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 "hypertension" symptom

achondroplasia

acute rheumatic fever

adrenal incidentaloma

aniridia

aromatase deficiency

cadasil

child syndrome

cohen syndrome

congenital adrenal hyperplasia

congenital diaphragmatic hernia

cushing syndrome

cystinuria

erdheim-chester disease

erythropoietic protoporphyria

esophageal adenocarcinoma

fabry disease

familial hypocalciuric hypercalcemia

gm1 gangliosidosis

heparin-induced thrombocytopenia

hereditary cerebral hemorrhage with amyloidosis

holt-oram syndrome

homocystinuria without methylmalonic aciduria

hydrocephalus with stenosis of the aqueduct of sylvius

inclusion body myositis

kallmann syndrome

kindler syndrome

lamellar ichthyosis

lymphangioleiomyomatosis

pendred syndrome

primary effusion lymphoma

scrub typhus

severe combined immunodeficiency

sneddon syndrome

typhoid

von hippel-lindau disease

well-differentiated liposarcoma

werner syndrome

x-linked adrenoleukodystrophy

zellweger syndrome

This symptom has already been validated