ECE2021 Presented Eposters Presented ePosters 11: Adrenal and Cardiovascular Endocrinology (8 abstracts)
Increased risk of cardiometabolic disease in patients with benign adrenal tumours with and without cortisol excess: a case–control study
Alessandro Prete1, 2, Anuradhaa Subramanian3, Irina Bancos1, 4, Alice J Sitch3, Vasileios Chortis1, 2, Katharina Lang1, 2, Stylianos Tsagarakis5, Magdalena Macech6, Danae A Delivanis4, Michael W O’Reilly1, 7, Jimmy R Masjkur8, Marcus Quinkler9, Grethe Å Ueland10, M Conall Dennedy11, Felix Beuschlein12, 13, Antoine Tabarin14, Martin Fassnacht15, Miomira Ivovic16, Massimo Terzolo17, Darko Kastelan18, William F Young Jr4, Konstantinos N Manolopoulos1, 2, Urszula Ambroziak6, Dimitra A Vassiliadi5, Krishnarajah Nirantharakumar1, 3 & Wiebke Arlt1, 2, 19
1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; 3Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 4Division of Endocrinology, Metabolism, Diabetes and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; 5Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece; 6Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland; 7Department of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland; 8Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, Technische Universitat Dresden, Dresden, Germany; 9Endocrinology in Charlottenburg, Berlin, Germany; 10Department of Endocrinology, Haukeland University Hospital, Bergen, Norway; 11Department of Endocrinology, University Hospital Galway, Newcastle, Galway, Ireland; 12Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts-Spital Zürich, Zürich, Switzerland; 13Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany; 14Service d’Endocrinologie, Centre Hospitalier Universitaire, Hopital du Haut Leveque, Pessac, France; 15Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Wuerzburg, Wuerzburg, Germany; 16Department for Obesity, Reproductive and Metabolic Disorders, University of Belgrade, Belgrade, Serbia; 17Division of Internal Medicine, University of Turin, San Luigi Hospital, Turin, Italy; 18Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia; 19NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Background
Benign adrenocortical tumours are found in 3–5% of adults and can be non-functioning (NFAT) or associated with cortisol excess. The latter group divides into patients with clinically overt signs (adrenal Cushing’s syndrome, CS) and patients lacking CS signs (mild autonomous cortisol excess, MACE). The 1 mg-overnight dexamethasone suppression test (DST) further differentiates MACE into MACE-1 (possible MACE; post-DST cortisol 50–138 nmol/l) and MACE-2 (definitive MACE; post-DST cortisol >138 nmol/l). A recent systematic review and meta-analysis reported a high prevalence of metabolic syndrome in patients with benign adrenocortical tumours; however, large-scale prospective data are lacking.
Methods
We included 1305 patients with confirmed benign adrenal tumours recruited to the prospective ENSAT EURINE-ACT study (2011–2016). The prevalence of hypertension, resistant hypertension (defined as treatment with ≥3 anti-hypertensives), type 2 diabetes (T2D), T2D with insulin use, and need for with lipid-lowering medications in the EURINE-ACT cohort was compared to 5268 population controls from the 2014 cohort of the Health Survey for England, which monitors health trends in the UK. Multinomial logistic regression was used to obtain BMI-, age, and sex-adjusted odds ratios (aOR).
Results
Cortisol excess was highly prevalent, affecting 50.3% of patients (MACE-1 34.6%, MACE-2 10.7%, CS 5%). Patients carried an increased risk of hypertension, which gradually increased with the degree of cortisol excess: NFAT aOR 3.66 (95%CI 3.02–4.43); MACE-1 aOR 5.03 (3.96–6.40); MACE-2 aOR 6.72 (4.37–10.32); CS aOR 11.86 (6.50–21.65) (all P <0.001). Similarly, all groups presented with an increased risk of resistant hypertension: NFAT aOR 6.40 (4.72–8.68); MACE-1 aOR 7.43 (5.43–10.16); MACE-2 aOR 10.04 (6.36–15.86); CS aOR 31.37 (16.00–61.50) (all P <0.001). Furthermore, patients showed an increased risk of T2D: NFAT aOR 2.62 (2.00–3.44); MACE-1 aOR 2.75 (2.05–3.69); MACE-2 aOR 4.06 (2.45–6.71); CS aOR 11.00 (5.31–22.77) (all P <0.001). Patients with cortisol excess and T2D more often required insulin treatment: MACE-1 aOR 2.70 (1.58–4.62); MACE-2 aOR 4.24 (1.98–9.09); CS aOR 11.08 (3.62–33.90) (all P <0.001). The use of lipid-lowering drugs was also higher in patients with NFAT (aOR 2.11 [1.71–2.59]), MACE-1 (aOR 2.20 [1.75–2.76]), and MACE-2 (aOR 2.65 [1.80–3.89]) (all P <0.001).
Conclusions
Patients with benign adrenocortical tumours have an increased prevalence of cardiometabolic disease and present with a more severe phenotype. The risk increases with the degree of cortisol excess and is highest in CS and MACE-2. However, even NFATs carry a considerably increased cardiometabolic burden, which may be due to underlying autonomous cortisol secretion that is not picked up by currently employed biochemical testing.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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