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Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study.
[adrenal incidentaloma]
Subclinical
Cushing
's
syndrome
(
SCS
)
is
defined
as
alterations
in
hypothalamic
-
pituitary
-
adrenal
axis
without
classic
signs
/
symptoms
of
glucocorticoid
excess
.
Whether
SCS
leads
to
metabolic
and
cardiovascular
diseases
is
still
controversial
.
To
evaluate
the
prevalence
of
hypertension
,
type
2
diabetes
(
T
2
D
)
,
coronary
heart
disease
(
CHD
)
,
ischemic
stroke
,
osteoporosis
,
and
fractures
,
and
their
relationship
to
increasing
patterns
of
subclinical
hypercortisolism
,
in
patients
with
nonsecreting
adrenal
adenomas
(
NSA
)
and
SCS
.
U
sing
the
1
mg
dexamethasone
suppression
test
(
DST
)
,
348
patients
were
classified
as
follows
:
203
were
defined
as
NSA
and
19
SCS
,
using
the
most
stringent
cutoff
values
(
<
50
and
>
138
nmol
/
l
respectively
)
.
Patients
with
cortisol
post-
DST
(
50
-
138
nmol
/
l
)
were
considered
as
intermediate
phenotypes
and
classified
as
minor
(
n
=
71
)
and
major
(
n
=
55
)
using
plasma
ACTH
and
/
or
urinary
free
cortisol
as
additional
diagnostic
tools
.
SCS
patients
showed
higher
prevalence
of
T
2
D
,
CHD
,
osteoporosis
,
and
fractures
with
respect
to
NSA
.
Intermediate
phenotypes
also
showed
higher
prevalence
of
CHD
and
T
2
D
with
respect
to
NSA
.
The
prevalence
of
all
clinical
outcomes
was
not
different
between
intermediate
phenotype
patients
,
which
were
therefore
considered
as
a
single
group
(
IP
)
for
multivariate
logistic
regression
analysis
:
both
IP
and
SCS
-secreting
patterns
showed
a
significant
association
with
CHD
(
odds
ratio
(
OR
)
,
4
.
09
;
95
%
confidence
interval
(
CI
)
,
1
.
47
-
11
.
38
and
OR
,
6
.
10
;
95
%
CI
,
1
.
41
-
26
.
49
respectively
)
,
independently
of
other
potential
risk
factors
.
SCS
was
also
independently
associated
with
osteoporosis
(
OR
,
5
.
94
;
95
%
CI
,
1
.
79
-
19
.
68
)
.
Patterns
of
increasing
subclinical
hypercortisolism
in
adrenal
adenomas
are
associated
with
increased
prevalence
of
adverse
metabolic
and
cardiovascular
outcomes
,
independently
of
other
potential
risk
factors
.
Diseases
Validation
Diseases presenting
"osteoporosis"
symptom
achondroplasia
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
aromatase deficiency
congenital adrenal hyperplasia
cushing syndrome
cutaneous mastocytosis
dentinogenesis imperfecta
erythropoietic protoporphyria
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
inclusion body myositis
kallmann syndrome
oligodontia
pyomyositis
werner syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated