Nondiabetic patients with either subclinical Cushing's or nonfunctional adrenal incidentalomas have lower insulin sensitivity than healthy controls: clinical implications.

[adrenal incidentaloma]

The aim of this study was to estimate insulin sensitivity (IS ) in nondiabetic patients with adrenal incidentalomas (AI ): nonfunctional adrenal incidentalomas (NAI ) and patients with AI and subclinical Cushing 's syndrome (SCS ).Based on the inclusion criteria (normal fasting glucose levels , no previous history of impaired fasting glucose and /or diabetes , and no medications or concomitant relevant diseases ) and the exclusion criteria (pheochromocytoma , overt hypercortisolism , hyperaldosteronism , adrenal carcinoma , metastasis of extra -adrenal tumors , extra -adrenal malignancies ), 142 subjects were drawn from a series of patients with AI . The subjects were age-, sex- and body mass index (BMI )-matched : 70 with NAI (50 women and 20 men ), 37 with AI and SCS (31 women and 6 men ) and 35 healthy control (HC ) subjects (30 women and 5 men ). The oral glucose tolerance test (OGTT ) and several indices of insulin sensitivity (IS ) were used : homeostasis model assessment (HOMA ), quantitative insulin sensitivity check index (QUICKI ), triglycerides and glucose index (TyG ), index of whole-body insulin sensitivity (ISI-composite ) and glucose to insulin ratio (G /I ).There was a significant difference in IS between subjects with NAI and HC (HOMA , p =0 .049 ; QUICKI , p =0 .036 ; TyG , p =0 .002 ; ISI-composite , p =0 .024 ) and subjects with SCS and HC (AUC insulin , p =0 .01 ; HOMA , p =0 .003 ; QUICKI , p =0 .042 ; TyG , p =0 .008 ; ISI-composite , p =0 .002 ). There was no difference in the tested indices of IS between subjects with NAI and SCS (p >0 .05 ). However , subjects with SCS had a significantly higher prevalence of impaired glucose tolerance and higher area under the curve for glucose than subjects with NAI (p =0 .0174 ). The linear regression analysis showed that 1 mg -DST can not be used as a predictor of HOMA (R (2 )=0 .004 , F =0 .407 , p =0 .525 ). Significant relationship was found between 1 mg -DST and ISI-composite (R (2 )=0 .042 , F =4 .981 , p =0 .028 ) but this relationship was weak and standard error of estimate was high . The linear regression model also showed that ACTH can not be used as a predictor of HOMA (R (2 )=0 .001 , F =0 .005 , p =0 .943 ) or ISI-composite (R (2 )=0 .015 , F =1 .819 , p =0 .187 ).Insulin resistance is a major cardiovascular risk factor ; therefore , the assessment of IS in patients with AI , even nonfunctional , has a valuable place in the endocrine workup of these patients .

Diseases
Validation

Diseases presenting "oral glucose tolerance test" symptom

adrenal incidentaloma

aromatase deficiency

cohen syndrome

congenital adrenal hyperplasia

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