ECE2020 Audio ePoster Presentations Adrenal and Cardiovascular Endocrinology (121 abstracts)
Prevalence and incidence of atrial fibrillation in a large cohort of adrenal incidentalomas: A long-term retrospective study
Guido Di Dalmazi , Valentina Vicennati , Carmine Pizzi , Cristina Mosconi , Lorenzo Tucci , Caterina Balacchi , Eugenio Cosentino , Pasquale Paolisso , Flaminia Fanelli , Alessandra Gambineri , Carla Pelusi , Andrea Repaci , Silvia Garelli , Nazzareno Galiè , Claudio Borghi , Rita Golfieri & Uberto Pagotto
University of Bologna, Bologna, Italy
Background: Chronic glucocorticoids excess leads to morphological and functional cardiac alterations, a substrate for arrhythmias. Autonomous cortisol secretion (ACS) from adrenal incidentalomas is a model of chronic endogenous hypercortisolism, leading to severe cardiovascular diseases.
Aim: To investigate prevalence and incidence of atrial fibrillation in a large cohort of patients with adrenal incidentalomas and ACS.
Methods: After excluding pheochromocytoma, primary aldosteronism, Cushing syndrome, congenital adrenal hyperplasia, and adrenal malignancy, we included 632 patients with adrenal incidentalomas evaluated between 1990 and 2018, aged 18-90 years old. Cortisol after 1 mg-dexamethasone suppression test (DST) < or >50 nmol/l defined non-secreting tumors (NS, n = 420) and ACS (n = 212), respectively. We evaluated the prevalence of atrial fibrillation at the time of first evaluation for the adrenal mass. We calculated the incidence of atrial fibrillation during a mean follow-up of 8.6 years (range 6 months-23 years), by retrospective data analysis of 357 patients (249 NS, 108 ACS). Contributing factors associated with prevalence and incidence of atrial fibrillation were analyzed by regression models.
Results: The prevalence of atrial fibrillation was higher in patients with ACS (8.5%) than NS (3.1%, P = 0.003) and the general population (1.7%; P < 0.001 vs ACS, P = 0.034 vs NS). The age-adjusted rate ratio was 1.0 for NS and 2.6 for ACS, compared to the general population. Atrial fibrillation was associated with ACS (Odds ratio 2.40; 95% confidence interval [CI] 1.07–5.39; P = 0.035). The proportion of patients with atrial fibrillation at the end of follow-up was higher in ACS (20.0%) than NS (11.9%; P = 0.026). Patients with ACS showed a higher risk of incident atrial fibrillation than NS (HR 2.95; 95% CI 1.27–6.86; P = 0.012). Post-DST cortisol was associated with risk of atrial fibrillation (HR 1.15; 95% CI 1.07–1.24; P < 0.001).
Conclusion: Patients with adrenal incidentalomas and ACS are at risk of atrial fibrillation. Electrocardiographic monitoring may be recommended during follow-up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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