Endocrine Abstracts

Background and Aims: Numerous studies have suggested that metabolic syndrome (MetS) is related to adrenal incidentaloma (AI) in young adults. Limited data about MetS in geriatric patients diagnosed with AI are available, despite the high incidence of this adrenal disease in the elderly. This study aims to assess the prevalence of MetS and its associated factors in aged patients harboring AI.

Patients and Method: We conducted a retrospective, comparative, and analytical study including 69 patients aged 65 years and above diagnosed with AI. All patients have undergone clinical examination, adrenal CT, and biochemical workup at the Endocrinology Department of Hedi Chaker University Hospital, Sfax, Tunisia, from 2011 to 2020. MetS was diagnosed based on the National Cholesterol Education Program’s Adult Treatment Panel III (ATP III) criteria. We compared two groups:

[MetS+]: elderly subjects with MetS (n=17)

[MetS-]: elderly subjects without MetS (n=52)

Results: There was no significant age diffrence between both groups ([MetS+]:72.1 vs [MetS=] 71.0 years old; P=0.82). Female gender was significatly associated with MetS ([MetS+] 82.4% vs [MetS-] 39.1%; P=0.006). Patients bearing bilateral AI were significantly more affected by MetS ([MetS+] 58.8% vs [MetS-]: 4.3%; P=0.000) compared to those having unilateral AI. Smaller incidentaloma size seems to aggravate substabtially the risk of developping MetS in the elderly (incidentaloma size in [MetS+] 21.0 vs [MetS-]:26.7 mm; P=0.009). Both groups had similar electrolyte profile except higher phosphatemia which was statistically linked to the prescence of MetS ([MetS+] 1.30 vs [MetS-]: 0.96 mmol/l; P=0.018). We noted no significant correlation between hormonal hypersecretion and MetS in older adults, since there was a comparable distribution of functioning ([MetS+] 46.7% vs [MetS-] 40.0%) and nonfunctioning AI([MetS+] 53.3% vs [MetS-] 60%; P=0.693) in the two groups.

Conclusion: AI is associated with a higher cardiometabolic risk. This risk seems to increase in advanced age. Metabolic abnormalities are classically attributed to hormonal hypersecretion, especially in Cushing’s syndrome. However, several studies have recently proven that insulin resistance and metabolic dysregulation also occur in nonfunctioning AI. Our results suggest that bilateral and smaller AI may worsen the risk of metabolic disturbances in geriatric patients, regardless of their secreting profile. Further research is needed to elucidate this hypothesis.