Endocrine Abstracts

JOINT2073

Introduction: About 20–50% of adrenal tumors in patients without symptoms of overt Cushing’s syndrome are associated with mild autonomous cortisol secretion (MACS) based on 1 mg dexamethasone suppression test (DST) (cortisol concentration >1,8 mg/dl). Some clinical data shows that patients with MACS are at a higher risk of developing obesity, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, cardiovascular diseases, prediabetes, type 2 diabetes, osteopenia, osteoporosis, and vertebral fractures as compared to patients with non-functioning adrenal tumor (NFAT). The prevalence of hypertension in MACS varies between 35% and 92% across different studies, compared to 43% to 73% in patients with NFAT or controls. Many studies reveal that patients with a higher degree of cortisol excess have a lower quality of life and survival rate.

Objectives: The aim of the study was to assess whether the cut-off point of 1.8 μg/dl in the 1 mg dexamethasone suppression test differentiates the cardiometabolic risk attributed to MACS in adrenal incidentalomas.

Methods: The results of cortisol suppression test of 347 incidentaloma patients (141 operated patients with confirmed of adenoma and 206 non-operated with homogenous adrenal mass <10 HU) were analyzed. 100 men and 247 women with median age 63.5 and 64 respectively were included to the analysis. Primary hyperaldosteronism, pheochromocytoma and Cushing’s syndrome were excluded. Patients with negative (serum cortisol concentration ≤1,8 mg/dl) and positive dexamethasone suppression test (serum cortisol concentration >1,8 mg/dl) were analyzed in relation to the presence of diabetes, obesity, hypertension, ischemic heart disease and chronic heart failure.

Results: In patients with a negative (serum cortisol concentration ≤1,8 mg/dl) and positive dexamethasone suppression test (serum cortisol concentration >1,8 mg/dl) the percentage of the diseases were as follow: hypertension: 72.22% vs. 77.88% (P=0.02); ischemic heart disease: 11.54% vs. 18.58% (P=0.15); chronic heart failure: 4.27% vs. 7.08% (P=0.16); diabetes: 23.93% vs. 32.74% (P=0.06) and obesity: 32.49% vs. 31.69% (P=0.88). No differences between male and female regarding the frequency of accompanying diseases were noted.

Conclusion: In patients with MACS, a cortisol cutoff of 1.8 μg/dl in the 1 mg dexamethasone suppression test may help differentiate those at higher risk for hypertension and diabetes, and appears to be an independent and significant factor in the development of these conditions.