Risk of cardiovascular events in adrenal incidentalomas: an Italian long-term follow-up study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-6
Alfredo Scillitani*1, Giuseppe Reimondo2, Valentina Morelli3, Roberta Giordano4, Silvia Della Casa5, Caterina Policola6, Antonio Salcuni1, Serena Palmieri3, Alessia Dolci7, Maura Arosio8, Bruno Ambrosi9, Ezio G G M Ghigo10, Paolo Beck-Peccoz11, Iacopo Chiodini3 and Massimo Terzolo*12
1Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy, 2Dpto di Scienze Cliniche e Biolo, Orbassano (TO), Italy, 3University of Milan, Fondazione IRCCS Cą Granda-Ospedale Maggiore Policlinico, Milan, Italy, 4Univ of Turin, Turin, Italy, 5Catholic Univ, Rome, Italy, 6Endocrinologia e Malattie del Metabolismo, Universitą Cattolica del Sacro Cuore, Rome, Italy, 7Endocrinology Unit,, Milan, Italy, 8Univ of Milan, Milano, Italy, 9University of Milan, Milano, Italy, 10University of Turin, Turin, Italy, 11IRCCS Cą Granda H Maggiore Policlinico, Milan, Italy, 12University of Turin, Orbassano, Italy
Introduction. The need of a long-term follow-up in adrenal incidentalomas (AI) is debated and data on cardiovascular events (CVE) are lacking.

Methods. In this retrospective study all patients referred to 7 Italian Endocrine Centers for AI, without signs of hypercortisolism at baseline and with a ≥5 years follow-up (81.9±31.5 months, range 60-286), were enrolled. From 196 patients (138 F) aged 59.2±10.2 yrs (range 25-79) the changes in weight, glucose and lipid metabolism, blood pressure control and the occurrence of CVE were obtained. Patients were classified as affected with subclinical hypercortisolism (SH) in the presence of cortisol after 1–mg dexamethasone suppression (1-mgDST) test >5 mcg/dl or ≥2 parameters out of low ACTH, increased urinary free cortisol and 1-mgDST >3 mcg/dl.

Results.  At baseline SH was found in the 10.7% of patients. The prevalence of obesity, diabetes mellitus, dyslipidemia and arterial hypertension (29%, 20%, 43% and 56%, respectively) was not different between patients with (SH+) and without SH (SH-). At baseline SH+ patients showed a higher CVE prevalence than SH- ones (24% vs 7%), regardless of age (OR 3.8, 95%CI 1.1-12.4, P<0.05). At the end of follow-up a new diagnosis of SH was made in the 7.1% of patients. The adenoma size (baseline 2.3±0.8 cm) increased >2.5 cm in the 2.0% of cases. The glucose and lipid metabolism, blood pressure and weight control worsened in the 24.5%, 16%, 33% and 15% of patients, respectively. The SH persistence/appearance was significantly associated with the worsening of ≥2 out of the metabolic parameters (P=0.005) and with the occurrence of new CVE (P=0.035).

Conclusion. In AI patients a long-term follow-up is recommended for the diameter increase and SH development risk. SH patients are at risk of worsening of the  metabolic control and, importantly, of CVE.

Disclosure: MT: Ad Hoc Consultant, HRA Pharma. Nothing to Disclose: AS, GR, VM, RG, SD, CP, AS, SP, AD, MA, BA, EGGMG, PB, IC

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm