Endocrine Abstracts

JOINT3709

Background: Emerging evidence suggests that mild autonomous cortisol secretion (MACS) might be directly associated with increased cardiac mass and diastolic dysfunction compared to non-functioning adrenal incidentalomas (NFAI). Nevertheless, the reversibility of these alterations following appropriate treatment has never been investigated. This study evaluated cardiac morphology in patients with adrenal incidentalomas over a 5-year follow-up period, comparing the effects of active surveillance to adrenalectomy in patients with MACS.

Methods: This prospective longitudinal case–control study included 60 patients with adrenal incidentalomas. After stratification based on cortisol levels post-dexamethasone suppression test, 34 patients with MACS and 26 with NFAI were evaluated for clinical, biochemical, and echocardiographic parameters at baseline and after 1 and/or 5 years of follow-up. Patients with MACS were managed either with active surveillance (AS, n=23) or unilateral adrenalectomy (ADRX, n=11), according to current recommendations.

Results: At baseline, patients with MACS showed higher left ventricular mass index (LVMi, P=0.021), interventricular septal (IVS) (P=0.007), and posterior wall (PW) thickness (P=0.004) compared to NFAI, along with higher prevalence of diastolic dysfunction and left ventricular hypertrophy (P=0.050 and P=0.013). Patients undergoing ADRX presented with larger adrenal mass diameters, higher prevalence of arterial hypertension, and lower ACTH levels (P<0.001 for all). After 1 year, the ADRX group showed a significant reduction in LVMi (P=0.031), IVS (P=0.042), and PW thickness (P=0.037), followed by a progressive increase to baseline values at the 5-year timepoint. The AS group showed overall long-term stability in cardiac parameters, while the NFAI group showed a significant, progressive increase of cardiac indexes through the 5-year follow-up. Accordingly, the ADRX showed a significantly higher decrease in LVMi and PW thickness compared to the other two groups at the 1-year follow-up, even adjusting for sex and age (P<0.001, P=0.003). No significant inter-group differences were detected at the 5-year follow-up. In patients with MACS, linear regression analysis showed that unilateral adrenalectomy was the element most strongly associated with the 1-year improvement in LVMi (R²=0.423, P=0.017) and PW thickness (R²=0.422, P=0.023). The overall progression of the main cardiometabolic comorbidities remained comparable among the three groups.

Conclusions: Patients with MACS exhibit early cardiac remodelling compared to NFAI, independent of conventional risk factors. Unilateral adrenalectomy induced short-term improvement in cardiac parameters, which was not maintained on the long-term. Active surveillance in MACS resulted in long-term cardiac stability, likely reflecting the more intensive cardiovascular monitoring compared to NFAI, and underscoring the importance of cardiovascular monitoring to pursue individualized treatment strategies.