Endocrine Abstracts

Introduction: We evaluated the prevalence of metabolic and cardiovascular complications in a Romanian population with adrenal incidentalomas in comparison with an age-matched control group, evaluated in our clinic.

Patients and methods: After excluding patients with overt functioning adrenal tumors, subclinical pheochromocytomas, malignant tumors, myelolipomas, data were retrieved from the files of 190 patients with adrenal incidentalomas ≥1 cm and 85 age-matched control patients (C) evaluated for non-functioning thyroid nodules or osteoporosis. According to the current consensus of evaluation, ten patients (5.2%) were diagnosed with subclinical Cushing’s disease (SCS) and 180 patients with non-functioning adrenal tumors (NFAT).

Results in groups SCS, NFAT and C. Mean age was similar (56, 55 and 52.5 years), with a female predominance; prevalence of obesity and overweight was 75, 74 and 49%, higher in NFAT vs C (P<0.001); prevalence of hypertension was 70, 56 and 40%, higher in NFAT vs C (P<0.05) and borderline higher in SCS vs NFAT (P=0.05); prevalence of glucose abnormalities (diabetes mellitus, impaired fasting glucose or glucose tolerance) was 50, 30 and 9%, higher in SCS vs NFAT, in SCS vs C and in NFAT vs C (P<0.01 in all comparisons); prevalence of dyslipidemia was 100, 76 and 39%, higher in SCS vs NFAT (P<0.001) and in SCS vs C (P< 0.01); prevalence of ischemic heart diseases was 50, 22 and 12%, higher in SCS vs NFAT (P<0.001), in SCS vs C (P<0.01) and borderline higher in NFAT vs C (P=0.06); prevalence of stroke was 20, 16 and 1%, higher in SCS AND in NFAT vs C (P<0.05 in both comparisons); prevalence of thrombembolism was 0, 1.6, 0%; prevalence of patients with any cardiovascular event was 60, 32 and 14%, higher in SCS and NFAT vs C (P<0.01 in both comparisons). Morning serum cortisol, midnight cortisol and morning cortisol after 1 mg overnight dexamethasone suppression test are significantly higher in SCS than NFAT.

Conclusion: Patients with adrenal non-functioning tumors and especially those with subclinical Cushing’s syndrome have higher prevalence of risk factors for cardiovascular disease than the age-matched control population.