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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
.
Diseases
Validation
Diseases presenting
"oral glucose tolerance test"
symptom
adrenal incidentaloma
aromatase deficiency
cohen syndrome
congenital adrenal hyperplasia
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