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Endocrine Abstracts (2015) 37 GP02.04 | DOI: 10.1530/endoabs.37.GP.02.04

ECE2015 Guided Posters Adrenal (1) (8 abstracts)

Mortality in patients with incidentally discovered adrenal adenomas: the experience of San Luigi Hospital

Giuseppe Reimondo 1 , Marcella Coletta 1 , Giulia Peraga 1 , Anna Pia 1 , Micaela Pellegrino 2 , Chiara Massaglia 1 , Barbara Zaggia 1 , Paolo Cosio 1 , Elena Mbachu 1 , Giorgio Borretta 2 & Massimo Terzolo 1


1Internal Medicine I, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy; 2Endocrinology, Santa Croce e Carle Hospital, Cuneo, Italy.


Background: Adrenal incidentalomas are found in 3–7% of radiological series and many of them are adrenal adenomas. Autonomous cortisol secretion without clinical signs of overt hypercortisolism is a common finding in these patients. Studies reported metabolic derangement and increased cardiovascular risk associated with this state of subtle cortisol excess, however scanty data are available on the natural history of this condition.

Aim: To assess the rate of mortality in patients with incidentally discovered adenomas.

Methods: We studied 110 patients (39 males and 71 females) with incidentally discovered adrenal adenomas from 1998 to 2013. Metabolic and hormonal parameters were determined. We collected the following data: blood pressure, plasma glucose, lipid profile, cortisol levels after 1 mg dexamethasone suppression test (1 mg-DST), plasma ACTH, and urinary free cortisol. Mortality data were obtained from the demographic registers.

Results: Mean age of patients was 67 years, with a mean follow-up of 94 months. Fourteen (12.7%) patients died: 4 (28.6%) for cancer, 7 (50.0%) for cardiovascular, and 3 (21.4%) for respiratory/infective causes. Twelve of them (85.6%) had 1 mg-DST >1.8 μg/dl (four had hypertension, four dyslipidaemia, and four diabetes) while 54/96 patients alive at the last follow-up (56.2%) had 1 mg-DST >1.8 μg/dl (P=0.04). Survival probability was significantly reduced in patients with 1 mg-DST >1.8 μg/dl, with a hazard ratio of death of 3.64 (95% CI, 1.34–9.7; P=0.013). Age did not differ between patients alive or dead at the last follow-up (65.1±9.8 years vs 65.1±9.8 years, NS).

Conclusion: Patients with incidental adrenal adenomas and autonomous cortisol secretion heralded by cortisol after 1 mg-DST >1.8 μg/dl may be at increased risk of mortality compared to patients with non-secreting adenomas. Excess mortality is mainly related to cardiovascular events.

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