Are comorbidities of patients with adrenal incidentaloma tied to sex? Results from a multicenter longitudinal study

Soraya Puglisi; Nekic Anja Barac; Valentina Morelli; Ylenia Alessi; Michele Fosci; Angelo Pani; Tomšić Karin Zibar; serena palmieri; Francesco Ferrau; Anna Pia; Giuseppe Reimondo; Iacopo Chiodini; Darko Kastelan; Massimo Terzolo

doi:10.1530/endoabs.99.EP195

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Endocrine Abstracts (2024) 99 EP195 | DOI: 10.1530/endoabs.99.EP195

ECE2024 Eposter Presentations Adrenal and Cardiovascular Endocrinology (155 abstracts)

Are comorbidities of patients with adrenal incidentaloma tied to sex? Results from a multicenter longitudinal study

Soraya Puglisi ¹ , Anja Barac Nekic ² , Valentina Morelli ³ , Ylenia Alessi ⁴ , Michele Fosci ⁵ , Angelo Pani ⁵ , Karin Zibar Tomšić ² , serena palmieri ⁶ , Francesco Ferraù ⁴ , Anna Pia ¹ , Giuseppe Reimondo ¹ , Iacopo Chiodini ⁷ , Darko Kastelan ² & Massimo Terzolo ¹

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¹Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy; ²Department of Endocrinology, University Hospital Zagreb, Zagreb, Croatia; ³Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, IRCCS, Istituto Auxologico Italiano, Milan, Italy; ⁴Endocrine Unit, Department of Human Pathology G. Barresi, University Hospital G. Martino, University of Messina; ⁵Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; ⁶Unit of Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy; ⁷Unit of Endocrinology, Department of Biotechnology and Translational Medicine, Ospedale Niguarda Cà Granda, University of Milan, Milan, Italy

Background: A recent cross-sectional study showed that both comorbidities and mortality in patients with adrenal incidentaloma (AI) are tied to sex. However, only few longitudinal studies evaluating the development of arterial hypertension, hyperglycemia, dyslipidemia and bone impairment in patients with AI are available. The aim of this study is to analyze the impact of sex in the development of these comorbidities during long-term follow-up.

Patients and Methods: We retrospectively evaluated 189 patients (120 females, 69 males) with AI, from four referral centers in Italy and Croatia. Clinical characteristics and hormonal data were collected at baseline and at last follow-up visit (LFUV). To compare each characteristic at baseline and at LFUV, we used the Wilcoxon test for continuous variables and the McNemar test for categorical variables. Differences between groups were analyzed with the Mann-Whitney test for continuous variables and the Chi-square test for categorical variables.

Results: Median follow-up was 52 (IQR 25-86) months. At LFUV, in both sexes arterial hypertension was more frequently reported than at baseline (females: 77.8% vs 65.8%, P=0.002; males: 69.1% vs 58.0%, P=0.035), as well as hyperglycemia (females: 39.6% vs 28.8%, P<0.001; males 54.0% vs 36.2%, P<0.001). Patients were stratified in two groups by cortisol after 1 mg-dexamethasone: 99 (62 females, 37 males) with non-functional adrenal tumors [NFAT] and 89 (57 females, 32 males) with tumors with mild autonomous cortisol secretion [MACS]. In the NFAT group, at baseline, we did not observe any difference in clinical characteristics and comorbidities between males and females. At LFUV, the NFAT group showed a higher frequency of hyperglycemia in males than in females (57.6% vs 33.9%, p=0.03). In the MACS group, at baseline, females were younger (60, IQR 55-69 vs 67.5, IQR 61-73, years; p=0.01) and presented higher rates of bone impairment (89.3% vs 54.5%, p=0.02) than males. At LFUV, in the MACS group, the median age remained lower (66, IQR 61-73 vs 73.5, IQR 65-78, years; p=0.02) and bone impairment more frequent (88.9% vs 58.8%, p=0.01) in females than males. Moreover, females presented a higher frequency of visceral adiposity (95% vs 60%, p=0.01)

Conclusions: Patients with AI frequently develop arterial hypertension and glycemic alterations and should be periodically checked for these comorbidities, regardless sex. Bone impairment was frequently reported in females with MACS, suggesting a sex-specific effect of cortisol on bones.