ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
The degree of cortisol secretion is associated with cardiometabolic complications in patients with nonfunctioning adrenal tumors
Vittoria Favero 1 , Carmen Aresta 2 , Chiara Parazzoli 1 , Elisa Cairoli 2 , Cristina Eller Vainicher 3 , Serena Palmieri 3 , Antonio Salcuni 4 , Maura Arosio 3,5 , Luca Persani 1,6 , Alfredo Scillitani 7 , Valentina Morelli 2 & Iacopo Chiodini 1,8
1University of Milan, Department of Medical Biotechnology and Translational Medicine, Milan, Italy; 2IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases, Milan, Italy; 3Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Unit of Endocrinology, Milan, Italy; 4University-Hospital S. Maria della Misericordia, Unit of Endocrinology and Metabolism, Milan, Italy; 5University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy; 6IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Diseases & Lab of Endocrine and Metabolic Research, Milan, Italy; 7Ospedale “Casa Sollievo della Soffererenza” IRCCS, San Giovanni Rotondo (FG), Italy; 8Ospedale Niguarda Cà Granda, Unit of Endocrinology, Milan, Italy
Most adrenal incidentalomas are benign and can be divided into nonfunctioning adrenal tumors (NFAT) and tumors with mild autonomous cortisol secretion (MACS). Several studies suggest that MACS may result in an increased risk for mortality and cardiometabolic disease. The cardiometabolic risk in MACS is possibly related to the increased frequency of cardiovascular risk factors such as diabetes mellitus (DM) and hypertension (HT) induced by cortisol excess. This is confirmed by the evidence that DM and HT ameliorate after adrenalectomy in patients with MACS. Recent data suggested that not only MACS but also NFAT patients may have an increased risk of cardiovascular events (CVE). The mortality risk in NFAT seems to be comparable to that in MACS and adrenalectomy seems to be beneficial for hypertension and diabetes mellitus even in patients with NFAT. Therefore, the aim of our study was to assess: i) the association between HT, DM, obesity, dyslipidemia, and CVEs with cortisol secretion; ii) the cut-off of the cortisol secretion parameters for identifying NFAT patients with a worse cardiometabolic profile.
Patients and Methods: In 615 NFAT patients (i.e. with 1mg overnight dexamethasone suppression test, F-1mgDST <1.8 µg/dl) F-1mgDST and adrenocorticotroph hormone (ACTH) levels and data on associated manifestations and CVE prevalence were collected.
Results: HT, DM and HT plus DM were associated with F-1mgDST levels (area-under-curve: 0.588±0.023, 0.610±0.028, 0.611±0.033, respectively, P<0.001 for all comparisons) but not with ACTH. The cut-off for identifying patients with either HT or DM or HTplusDM was set at ≥1.2 µg/dl (33 nmol/l). As compared with patients with F-1mgDST <1.2 µg/dl (n=289), patients with F-1mgDST ≥1.2 µg/dl (n=326) had lower ACTH levels (17.7±11.9 vs 15.3±10.1 pg/ml, respectively, P=0.008), and higher age (62.5±10.9 vs 57.5 ± 12.3 years, respectively, P<0.001), prevalence of HT (38.1% vs 52.5% respectively P<0.001), DM (13.1% vs 23.3%, respectively, P=0.001), HTplusDM (8.3% vs 16.9%, respectively, P<0.002) and CVE (7.3% vs 3.2%, respectively, P=0.028). F-1mgDST≥1.2 µg/dl was associated with either HT (odd ratio, OR, 1.55, 95% confidence interval, 95%CI 1.08-2.23, P=0.018) or DM (OR 1.60, 95%CI 1.01-2.57, P=0.045) after adjusting for age, gender, obesity, dyslipidemia, and DM (for HT) or HT (for DM), and with the presence of HTplusDM (OR 1.96, 95%CI 1.12-3.41, P=0.018) after adjusting for age, gender, obesity, and dyslipidemia.
Conclusions: In NFAT patients cortisol secretion is associated with the prevalence of HT and DM; patients with F-1mgDST ≥1.2 µg/dl could have a worse cardiometabolic profile.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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