.

Ethics

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Hospital Universitario Ramón y Cajal. Madrid. Spain (approval date: 23 September 2019, acta CEIm 10/19, approval number: 3702)

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Patient consent was waived due to the retrospective nature of the study. Only for patients who continued follow-up or prospectively included the informed consent was requested.

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Araujo-Castro, M., Parra Ramírez, P., Martín Rojas-Marcos, P. et al. Nonfunctioning adrenal incidentalomas with cortisol post-dexamethasone suppression test >0.9 µg/dL have a higher prevalence of cardiovascular disease than those with values ≤0.9 µg/dL. Endocrine 79, 384–391 (2023). https://doi.org/10.1007/s12020-022-03228-z

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