Abstract
Subclinical Cushing's syndrome (SCS) is a condition of slight but chronic cortisol excess in patients with adrenal incidentaloma (AI) without typical signs and symptoms of Cushing's syndrome. Adiponectin has potent roles in modulating energy balance and metabolic homeostasis and acts in opposition to glucocorticoids. This study aimed to evaluate adiponectin level in SCS and nonfunctional AI (NAI) patients and its relation with metabolic parameters. Patients with AI (n = 40) and metabolically healthy controls (n = 30) were included. In AI patients and controls, detailed medical history assessment, physical examinations, anthropometric measurements, and laboratory measurements were performed. Age, body mass index, waist circumference, and lipid profiles were significantly higher and waist-to-hip ratio and adiponectin level were significantly lower in the AI patients than in the controls. The midnight cortisol and urinary free cortisol levels were significantly higher in the SCS patients (n = 8) than in the NAI patients (n = 32). Adiponectin level of the SCS group was significantly lower than those of the NAI and control groups. The sensitivity and specificity for an adiponectin level of ≤13.00 ng/mL in predicting the presence of SCS were 87.5% and 77.4%, respectively. In conclusion, adiponectin is valuable in predicting the presence of SCS in AI patients.
Highlights
Adrenal incidentaloma (AI) is an adrenal mass that is typically discovered serendipitously during radiologic examinations performed for unrelated reasons [1]
body mass index (BMI), waist circumference, and levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), HDL-C, and triglyceride were significantly higher and waistto-hip ratio and adiponectin level were significantly lower in the AI patients than in the controls
The midnight cortisol and urinary free cortisol (UFC) levels were significantly higher in the subclinical Cushing’s syndrome (CS) (SCS) patients than in the nonfunctional AI (NAI) patients
Summary
Adrenal incidentaloma (AI) is an adrenal mass that is typically discovered serendipitously during radiologic examinations performed for unrelated reasons [1]. AI is observed in approximately 5% of all abdominal computed tomography (CT) scans and its prevalence in the general population has been estimated as 3%–7% [2]. Autonomous cortisol (a glucocorticoid hormone) secretion in patients with features similar to Cushing’s syndrome (CS) such as obesity, hypertension, glucose intolerance, and osteoporosis but without typical signs or symptoms of hypercortisolism is defined as subclinical CS (SCS) [4,5,6]. In patients with SCS, slight but chronic cortisol release has been associated with increased cardiovascular risks and metabolic syndrome [11, 12]. SCS diagnosis is established via abdominal CT scan in patients having an incidental adrenal mass, without the above-mentioned typical physical features of CS, and exhibiting endogenous hypercortisolism in hormonal tests.
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