Long-term metabolic comorbidities in patients with adrenal incidentalomas - a single center experience

Sojat Antoan Stefan; Miomira Ivovic; Bogdan Dugic; Natalija Antic; Kristina Saravinovska; Svetlana Vujovic; Ljiljana Marina

doi:10.1530/endoabs.110.EP43

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Endocrine Abstracts (2025) 110 EP43 | DOI: 10.1530/endoabs.110.EP43

ECEESPE2025 ePoster Presentations Adrenal and Cardiovascular Endocrinology (170 abstracts)

Long-term metabolic comorbidities in patients with adrenal incidentalomas - a single center experience

Antoan Stefan Sojat ¹ , Miomira Ivovic ¹ , Bogdan Dugic ² , Natalija Antic ¹ , Kristina Saravinovska ¹ , Svetlana Vujovic ¹ & Ljiljana Marina ¹

Author affiliations

¹Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, National Centre for Infertility and Endocrinology of Gender, Belgrade, Serbia; ²The University of Belgrade, School of Electrical Engineering, Belgrade, Serbia

JOINT1229

Introduction: Current guidelines for managing adrenal incidentalomas (AI) do not recommend long-term follow-up for patients with non-functioning adrenal incidentalomas (NAI) unless in case of significant changes in comorbidities potentially attributed to mild autonomous cortisol secretion (MACS).

Aim: This study aimed to assess the long-term development of cardiometabolic risk factors in patients with AI and evaluate the need for follow-up.

Methods: In this single-center prospective cohort study, 88 patients with AI (70 females [79.5%], 18 males [20.5%]) underwent clinical, biochemical, and imaging evaluations at baseline and final follow-up (median 55 months, IQR 47–80). Based on the result of 1 mg dexamethasone suppression test at baseline, patients were stratified into NAI (1 mg dexamethasone suppression test [1 mg DST] cortisol ≤50 nmol/l) or MACS (1 mg DST cortisol >50 nmol/l).

Results: At the final follow-up, patients with MACS demonstrated a significant increase in body mass index (BMI) (27.1 vs. 27.8 kg/m², P = 0.03), a higher incidence of bilateral tumors (51.2% vs. 34%, P = 0.016), increase in antihypertensive medication count (P < 0.001), and a nonsignificant trend toward higher dyslipidemia rates (66% vs. 41%, P = 0.06). In contrast, NAI patients exhibited a significant increase only in antihypertensive medication count (P < 0.001). In the univariate linear regression model, significant predictors for antihypertensive medication count in NAI were baseline BMI (B = 0.08, 95% CI [0.005–0.166], P= 0.04), follow-up duration (B = 0.01, 95% CI [0.004–0.026], P = 0.01), and baseline antihypertensive medication count (B = 0.85, 95% CI [0.548–1.146], P < 0.001). In multivariate regression, follow-up duration (B = 0.01, 95% CI [0.001–0.018], P = 0.04), and baseline antihypertensive medication count (B = 0.73, 95% CI [0.406–1.056], P = 0.01) remained significant. Notably, 19.1% (9/47) of NAI patients progressed to MACS during follow-up.

Conclusions: Although NAI patients did not exhibit significant cardiometabolic risk progression over a median follow-up of 4.6 years, nearly 20% developed MACS. These findings suggest that patients with NAI should undergo at least one reassessment for MACS within a 4-year period to guide clinical management.