Carotid intima media thickness is increased and associated with morning cortisol in subjects with non-functioning adrenal incidentaloma
Serkan Yener1, Sinan Genc2, Baris Akinci1, Mustafa Seci2, Tevfik Demir1, Abdurrahman Comlekci1, Senem Ertilav1 & Sena Yesil1
Data regarding cardiovascular risk in subjects with non-functioning adrenal adenoma is limited. The aim of this study is to investigate carotid intima media thickness (IMT) as a robust indicator of atherosclerosis in subjects with AI.
Of 49 subjects without findings of hypercortisolism or other adrenal gland disorders, 34 BMI-unmatched controls (C) and 18 BMI-matched controls (BC) were enrolled. Participants underwent hormonal evaluation including morning cortisol, adrenocorticotrophic hormone (ACTH), post dexamethasone suppression test (DST), dehydroepiandrosterone sulfate (DHEAS) and urinary free cortisol. Anthropometric and metabolic parameters and carotid IMT were measured.
AI group had increased BMI, blood pressure, waist circumference, post DST cortisol, uric acid and HOMA levels when compared with C. Blood pressure, uric acid and post DST cortisol remained significantly elevated in AI vs BC. Average IMT was increased significantly in AI vs C (0.74 vs 0.68 mm, P=0.029) and insignificantly elevated in AI vs BC (0.74 vs 0.67 mm, P=0.086). IMT was correlated with age, BMI, HOMA, waist ciricumference, morning cortisol and uric acid. Morning cortisol was independently associated with HOMA levels in both AI group and all participants.
Increased IMT in non-functioning AI was a consequence of insulin resistant state associated with subtle cortisol autonomy rather than a direct effect of cortisol. The difference of IMT values between AI and BMI-matched controls and the linear association between morning cortisol and IMT favor but not exactly illuminate the direct effects of hypothalamus-pituitary-adrenal axis disturbances on vasculature.