Endocrine Abstracts

Introduction: Recent studies found an increased cardiometabolic risk in patients with Non-Functioning Adrenal Incidentaloma (NFAI), but all these data have low quality of evidence.

Objective: To establish whether cardiometabolic risk and complications in NFAI patients can be associated to the presence of a non-secreting adrenal tumor, independently from potential confounding factors.

Subjects and Methods: In this cross-sectional and retrospective study, all the NFAI patients referred to the University Hospital of Turin, between 2000 and 2022, were consecutively enrolled and compared with subjects not affected by adrenal disease. For each patient, clinical and biochemical data were evaluated, in addition to their cardiovascular (CV) risk scores and cardiometabolic outcomes.

Results: A total of 2381 subjects were enrolled in the study (1137 patients with NFAI, including 831 with arterial hypertension and 306 with normal blood pressure values; 1244 non-NFAI, of which 1177 hypertensive patients and 67 normotensives). In the NFAI group, a significant increase of the CV risk was observed exclusively among subjects suffering from hypertension and it was calculated using risk scores (SCORE: 4.93±5.79% vs 3.94±6.77%, P=0.006; Framingham Risk Score: 11.03±9.32% vs 9.45±8.97%, P=0.002; Cuore project: 15.63±15.66% vs 11.46±13.42%, P=0.000). Moreover, the NFAI group presented globally higher AASI (Ambulatory Arterial Stiffness Index) values compared to the subjects with no adrenal mass, both among patients with arterial hypertension (0.47±0.16 vs 0.43±0.14; P=0.022) and among those with normal blood pressure values (0.45±0.14 vs 0.31±0.08; P=0.012). Regarding cardiometabolic complications, at multivariate logistic regression, NFAI proved to be independently associated with aortic ectasia (OR 2.779, 95% CI 1.287-6.001, P=0.009), correcting for age, sex, metabolic syndrome (MS) and previous CV events. To minimize the impact of differences between the NFAI and non-NFAI groups, propensity score matching (1:1) was used. Even in this analysis, NFAI retained a statistically significant association with aortic ectasia (β=0.074, 95% CI 0.016-0.131, P=0.012). The matching variables were the same covariates applied in the logistic regression. Conversely, no significant associations with MS, type II diabetes, eGFR <60 mL/min/1.73m², microalbuminuria, atrial fibrillation or hypertensive cardiomyopathy were found.

Conclusions: The results of this study suggest the presence of an augmented cardiometabolic risk in patients affected by NFAI. Considering cardiometabolic complications, we described for the first time an association between NFAI and aortic ectasia. If these data will be confirmed in longitudinal studies, NFAI could be considered a condition of high cardiovascular risk and, therefore, patients with this disease could benefit from appropriate cardiometabolic follow-up and treatment.