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Endocrine Abstracts (2022) 81 S7.2 | DOI: 10.1530/endoabs.81.S7.2

ECE2022 Symposia Are adrenal steroids the guilty? (3 abstracts)

Cardiometabolic outcomes and mortality in patients with autonomous cortisol secretion

Henrik Olsen 1,2


1Department of Medicine, Ängeholm Hospital, Ängelholm, Sweden; 2Department of Clinical Scien ces, Lund University, Lund, Sweden


Mild autonomous cortisol secretion (MACS) has been associated with cardiometabolic risk factors and cardiovascular disease in the 2000s and with increased mortality in the 2010s. Since the range of cortisol after dexamethasone suppression (cortisolDST) in MACS is wide, the associated risk may vary. To adequately decide treatment, the risk associated to the different levels of cortisolDST must be known. This year the ENSAT group published a study on cardiometabolic complications in MACS. Patients with cortisolDST 138 nmol/l or more had an increased adjusted prevalence ratio of hypertension 1.15 and more often had treatment with three or more antihypertensives. The adjusted prevalence ratios of dyslipidaemia and diabetes were similar, but insulin treatment was more common. Patients with cortisolDST 50 to 137 nmol/l had no increase in the prevalence of hypertension, diabetes, and dyslipidaemia. Last year our group published a study on 1048 patients with a median follow-up of 6.4 years. Patients with cortisolDST 83 to 137 nmol/l had a hazard ratio of 2.30 for mortality and patients with cortisolDST 138 nmol/l or more 3.04. Patients with cortisolDST 50 to 82 nmol/l had no significant increase in mortality. The increase in mortality was found to be linear up to cortisolDST levels of 200 nmol/l. The cardiovascular event rate was increased in patients with cortisolDST 138 nmol/l or more but unchanged at cortisolDST levels 50 to 137 nmol/l. The risk ratios for mortality seem larger than the relative prevalence of cardiometabolic complications. Therefore, improved medical treatment may not normalise the mortality risk in MACS. We suggest treatment of cardiovascular risk factors and incorporation of our results into the decision of which patients to recommend for adrenalectomy.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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