ECE2013 Poster Presentations Adrenal cortex (64 abstracts)
Long-term follow-up in adrenal incidentalomas: an Italian Multicentre Study
Valentina Morelli 1 , Giuseppe Reimondo 2 , Roberta Giordano 3 , Silvia Della Casa 4 , Giovanna Muscogiuri 4 , Caterina Policola 4 , Antonio Stefano Salcuni 5 , Alessia Dolci 6 , Giulia Beltrami 7 , Serena Palmieri 1 , Alfredo Scillitani 5 , Maura Arosio 6 , Bruno Ambrosi 7 , Ezio Ghigo 8 , Paolo Beck-Peccoz 1 , Iacopo Chiodini 1 & Massimo Terzolo 2
1Unit of Endocrinology and Diabetology, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; 2Division of Internal Medicine I, Department of Biological and Clinical Sciences, San Luigi Hospital, Orbassano, University of Turin, Turin, Italy; 3Department of Biological and Clinical Sciences, University of Turin, Turin, Italy; 4Unit of Endocrinology, Università Cattolica, Rome, Italy; 5Unit of Endocrinology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; 6Unit of Endocrine Disease and Diabetology, S. Giuseppe Hospital, Gruppo Multimedica, University of Milan, Milan, Italy; 7Unit of Endocrinology and Diabetology, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy; 8Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy.
Introduction: The need of a long-term follow-up in adrenal incidentalomas (AI) is debated and data on cardiovascular events (CVE) are lacking.
Methods: In this retrospective study all patients referred to seven Italian Endocrine Centers for AI, without signs of hypercortisolism at baseline and with a ≥5 years follow-up (80.7±30 months, range 60–286), were enrolled. From 171 patients (121 F) aged 59.5±10.2 years (range 25–79) the changes in weight, glucose and lipid metabolism, blood pressure control and the occurrence of CVE were obtained. Patients were classified as affected with subclinical hypercortisolism (SH) in the presence of cortisol after 1-mg dexamethasone suppression (1-mg DST) test >5 μg/dl or ≥2 parameters out of low ACTH, increased urinary free cortisol and 1-mg DST >3 μg/dl.
Results: At baseline SH was found in the 14% of patients. The prevalence of obesity, diabetes mellitus, dyslipidemia, and arterial hypertension (54, 21, 25, and 45% respectively) was not different between patients with (SH+) and without SH (SH−). At baseline SH+ patients showed a higher CVE prevalence than SH− ones (21 vs 7%), regardless of age (OR 3.3, 95% CI 1.0–11.1, P<0.05). At the end of follow-up a new diagnosis of SH was made in the 7.6% of patients, whereas in the 3.5% the SH diagnosis was not confirmed. The adenoma size (baseline 2.3±0.8 cm) increased >2.5 cm in the 2.9% of cases. The glucose and lipid metabolism, blood pressure, and weight control worsened in the 24, 16, 36 and 14% of patients, respectively. The SH persistence/appearance was significantly associated with the worsening of ≥2 out of the metabolic parameters (P=0.013) and with the occurrence of new CVE (P=0.05).
Conclusion: In AI patients a long-term follow-up is recommended for the diameter increase and SH development risk. SH patients are at risk of worsening of the metabolic control and, importantly, of CVE.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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