The measurement of epicardial fat thickness is an index of cardiometabolic risk in patients with adrenal incidentaloma
Laura Iorio1, Roberta Zelaschi1, Calin Coman2, Alexis Elias Malavazos1, Giada Dogliotti3, Massimiliano Marco Corsi3 & Bruno Ambrosi1
An augmented cardiovascular risk is present in adrenal incidentalomas (AI), as in overt hypercortisolism. Recent studies recommended epicardial fat (EF) thickness as a new marker of visceral adiposity and an indicator of cardiometabolic risk.
In this study, we evaluated the possible relationship between EF thickness, indices of left ventricular (LV) hypertrophy and adipocytokines levels in AI.
We studied 26 patients with AI (62.3±10.3 years, BMI 27.2±3.3 kg/m2, mean±S.D.) and 21 controls matched for age and BMI (59.9±6.7 years, BMI 25.3±3.6 kg/m2). In all patients basal ACTH, cortisol, urinary free cortisol, IL-6 and resistin levels were measured. One mg dexamethasone test was performed. EF thickness and indices of LV hypertrophy were assessed by transthoracic echocardiography.
Four patients had a subclinical Cushings syndrome (SCS) and 22 had non functioning masses. Overall, the prevalence of arterial hypertension was 69.2%, type 2 diabetes was 19.2%, dyslipidemia 26.9%, overweight 50% and obesity 19.2%.
Patients with AI had greater EF thickness and LVMI values than controls (8.1±2.1 vs 1.3±0.2 mm, P<0.0001; 111.0±25.8 vs 96.9±3.6 g/m2.7 P<0.01, respectively). In AI patients, LV hypertrophy (defined as LV mass indexed for height2.7 (LVMI) >51 g/m2.7 or relative wall thickness >0.45) was present in 84.6%. Interestingly, EF thickness correlated with LVMI (r=0.40, P<0.05) and with BMI (r=0.44, P<0.05).
Plasma IL-6 and resistin levels were higher in AI than in controls (14.9±22.9 vs 4.1±6.9 pg/ml, 11.6±6.1 vs 7.2±2.5 ng/ml, respectively, P<0.05).
Basal cortisol positively correlated (P<0.05) with indices of LV hypertrophy (LVMI, IVST, PWT), but not with EF thickness and adipocytokines levels.
Conclusions: a) The increase of EF thickness and adipocytokines levels, together with the high prevalence of LV hypertrophy indicate an high cardiometabolic risk in AI; b) a possible role of cortisol on cardiac alterations is suggested; c) the measurement of EF should be helpful during follow-up.