Endocrine Abstracts

Background: Mild autonomous cortisol secretion (MACS) is a common finding in patients who have an adrenal incidentaloma (AI). Evidence suggests patients with MACS are at risk of cardiovascular morbidity, but there is not yet a consensus on the management of this cohort. Our study assesses the cardiovascular risk of patients with MACS, compared to patients with non-functioning AIs.

Methods: Data were collected retrospectively between 2019-2022. Inclusion criteria were patients with AI and an overnight dexamethasone suppression test (ONDST) cortisol between 50-138 nmol/l. Patients with AI and ONDST cortisol <50 nmol/l were the comparator group. Cardiovascular co-morbidities and medications were collected. Relative Risk (RR) of cardiovascular disease was calculated using the QRISK3 algorithm. Statistical analysis was conducted using PRISM v9.3.1.

Results: 391 patients (47% male), median age 69±10 years (SD) were identified with MACS. 630 patients were included in the non-MACS group (median age 63±12 years, 43% male). 70.8% of MACS had hypertension, vs 51.5% of the non-MACS group (P<0.0001). 43.5% of the MACS group were on more than one anti-hypertensive vs 24.8% (P<0.0001). 66.8% of MACS patients were on statin therapy vs 49% (P<0.0001 for both). 35% of the MACS group had T2DM vs 20% of the non-MACS group (P<0.0001). 25% of MACS patients had IHD vs 9.8% (P<0.0001). Mean QRISK3 score was 27±13% in the MACS group, compared with 16±10% in age/sex matched healthy controls (P<0.0001). RR for MI/stroke was 2.0 in the MACS group and 1.6 in the non-MACS group (P=0.0004).

Conclusions: Within our unselected cohort of patients with MACS, there was higher prevalence of hypertension, T2DM and IHD, and increased RR for MI/stroke, compared with the non-MACS AI group. Our data suggest a need for consideration and optimisation of cardiometabolic morbidity when managing patients with MACS, in line with recent guidelines.