Adrenal adenomas, subclinical hypercortisolism, and cardiovascular outcomes

Dalmazi, Guido Di; Pasquali, Renato

doi:10.1097/med.0000000000000153

Cited by 29 publications

(22 citation statements)

References 27 publications

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“…Finally, some recent reports suggested that patients with NFA may also carry an increased CV risk compared with the general population, thus our study may underestimate the magnitude of cardiac damage associated with pACS. Among the hypotheses proposed, there is the possibility that NFAs produce excess cortisol in a cyclic manner, or during stress, or release excess steroid precursors, such as deoxycorticosterone and corticosterone (6,33,34).…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, the ERGO trial (Endocrine Cardiomyopathy in Cushing Syndrome: Response to Cyclic GMP PDE5 inhibitOrs) was designed. Retrospective analysis unexpectedly revealed that also asymptomatic patients with adrenal adenomas and low-grade autonomous cortisol secretion suffer from a higher rate of CV events and mortality than patients with normal HPA axis suppression (5,6,7). Despite these epidemiological associations, only two small studies investigated morphological and functional changes to the CV system in patients with mild hypercortisolism (8,9).…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

Sbardella

Minnetti

D’Aluisio

et al. 2018

European Journal of Endocrinology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

Sbardella

Minnetti

D’Aluisio

et al. 2018

European Journal of Endocrinology

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“…Previous studies suggest that patients with SCS are at higher risk for developing cardiovascular events (14,15,16) and experience an increased cardiovascular mortality (17,18). However, studies attempting to investigate the beneficial effect of adrenalectomy on cardiovascular risk factors in patients with SCS are characterized by small sample sizes and have generated inconsistent results.…”

mentioning

confidence: 87%

THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis

Bancos

Alahdab

Crowley

et al. 2016

European Journal of Endocrinology

147

110

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Objective: Beneficial effects of adrenalectomy on cardiovascular risk factors in patients with subclinical Cushing's syndrome (SCS) are uncertain. We sought to conduct a systematic review and meta-analysis with the following objectives: (i) determine the effect of adrenalectomy compared with conservative management on cardiovascular risk factors in patients with SCS and (ii) compare the effect of adrenalectomy on cardiovascular risk factors in patients with SCS vs those with a nonfunctioning (NF) adrenal tumor. Methods: MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial were searched on 17 November 2015. Reviewers extracted data and assessed methodological quality in duplicate. Results: We included 26 studies reporting on 584 patients with SCS and 457 patients with NF adrenal tumors. Studies used different definitions of SCS. Patients with SCS undergoing adrenalectomy demonstrated an overall improvement in cardiovascular risk factors (61% for hypertension, 52% for diabetes mellitus, 45% for obesity and 24% for dyslipidemia). When compared with conservative management, patients with SCS undergoing adrenalectomy experienced improvement in hypertension (RR 11, 95% CI: 4.3-27.8) and diabetes mellitus (RR 3.9, 95% CI: 1.5-9.9), but not dyslipidemia (RR 2.6, 95% CI: 0.97-7.2) or obesity (RR 3.4,. Patients with NF adrenal tumors experienced improvement in hypertension (21/54 patients); however, insufficient data exist for comparison to patients with SCS. Conclusions: Available low-to-moderate-quality evidence from heterogeneous studies suggests a beneficial effect of adrenalectomy on cardiovascular risk factors in patients with SCS overall and compared with conservative management.

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“…Interestingly, DHEA was also reduced in patients with NS, despite the fact that ACTH levels fell within the normal range. It is tempting to speculate that some degrees of cortisol alteration could have occurred in those patients (33,34), leading to DHEA levels between normal subjects and patients with SH. Unfortunately, consistent follow-up data on the evolution of the secreting pattern of those adenomas are not available in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Steroid Profiling by LC-MS/MS in Nonsecreting and Subclinical Cortisol-Secreting Adrenocortical Adenomas

Dalmazi¹,

Fanelli²,

Mezzullo³

et al. 2015

The Journal of Clinical Endocrinology & Metabolism

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Context: Long-term follow-up studies revealed that patients with subclinical hypercortisolism (SH) due to adrenocortical adenomas have an increased incidence of cardiovascular diseases and mortality. No studies have yet investigated the steroid profile and its implications in patients with SH.Objective: The objective of the study was to analyze the steroid profile by liquid chromatographytandem mass spectrometry in sera from patients with unilateral adrenocortical adenomas.Design: This was a cross-sectional study. Setting:The study was conducted at an outpatient clinic. Participants:Patients with adrenocortical adenomas (nonsecreting, n ϭ 66; SH, n ϭ 28) and 188 ageand sex-matched controls drawn from the general population participated in the study. Main Outcome Measures:Cortisol, 21-deoxycortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, T, progesterone, 11-deoxycorticosterone, and corticosterone in the basal condition and after a 1-24 ACTH test, and clinical data were measured. Results:Patients with SH showed lower basal and 1-24 ACTH-stimulated levels of dehydroepiandrosterone and androstenedione than those with nonsecreting adenomas and controls. T was also lower in SH females. Receiver-operating characteristic curves showed that androgens had good accuracy in predicting SH (sensitivity and specificity were 71% and 76% for dehydroepiandrosterone and 69% and 61% for androstenedione, respectively). Increased cortisol and reduced dehydroepiandrosterone levels were independently associated with increased waist circumference. Cortisol was also independently associated with increased number of cardiovascular risk factors in SH patients. After 1-24 ACTH stimulation, the SH patients also showed increased production of 21-deoxycortisol and 11-deoxycorticosterone. Conclusions:Liquid chromatography-tandem mass spectrometry steroid profile performed for the first time in sera from patients with adrenocortical adenomas showed impaired secretion of several steroids in SH patients. This fingerprint can help in better characterizing the functional status of these tumors. (J Clin Endocrinol Metab 100: 3529 -3538, 2015)

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Adrenal adenomas, subclinical hypercortisolism, and cardiovascular outcomes

Abstract: An impaired cardiovascular profile is a common finding in patients with apparently nonfunctional adrenal masses. However, the incidence of cardiovascular outcomes and related mortality seems to be increased only in patients with mild cortisol hypersecretion.

Cited by 29 publications

References 27 publications

Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas

THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis

Steroid Profiling by LC-MS/MS in Nonsecreting and Subclinical Cortisol-Secreting Adrenocortical Adenomas

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