Background: Possible Autonomous Cortisol Secretion (pACS) is a condition found in 129% of patients with adrenal incidentalomas. The diagnosis of pACS has been variably associated with an increased risk of cardiovascular events and mortality. However, dedicated studies describing the morphologic and functional cardiac alterations in these patients are lacking.
Aim: To compare the cardiovascular features of patients with pACS to those with nonfunctioning (NF) adrenal masses.
Materials and methods: Fifty-eight patients with adrenal incidentaloma without the classic signs or symptoms of overt hypercortisolism were prospectively enrolled. Anthropometric, metabolic and hormonal parameters, adrenal magnetic resonance, echocardiography B-mode ultrasound and arterial stiffness calculated with oscillatory method were assessed in all patients. We diagnosed patient with pACS after 1-mg overnight dexamethasone suppression test (1 mg-DST), confirmed by traditional 48-h Liddle tests, if post-test serum cortisol felt between 51 and 138 nmol/l.
Results: Overall 30 patients had pACS and 28 NF adrenal masses. No differences in gender, smoke habits, hypertension, obesity and diabetes prevalence were observed between pACS and NF patients. Mean left ventricular (LV) mass index was increased in the pACS compared to the NF group (112.6±29.2 vs 94.8±31 g/m2 P=0.032). We also detected a significantly higher prevalence of LV hypertrophy in PACS than NF group (35.7% vs 14.3% P=0.007). Furthermore, there was a negative correlation between the post-dexamethasone cortisol levels and ejection fraction (r=−0.26; P=0.041). The assessment of arterial stiffness showed a higher pulse wave velocity in pACS compared with the NF group (11.3±1.4 vs 10.2±0.6 m/s; P=0.048).
Conclusions: Autonomous Cortisol Secretion (pACS) can lead to early cardiac and vascular dysfunction even in apparently asymptomatic patients. These results underline the need for further studies, including second line cardiovascular assessment, to correctly define the management of pACS and allow early recognition of possible complications.
20 - 23 May 2017
European Society of Endocrinology