Endocrine Abstracts

Background: Patients with adrenal incidentalomas and possible autonomous cortisol secretion (pACS) suffer from a high rate of cardiovascular events and mortality. We have previously showed that left ventricular mass index (LVMi) is higher in patients with pACS, compared with patients with non-functioning adenomas (NFA). To date, the management of pACS is still controversial, with a lack of consensus regarding the benefits of surgery.

Objectives: This prospective longitudinal study (NCT04127552) in patients with pACS aims to assess the effect of surgical and conservative management on cardiovascular and metabolic features.

Methods: At baseline, 102 adrenal adenomas were identified by magnetic resonance. Anthropometric, hormonal and metabolic parameters, echocardiography B-mode ultrasound and noninvasive measurement of arterial stiffness were assessed at baseline and after one year to identify cardiovascular alterations in patients with pACS receiving conservative management (CONS) or adrenalectomy (ADR). Adrenalectomy was chosen according to size of the lesion, cortisol secretion grade, patient’s age and cortisol-related comorbidities, following an internal algorithm interpreting the 2016 ESE guidelines.

Results: 47 patients completed the 1-year follow-up. According to post-dexamethasone suppression cortisol values, 23 NFA and 24 pACS were found. 14 patients with pACS received CONS and 10 patients with pACS underwent ADR. At 12 months, ADR patients showed a reduction in the median LVMi (-12 g/m² (95% CI:-22;-0.24)), compared with CONS group (+10 g/m² (95% CI:-0.9;21.7); P=0.023). ADR patients showed also a reduction in BMI (P=0.009), systolic and diastolic blood pressure (P<0.001) than CONS.

Conclusions: pACS is associated with significant cardiovascular complications. In our cohort of selected patients with an adrenal adenoma and mild cortisol secretion, cardiovascular outcomes improved after adrenalectomy.