CARDIOVASCULAR RISK AND CORTISOL SECRETION IN ADRENAL INCIDENTALOMAS

Abstract

Objective: Adrenal incidentalomas (AIs) are often discovered after an imaging-work up that is unrelated to specific adrenal gland disease. Up to 30% of AIs show endogenous cortisol excess, without signs or symptoms of clinically evident Cushing's syndrome. According to literature, subclinical hypercortisolism (SH) is more frequently associated to hypertension as well as obesity and metabolic disorders. Previous studies have established in SH higher cardiovascular (CV) risk, and increased incidence of CV events. Aim of the study was to confirm the existence of a linear relationship between augmented level of cortisol obtained by 24h-urinary free cortisol and overnight 1-mg dexamethason suppression test, and worsening clinical outcomes.Design and method: We retrospectively analyzed data from 543 patients (224 F, 319 M; mean age 59.6+12.4 yrs) with AIs, referred to our Unit between January 2000 to December 2017. After follow-up duration of at least 36 months, we have registered main comorbidities, such as cardiovascular events (pulmonary embolism, deep vein thrombosis, myocardial infarction), metabolic disorders, neoplasms and autoimmune disorders. Results: In Table 1 we reported anthropometric and laboratory data baseline in patients with non-producing - AIs and SH patients. 33 patients with SH (13 M, 20 F; mean age 58.44+10,76 yrs) underwent unilateral laparoscopic adrenalectomy; 48 patients (23 M, 25 F; mean age 57.21+8 yrs) performed a conservative pharmacological treatment. Surgery group showed a minor prevalence of cardiovascular events than conservative group, especially acute myocardial infarction and related therapeutic procedures (percutaneous stenting and surgical bypass) (0.03 % and 0.03 % vs 11 % and 8.9 %, respectively). Conclusions: In SH patients higher levels of 24h-urinary free cortisol and higher levels of plasma cortisol after overnight 1-mg dexamethason suppression test are strictly linked to higher levels of total cholesterol, LDL cholesterol and uric acid, as well as worsen clinical outcomes. Our results confirm that hormonal activity and autonomous production of cortisol is related to higher prevalence of cardiovascular diseases, i.e. arterial hypertension, and CV complications, as myocardial infarction.