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Endocrine Abstracts (2022) 81 RC13.6 | DOI: 10.1530/endoabs.81.RC13.6

ECE2022 Rapid Communications Rapid Communications 13: Adrenal and Cardiovascular Endocrinology 2 (8 abstracts)

Mild autonomous cortisol secretion in patients with adrenal incidentalomas and raised cardiovascular risk

Rebecca Sagar 1 , Sheila Fraser 2 , Emma Collins 2 , Russell Frood 2 , Andrew Scarsbrook 2 , Paul M Stewart 1,3 & Afroze Abbas 1


1Leeds Teaching Hospitals Trust, Leeds Centre for Endocrinology and Diabetes, Leeds, United Kingdom; 2Leeds Teaching Hospitals Trust, Leeds, United Kingdom; 3University of Leeds, School of Medicine, Leeds, United Kingdom


Background: Adrenal incidentalomas are common and require investigation to exclude malignancy and evidence of hormone overproduction. Clinical guidelines recommend overnight dexamethasone suppression tests (ONDST) to assess for cortisol hypersecretion with cortisol levels of 50-138 nmol/l termed “mild autonomous cortisol secretion” (MACS). MACS may be associated with both cardiovascular and metabolic morbidity. We assessed cardiovascular risk in patients with MACS using QRISK3. This is a validated algorithm used in the UK to predict cardiovascular risk, calculating a predicted percentage risk of myocardial infarction (MI) or stroke over the next 10 years.

Methods: Data were collected retrospectively on patients over a two-year period, who had an adrenal incidentaloma with a cortisol between 50-138 nmol/l following ONDST. Presence of cardiovascular co-morbidities including hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation and ischaemic heart disease (IHD) was recorded. Relative Risk (RR) of cardiovascular disease (MI or stroke) was calculated using the QRISK3. Statistical analysis was conducted using PRISM v9.3.1.

Results: 228 patients (50% male), mean age 69 years± 11.4 (SD), mean BMI 30.5 kg/m2± 15.1 were identified with MACS. 79.8% of patients had a diagnosis of hypertension with 62% on more than one anti-hypertensive medication. 73% of patients were on statin therapy. 34.5% of patients had a diagnosis of T2DM. 27.1% of patients had ischaemic heart disease and 8% had congestive cardiac failure. Mean QRISK3 score was 26.7 ± 13%, compared with 16.6 ± 10% in age/sex matched healthy controls as per the QRISK3 algorithm. Relative risk for MI or stroke was 2.2 compared to the healthy age/sex matched controls. 88% of the cohort had a relative risk >1. There was no clear correlation between radiological characteristics and QRISK.

Conclusions: Amongst our unselected cohort of patients with adrenal incidentalomas and biochemistry consistent with MACS, there was high prevalence of hypertension, T2DM and IHD compared with the background population. Additionally cardiovascular QRISK-3 demonstrated this patient cohort had >2 times the likelihood of having an MI or stroke within the next 10 years compared with healthy age and sex matched people. Although the data suggests an association, it is possible other confounders such as BMI may influence both ONDST results and CV risk. CV risk assessment should be considered in all patients with an adrenal incidentaloma and MACS.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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