Increased Rates of Coronary Artery Calcium Score in Patients with Non - Functioning Adrenal Incidentaloma

Abstract

Aim: We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal incidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. Materials and Method: The participants were patients with an NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score and a non-diagnostic treadmill-exercise test, which served as the control group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units – mild coronary-artery calcification (n = 40) – and ≥100 Agatston units – moderate-to-severe calcification (n = 15). Results: Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group than the control group. Glucose, potassium, adrenocorticotropic-hormone and basal-cortisol levels were higher in those with a CAC score of ≥100. High-density-lipoprotein cholesterol, estimated glomerular filtration rate and ejection fraction (EF) were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF and glucose were the most significant variables related to CAC score in patients with an NFAI, at ≥100 Agatston units. Discussion: Patients with a low-intermediate CV risk profile and an NFAI have a higher risk of atherosclerosis, when compared to patients with a low-intermediate CV risk profile, but no NFAI. Conclusion: In cases where an NFAI exists, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.

Cardiometabolic profile and urinary metabolomic alterations in non‐functioning adrenal incidentalomas: A review

“…Similarly, findings were reported in another study comparing 35 NFAI and 35 healthy controls, where the carotid intima‐media thickness, pulse wave velocity and augmentation index were significantly higher in NFAIs than in the control group 18 . There is even one study that showed similar prevalence of hypertension in patients with ACS and NFAIs 35 . Moreover, Bernini et al 33 demonstrated a significant reduction in systolic blood pressure and weight after the intervention in patients with NFAIs who underwent adrenalectomy.…”

“…Furthermore, a large longitudinal follow‐up study found that patients with NFAI had higher BMI compared to age‐ and sex‐matched controls without adrenal tumours (25.1 vs. 24.0 kg/m 2 ) 13 . Similarly, two observational studies reported a similar prevalence of dyslipidaemia in patients with ACS and NFAIs 9,35 …”

“…In the last 2 years, new studies with a higher degree of evidence have emerged that support the association between NFAIs with an increased risk of hypertension, including resistant hypertension 13,19 and coronary artery/endothelial disease 35,52 . Tuna et al described a prevalence of hypertension of 39.3% in the NFAI group compared to 12.2% in controls ( p < .05) 53 .…”

“…13 Similarly, two observational studies reported a similar prevalence of dyslipidaemia in patients with ACS and NFAIs. 9,35 There are also several studies that support the association between NFAIs with a greater risk of alterations in hydrocarbon metabolism. 13,14,50 A cohort study by Lopez et al 51 showed that the NFAI group had approximately a 2-fold higher risk for incident diabetes than controls without adrenal tumours.…”

“…[24][25][26][27][28] Over the last few years, new discoveries have emerged regarding the deleterious effects of ACS, such as an increased risk of periodontitis, 29 mental disorders, and worsening of quality of life. 30 Although with less evidence than in ACS, but increasing, a greater cardio-metabolic risk has been found in patients with apparently NFAIs than in the general population [10][11][12]14,[31][32][33][34][35] (Figure 1 and Table 1). In fact, in a recent study, 36 it has been observed that the cardio-metabolic risk of patients with ACS and NFAI was higher than in the general population, but did not differ between the two groups when a stratification by body mass index (BMI) was performed, which suggests that both entities are equally deleterious for the cardiometabolic system.…”