Endocrine Abstracts

Introduction: Cortisol autonomy may be frequently demonstrated in patients with adrenal incidentaloma and this has been associated to increased cardiovascular (CV) risk. However, only few data are available on CV events and related mortality in such patients. Aims of the study were: 1) to stratify CV events and mortality by the degree of cortisol secretion; 2) to evaluate the effect of adrenalectomy on CV events and mortality.

Methods and Design: Data of 218 patients (89 M, 129 F, median age 62 years) followed for a median period of 60 (24–348) months were retrieved. All patients underwent a standard baseline hormonal evaluation. Patients with malignancy, aldosterone producing adenoma and pheochromocytoma were excluded; 30 patients underwent adrenalectomy.

Results: Patients who died during follow-up had higher post-DST cortisol at baseline than patients who survived (P=0.04). Death was mostly due to CV causes (41%). Among patients who were not operated on, more CV events (P=0.04) and more deaths (P=0.07) were observed in the group with post-DST cortisol ≥1.8 mcg/dl. Mortality was significantly increased in patients with post-DST cortisol ≥5 mcg/dl (P=0.008). Patients who were operated on had at baseline higher post-DST cortisol (P<0.001), lower ACTH (P=0.02) larger mass size (P<0.01) and younger age (P=0.02) than the remainders. At the last follow-up visit, the patients who were operated on had a lower frequency of hypertension (P=0.01). Non-operated patients had a higher frequency of new CV events during follow-up (23.5% vs 6.7%, P=0.04). One death was observed during follow-up in the surgical group (3.3%) versus 16 deaths among non-operated patients (8.5%).

Conclusions: In patients with adrenal incidentaloma cortisol autonomy is associated with increased risk of CV events and mortality. A selective use of adrenalectomy in younger patients with higher degree of cortisol autonomy may have a positive effect on CV outcomes.