Endocrine Abstracts

Background: Active smoking has been associated with alterations of the hypothalamic-pituitary-adrenal axis. A role in the pathogenesis of adrenal tumors has also been proposed previously. No data investigating the relationship between smoking and hormonal secretion of adrenal tumors are yet available.

Aim: To investigate the association between smoking habit with morphology and hormonal pattern of adrenal tumors.

Methods: We retrospectively evaluated 1346 patients with adrenal adenomas, hyperplasia, or adrenocortical carcinoma (ACC). We enrolled 1024 patients (wome n=646) fulfilling the inclusion criteria (adrenocortical tumors with data on hormonal secretion and smoking status): non-functioning tumors (NF, n=572), mild autonomous cortisol secretion (MACS, n=310), ACTH-independent Cushing Syndrome (CS, n=33), ACC (n=34), primary aldosteronism (PA, n=75). We analyzed the prevalence of active, former, and non-smokers among groups and the association with cortisol levels by regression analysis.

Results: Prevalence of active smokers was significantly different among groups (overall P<0.001): 28.1% (n=161) in NS, 39.4% (n=122) in MACS, 60.6% (n=20) in CS, 35.3% (n=12) in ACC, and 22.7% (n=17) in PA. Paired test revealed significant differences between NF vs MACS and CS, with no differences between MACS vs CS. Prevalence of former smokers was not significantly different among groups. The significant differences in active smokers among groups was confirmed in males (P=0.002) and females (P<0.001). Prevalence of smokers was significantly higher in female MACS (43.6%, n=85/195) and CS (53.8%, n=14/26) vs NF (28.5%, n=102/358), whereas it was not significantly different in MACS vs CS. In males, the proportion of smoker was higher in CS (85.7%, n=6/7) vs NF (27.6%, n=59/214) and MACS (32.2%, n=37/115), with no significant differences in MACS vs NF. Prevalence of former smokers was not significantly different in either sex. Logistic regression analysis revealed a significant association between cortisol after 1 mg-dexamethasone suppression test (DST) with active smoking (odds ratio [OR]=1.03 each 10 nmol/l increase, 95% confidence interval [CI]=1.01-1.04, P=0.001). This significant association was confirmed when sex (P for sex not significant) and age (P for age=0.001, OR=0.98, 95%CI=0.97-0.99) where added to the model. When adrenal tumor morphology was analyzed, the prevalence of active smokers was significantly higher in patients with adrenal hyperplasia and MACS, when compared to NF adenomas and hyperplasia and adenomas with MACS.

Conclusion: The prevalence of active smokers is significantly higher in cortisol-producing lesions vs NF tumors, with some differences according to sex. Increasing post-DST cortisol is significantly associated with active smoking, independently of sex and age.