SFEBES2025 Oral Communications Adrenal and Cardiovascular (6 abstracts)
Incident changes of the 1 mg-overnight dexamethasone suppression test correlate with long-term clinical outcomes in patients with adrenal incidentalomas: results from the multi-centre DEX-AI and CORTEX-AI ENSAT studies
Onnicha Suntornlohanakul 1,2,3 , Giuseppe Reimondo 4 , Marco Ghislieri 5 , Luigi Petramala 6 , Kimberly Coscia 7,8 , Ivana Kraljevic 9,10 , Anna Perini 4 , Filippo Ceccato 11,12 , Serena Palmieri 13 , Lakshmi Regarajan 1 , Malgorzata Bobrowicz 14 , Barbara Altieri 15 , Leili Rahimi 16 , Joanna Matrozova 17 , Maria Elena Aloini 18 , Diego Rivas-Otero 19,20 , Magnus Löndahl 21,22 , Ljiljana Marina 23 , Krystallenia I. Alexandraki 24 , Henrik Falhammar 25,26 , Nuria Valdés Gallego 27 , Valentina Morelli 28 , Anna Angelousi 29 , Grethe Æ. Ueland 30 , Andrea M. Isidori 31 , Duarte Pignatelli 32 , Vittoria Favero 33,34 , Verena Theiler-Schwetz 35 , Francesco Circosta 36 , Lorenzo Tucci 7 , Mirjana Đukić 37 , Soraya Puglisi 4 , Giulia Bovo 11,12 , Alessandra Mangone 13,38 , Cristina L. Ronchi 1,2 , Adrianna Gladka 14 , Mario Detomas 15 , Vladimir Vasilev 17 , Adriana Debora Servello 36 , Francesca Donnarumma 7 , Cristina Botto 4 , Yasir S. Elhassan 1,2 , Miomira Ivović 23 , Olga Lindgren 21,22 , Edelmiro Menéndez Torre 19,20 , Antonio Stigliano 18 , Irina Bacos 16 , Urszula Ambroziak 14 , Giovanna Mantovani 13,38 , Carla Scaroni 11,12 , Darko Kastelan 9,10 , Guido Di Dalmazi 7,8 , Claudio Letizia 36 , Timo Deutschbein 15,39 , Martin Fassnacht 15,40 , Massimo Terzolo 4 , Valentina Agostini 5 & Alessandro Prete 1,2,41
1Department of Metabolism and Systems Science, School of Medical Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom; 3Endocrinology and Metabolism Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand; 4Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy; 5Department of Electronics and Telecommunications, PolitoBIOMed Lab, Politecnico di Torino, Turin, Italy; 6Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy; 7Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, 40138, Bologna, Italy; 8Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy; 9Department of Endocrinology, University Hospital Zagreb, Zagreb, Croatia; 10School of Medicine, University of Zagreb, Zagreb, Croatia; 11Department of Medicine DIMED, University of Padova, Padova, Italy; 12Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy; 13Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 14Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland; 15Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; 16Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA; 17University Hospital of Endocrinology, Medical University, Sofia, Sofia, Bulgaria; 18Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital - Sapienza University of Rome, Rome, Italy; 19S. de Endocrinología. Hospital Universitario Central de Asturias, Oviedo, Spain; 20Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; 21Department of Endocrinology, Skåne University Hospital, Lund, Sweden; 22Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; 23Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 24Second Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece; 25Department of Endocrinology, Karolinska University Hospital, 17176, Stockholm, Sweden; 26Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden; 27Section of Endocrinology and Nutrition, Hospital Universitario de Cabueñes, Gijón, Spain; 28Department of Endocrine and Metabolic Disease, Istituto Auxologico Italiano, IRCCS, Milan, Italy; 29First Department of Internal Medicine, Unit of Endocrinology, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; 30Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway; 31Department of Experimental Medicine, Sapienza University of Rome, 00161, Rome, Italy; 32Department of Endocrinology - Centro Hospitalar Universitário S. João, Porto, Portugal; 33Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy; 34Unit of Endocrinology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 35Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; 36Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy; 37Department of Endocrinology and Diabetes, General Hospital ’Dr. Ivo Pedisic’ Sisak, Sisak, Croatia; 38Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 39Medicover Oldenburg MVZ, Oldenburg, Germany; 40Central Laboratory, University Hospital Würzburg, Würzburg, Germany; 41NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Introduction: Patients with adrenal incidentalomas (AI) should undergo a 1 mg-overnight dexamethasone suppression test (1 mg-DST) to exclude cortisol excess (non-functioning adrenal tumours, NFAT; serum cortisol ≤50 nmol/l) or diagnose mild autonomous cortisol secretion (MACS; serum cortisol >50 nmol/l). Guidelines recommend repeating 1 mg-DST only if treatment is intended; however, data underpinning this recommendation are scarce.
Methods: Retrospective multi-centre study including patients with benign AI with at least two 1 mg-DST and follow-up ≥3 years. Incident 1 mg-DST changes were correlated with clinical and radiological characteristics. Cox proportional hazard regression was used to calculate effect estimates of clinical outcomes.
Results: 2525 patients from 25 centres were included, with a median follow-up of 6.7 years (range 3-22.9). 1 mg-DST incident changes were observed in 22.5% of patients: 9.0% NFAT developed MACS (NFAT→MACS); 7.7% MACS developed normal 1 mg-DST (MACS→NFAT); 7.7% had 1 mg-DST results fluctuating around the 50 nmol/l cutoff. Most 1 mg-DST changes (~60-70%) occurred within 3 years of the baseline 1 mg-DST. NFAT→MACS patients had larger tumours, more frequently bilateral, were more likely to be smokers and had a higher prevalence of hypertension, type 2 diabetes, osteoporosis, and cardiovascular events than those with persistently normal 1 mg-DST (NFAT→NFAT). MACS→NFAT patients were younger with smaller and more frequently unilateral tumours than those with persistently abnormal 1 mg-DST (MACS→MACS). At the last available clinical follow-up, there was a progressive increased risk of hypertension, type 2 diabetes, dyslipidaemia, and cardiovascular events across the spectrum of NFAT→NFAT, NFAT→MACS, MACS→NFAT, and MACS→MACS. Only MACS→MACS patients had significantly increased age- and sex-adjusted risk of composite cardiovascular events (hazard ratio 1.50 [95%CI 1.04-2.15] vs. NFAT→NFAT, P=0.03).
Conclusions: Incident 1 mg-DST changes are frequent in patients with benign AI and correlate with tumour characteristics and clinical outcomes. Repeating 1 mg-DST within 3 years may be advocated to risk-stratify patients during long-term follow-up.
Volume 109
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Endocrine Abstracts
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