Evaluation of Midnight Salivary Cortisol as a Predictor Factor for Common Carotid Arteries Intima Media Thickness in Patients with Clinically Inapparent Adrenal Adenomas

Abstract

Purpose. The aim of the present study was to investigate the atherosclerotic vascular damage in a consecutive series of patients with AI and to correlate it with MSC. Methods. We studied 32 patients with AI matched with control subjects for age, sex, and cardiovascular risk factors. Either patients or control subjects underwent MSC measurement as outpatients and carotid arteries ultrasound (US) imaging studies. Results. The patients with AI had higher mean carotid artery IMT values and higher MSC levels than control subjects. In a multivariate analysis performed in AI age was the best predictor for IMT. We have stratified patients and control subjects by age (<60 yrs and ≥60 yrs). The patients showed significantly higher MSC levels than controls in both groups, whereas significantly higher IMT values were observed only in older subjects. Conclusions. Patients with AI have signs of accelerated atherosclerosis. Patients older than 60 years seem more susceptible to the possible detrimental effect of subclinical hypercortisolism on cardiovascular system. The MSC levels are not a strong predictor of the accelerated atherosclerosis, but they seem to indicate the subtle but not autonomous cortisol excess that may potentially raise the cardiovascular risk.

Autonomous hypercortisolism: definition and clinical implications

“…Recently, data published by Ceccato and colleagues 19 have confirmed the reduced accuracy of midnight salivary cortisol in the screening of subclinical hypercortisolism, although measured by LC-MS/MS. Furthermore, it has not been shown to be a strong predictor of accelerated atherosclerosis in patients with subclinical hypercortisolism 20 .…”

Adrenal Incidentaloma: Picking out the High-Risk Patients

“…In addition to hypertension, several markers of subclinical ath erosclerosis have been studied in patients with ACS. Among them, higher values of intima-media thickness (IMT) and lower flow-me diated dilation (FMD) have been reported in crosssectional evi dence, in patients with ACS, when compared to nonfunctioning tumors [5][6][7]. The association between altered IMT and severity of hypercortisolism has been recently investigated in a metaanalysis of 14 studies that characterized the cardiovascular risk of patients with Cushing's syndrome.…”

“…The lack of agreement among the dif ferent studies is mainly due to the different parameters that were selected as markers of cortisol hypersecretion, like urinary free cor tisol or midnight cortisol, which are frequently within the normal range in patients with ACS. Nonetheless, the association between ACS and increased IMT seems to be a relevant issue only in older patients [5]. Several studies shed light on the potential association between altered markers of subclinical atherosclerotic and non functioning adrenal incidentalomas (reviewed in [9]).…”