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 .

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adrenal incidentaloma

cushing syndrome

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