Patients with apparently nonfunctioning adrenal incidentalomas may be at increased cardiovascular risk due to excessive cortisol secretion.

[adrenal incidentaloma]

Although adrenal incidentalomas (AIs ) are associated with a high prevalence of cardiovascular risk (CVR ) factors , it is not clear whether patients with nonfunctioning AI (NFAI ) have increased CVR .O ur objective was to investigate CVR in patients with NFAI .T his case-control study was performed in a tertiary general hospital .SUBJECTS included 60 normotensive euglycemic patients with AI and 32 healthy controls (C ) with normal adrenal imaging .All participants underwent adrenal imaging , biochemical and hormonal evaluation , and the following investigations : 1 ) measurement of carotid intima-media thickness (IMT ) and flow-mediated dilatation , 2 ) 2 -hour 75 -gram oral glucose tolerance test and calculation of insulin resistance indices (homeostasis model assessment , quantitative insulin sensitivity check , and Matsuda indices ), 3 ) iv ACTH stimulation test , 4 ) low -dose dexamethasone suppression test , and 5 ) NaCl (0 .9 %) post-dexamethasone saline infusion test .Based on cutoffs obtained from controls , autonomous cortisol secretion was documented in 26 patients (cortisol-secreting AI [CSAI ] group ), whereas 34 exhibited adequate cortisol and aldosterone suppression (NFAI group ). IMT measurements were higher and flow-mediated vasodilatation was lower in the CSAI group compared with both NFAI and C and in the NFAI group compared with C . The homeostasis model assessment index was higher and quantitative insulin sensitivity check index and Matsuda indices were lower in the CSAI and NFAI groups compared with C as well as in CSAI compared with the NFAI group . The area under the curve for cortisol after ACTH stimulation was higher in the CSAI group compared with the NFAI group and C and in the NFAI group compared with C . In the CSAI group , IMT correlated with cortisol , urinary free cortisol , and cortisol after a low -dose dexamethasone suppression test , whereas in the NFAI group , IMT correlated with area under the curve for cortisol after ACTH stimulation and urinary free cortisol .Patients with CSAI without hypertension , diabetes , and /or dyslipidemia exhibit adverse metabolic and CVR factors . In addition , NFAIs are apparently associated with increased insulin resistance and endothelial dysfunction that correlate with subtle but not autonomous cortisol excess .

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adrenal incidentaloma

scrub typhus

werner syndrome

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