Endocrine Abstracts

Background: Adrenal incidentalomas (AI) represent incidentaly discovered adrenal mases, without simptoms or signs suggestive of adrenal pathology, at the time of visualization. It is well-known that overt or subclinical hypercorticism, as well as metabolic syndrome (MetS) harbour increased CV risk.There is still persisting debate on eventual cause-effect relationship of AI with metabolic syndrome MetS or probability of simply more frequent occurance of AI among these patients.

Objective: The aim of this investigation was to assess the 10-year CV risk in patients with AI, as well as the impact of the presence of MetS or hypercorticism on CV risk in thise patients.

Methods: Study included 64 patients with AI, 49 patients with MetS and without adrenal pathology and 23 patients with proven Cushing’s syndrome. For the identification of MetS, the International Diabetes Federation (IDF) definition was used. The patients were diagnosed with subclinical hypercorticism (SC) based on the presence of laboratory abnormalities of the hypothalamic-pituitary-adrenal axis, without clinical signs of Cushing’s syndrome and hypercortisolism. Ten-year CV risk was assessed for every subject using the Framinghamskog score system.

Results: Prevalence of MetS among patients with AI was high (76.6%) and did not differ significantly from its prevalence among patients with proven Cushing’s syndrome (69.6%). Presence of MetS significantly affected estimated 10-year CV risk in patients with AI (MetS+: 24.39% vs MetS-: 14.58%, P<0.05), while such impact of SC was not observed (SC+: 23.63% vs 21.23%, ns) in these patients. Among parameters that were tested, the most important predictors of 10-year CV risk, among patients with AI, as well as in those with MetS and those with proven Cushing’s syndrome, proved to be age, high density cholesterol and fasting plasma glucose.

Conclusions: High prevalence of MetS in patients with AI and its influence on amplification of CV risk, indicate the necessity of inclusion of screening on its components, beside usual screening of adrenal function, in regular follow-up of these patients. This approach could allow appropriate and more agresive treatment aiming at the prevention of adverse cardiovascular events.

Key words: adrenal incidentaloma, metabolic syndrome, subclinical hypercorticism, cardiovascular risk