Introduction: The European Society of Endocrinology Clinical Practice Guideline defines follow-up recommendations for AI based on the 1 mg overnight dexamethasone suppression test and the presence of associated comorbidities. Follow-up is not recommended for AI presenting serum cortisol levels post dexamethasone ≤1.8 μg/dl neither those presenting serum cortisol levels post dexamethasone between 1.95 μg/dl (defined as possible autonomous cortisol secretion PACS-) in absence of comorbidities (such as arterial hypertension, diabetes, dyslipidemia, osteoporosis or obesity). On those patients presenting PACS and comorbidities the functional status should be reassessed after 612 months.
Objective: To evaluate hypercortisolism related comorbidities in a case series on AI patients attended in a specialized unit on diseases of the adrenal glands.
Patients and methods: We analyzed data from 237 AI diagnosed from February 2014 to June 2017. After excluding patients with hormonally active AI, malignancy or lesions not requiring follow-up (such as myelolipoma, adrenal hyperplasia or lesions <1 cm), 174 patients were catalogued as non-functioning AI. We compared the presence of comorbidities between patients presenting serum cortisol levels post dexamethasone ≤1.8 μg/dl (non-pathological NP-) and those with PACS.
Results: From 237 patients, 78.1% were referred from: Urology Department 42, Gastroenterology Department 55, Internal Medicine Department 28 and Pneumology Department 11. 58.6% (102) were women and 41.1% (72) men. Mean age: 62.6±11.4 years (2686). 80.5% (140) unilateral masses, most frequently on left adrenal gland (92/42). Masses on left side were bigger (2.43±1.15 cm, 18.2 cm) than those on right side (2.11±0.96 cm, 0.65.5 cm). From 174 non-functioning AI, 58.6% (113) presented NP and 34.5% (61) PPAC. Comorbidities: 58% (101) hypertension, 32.2% (56) diabetes, 33.9% (59) dyslipidemia and 31% (54) obesity. Mean BMI: 30.1±7.4 kg/m2. Not statistically significant differences were found in prevalence of comorbidities between NP and PACS: arterial hypertension (52% vs 66%, P=0.053), diabetes (27.5% vs 38.9%, P=0.133), dyslipidemia (33.3% vs 34.7%, P=0,849), obesity (33.3% vs 27.8%, P=0.288).
Conclusions: A closer follow-up is recommended, in patients with AI, depending on presence of comorbidities, assuming those patients with comorbidities to have a higher risk of develop a marked hypercortisolism in the future. However, we have observed that comorbidities are present independently of serum cortisol levels post dexamethasone. Therefore, presence of comorbidities not seems not be attributable to the presence of subclinical hypercortisolism.
19 May 2018 - 22 May 2018