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Endocrine Abstracts (2016) 41 GP23 | DOI: 10.1530/endoabs.41.GP23

ECE2016 Guided Posters Adrenal (2) (10 abstracts)

Deterioration of indices of insulin resistance in patients with non-functioning and cortisol secreting adrenal incidentalomas during a long term follow-up

Labrini Papanastasiou 1, , Krystallenia Alexandraki 2, , Stelios Fountoulakis 1, , Theodora Kounadi 1, , Athina Markou 1, , Vaios Tsiavos 1, , Ioannis Androulakis 1, , Christianna Samara 1, , George Piaditis 1, & Gregory Kaltsas 2,

1Department of Endocrinology and Diabetes Center, ‘G Gennimatas’ General Hospital, Athens, Greece; 2Department of Pathophysiology, Laikon Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece; 3Department of Radiology, ‘G Gennimatas’ General Hospital, Athens, Greece.

Introduction: Adrenal incidentalomas (AI) with or without concomitant autonomous cortisol secretion can be associated with several metabolic alterations that may lead to increased cardiovascular risk. However, data regarding insulin resistance (IR) during long term follow-up of AI are scarce. The aim was to prospectively investigate the presence and evolution of IR in patients with AI between 2003 and 2014.

Methods: Seventy three patients with AI for at least a 3-year follow-up underwent a diagnostic protocol, which included clinical examination, anthropometric assessment, basal and dynamic adrenal testing for autonomous cortisol secretion (low dose dexamethasone suppression test). IR was define at HOMA >2.16 and QUICKI<0.34. Pheochromocytomas, aldosterone secreting adenomas and adrenocortical carcinomas were excluded.

Results: During the follow-up (5.60±1.74 years) AI max diameter was increased (P<0.001) but this increase measured <0.5 cm; BMI (P=0.02) and waist circumference (P=0.001) increased, while more patients developed hypertension (11%), dyslipidemia (22%) and diabetes mellitus (T2DM). At baseline 2 (2.7%) patients were found to have T2DM that increased to 9 (12.3%) at the last follow-up (P<0.001). Hence, T2DM developed in 9.4% of patients with non-functioning AI (NFAI) and 20% with subtle autonomous cortisol secretion (CSAI). Moreover, 49.3% of patients had IR that increased to 68.5% at the last follow-up (P<0.001). At baseline, 41.5% of NFAI and 70% of CSAI patients exhibited IR compared to 58.5% of NFAI and 95% of CSAI at the last follow-up (P<0.001 and 0.3 respectively). At baseline, 20 AI patients had CSAI that increased to 31 at last follow-up (P<0.001). There was a positive correlation between post-dexamethasone cortisol levels (F-post-LDDST) and indices of IR in the whole group of patients both at baseline and at the last follow-up

Conclusions: Apparently non-functioning and/or autonomous cortisol secreting AI exhibit deterioration of carbohydrates metabolism and IR over a >3years follow-up that correlates with the F-post-LDDST levels.

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