Endocrine Abstracts

Autonomous cortisol secretion (ACS), a term that refers to biochemical evidence of excess cortisol, but without the overt Cushing’s syndrome in people with adrenal adenomas. Prevalence of adrenal tumours is 5-10%. Up to 50% of benign adenomas present with some degree of cortisol excess. There is little guidance for investigating and managing these patients leading to different standards of care. Cortisol secretion here is in wide range although post dexamethasone suppression test (ODST) cortisol of 50 nmol/l has been accepted widely below which ACS could be ruled out. There is emerging evidence to support that any amount of excess cortisol could be associated with increased risk of comorbidities, cardiovascular events, mortality and bone fractures compared to non-functioning adrenal tumours. We looked at 113 patients over the past 5 years who had screening for cortisol excess. We categorised them into 3 groups of cortisol values post ODST: group1: 40-49mmol/l (32patients), group 2: 50-138mmol/l (65 patients) and group 3: >138mmol/l (16 patients). The mean age of each group was 65.47, 66.11 and 63.34 respectively. 81% in group1, 75% in group 2 and 39% in group 3 had hypertension. Type 2 diabetes and pre-diabetes were similar across the groups (35.7%, 44.6% and 33.3%) respectively. overweight/obesity was noted in 62.5%, 70.8% and 55.5% in three groups respectively. The majority had no data on Bone density. Of the ones reported, 9% in group 1 , 22% in group 2 and 27% in group 3 had decreased bone density. 28% in group1, 17% in group 2 and 33% in group 3 had dyslipidemia. We found that prevalence of comorbidities were comparable across all the three groups. More research is needed in this area. Individualised care, proactive approach in screening for comorbidities and a dedicated pathway is highly recommended to risk stratify these patents.