Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship?

Peppa, Μelpomeni; Boutati, Eleni; Koliaki, Chrysi; Papaefstathiou, Nasos; Garoflos, Efstathios; Economopoulos, Theofanis; Hadjidakis, Dimitrios; Raptis, Sotirios A.

doi:10.1016/j.metabol.2010.01.007

Cited by 84 publications

(64 citation statements)

References 30 publications

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“…There was no difference in terms of insulin sensitivity between the two groups of adrenal lesion patients, but subjects with sCS had a significantly higher prevalence of IGT and a higher area under the curve for glucose (19). These data and other studies demonstrate that patients with adrenal incidentaloma, regardless of the functional status, show insulin resistance (20,21,22,23). Moreover, one study found a correlation between adrenal lesion size and insulin resistance (20).…”

Section: Gcs and Glucose Metabolismsupporting

confidence: 53%

Metabolic comorbidities in Cushing's syndrome

Ferraú

Korbonits

2015

European Journal of Endocrinology

149

121

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Cushing's syndrome (CS) patients have increased mortality primarily due to cardiovascular events induced by glucocorticoid (GC) excess-related severe metabolic changes. Glucose metabolism abnormalities are common in CS due to increased gluconeogenesis, disruption of insulin signalling with reduced glucose uptake and disposal of glucose and altered insulin secretion, consequent to the combination of GCs effects on liver, muscle, adipose tissue and pancreas. Dyslipidaemia is a frequent feature in CS as a result of GC-induced increased lipolysis, lipid mobilisation, liponeogenesis and adipogenesis. Protein metabolism is severely affected by GC excess via complex direct and indirect stimulation of protein breakdown and inhibition of protein synthesis, which can lead to muscle loss. CS patients show changes in body composition, with fat redistribution resulting in accumulation of central adipose tissue. Metabolic changes, altered adipokine release, GC-induced heart and vasculature abnormalities, hypertension and atherosclerosis contribute to the increased cardiovascular morbidity and mortality. In paediatric CS patients, the interplay between GC and the GH/IGF1 axis affects growth and body composition, while in adults it further contributes to the metabolic derangement. GC excess has a myriad of deleterious effects and here we attempt to summarise the metabolic comorbidities related to CS and their management in the perspective of reducing the cardiovascular risk and mortality overall.

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Section: Gcs and Glucose Metabolismsupporting

confidence: 53%

Metabolic comorbidities in Cushing's syndrome

Ferraú

Korbonits

2015

European Journal of Endocrinology

149

121

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“…In line with these findings, we previously reported increased epicardial fat thickness and left ventricular mass in NFA subjects [72]. Careful analysis of many of these studies reveals statistically significant higher indices of cortisol production, particularly late night serum cortisol and dexamethasone suppressed cortisol levels, but not to the degree meeting accepted criteria for SCS [71, 73]. Since cortisol production can be best understood as a continuous spectrum, one explanation for the abnormalities in adiposity and metabolic parameters observed in NFA patients could be subtle hypercortisolism.…”

Section: Nonfunctioning Adrenal Adenomas and Adipose Tissuementioning

confidence: 55%

Adipose Tissue and Adrenal Glands: Novel Pathophysiological Mechanisms and Clinical Applications

Kargi

Iacobellis

2014

International Journal of Endocrinology

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Hormones produced by the adrenal glands and adipose tissues have important roles in normal physiology and are altered in many disease states. Obesity is associated with changes in adrenal function, including increase in adrenal medullary catecholamine output, alterations of the hypothalamic-pituitary-adrenal (HPA) axis, elevations in circulating aldosterone together with changes in adipose tissue glucocorticoid metabolism, and enhanced adipocyte mineralocorticoid receptor activity. It is unknown whether these changes in adrenal endocrine function are in part responsible for the pathogenesis of obesity and related comorbidities or represent an adaptive response. In turn, adipose tissue hormones or “adipokines” have direct effects on the adrenal glands and interact with adrenal hormones at several levels. Here we review the emerging evidence supporting the existence of “cross talk” between the adrenal gland and adipose tissue, focusing on the relevance and roles of their respective hormones in health and disease states including obesity, metabolic syndrome, and primary disorders of the adrenals.

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“…Although a study reported that patients with nonfunctioning adrenal incidentalomas exhibit higher fasting glucose with insulin resistance and dyslipidemia as part of the metabolic syndrome,[19] this patient had nearly normal blood glucose and diabetic monitoring did not show results of high blood sugar necessitating insulin administration. However, intraoperatively she developed hyperglycemia and needed insulin infusion to control it and this could be part of stress response and glycogenolysis or due to release of cortisol hormones from the mass during manipulation.…”

Section: Discussionmentioning

confidence: 97%

Adrenal incidentaloma: Anesthetic management, the challenge and the outcome

et al. 2011

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Adrenal incidentalomas is a term increasingly used now and applied to any adrenal mass that is found incidentally on an imaging of a patient with complaints not related to adrenal pathology. This case report presents a patient with incidental adrenal mass that was evaluated according to proposed recommendations and planned for robotic-assisted laparoscopic adrenalectomy. There is increasing number of literatures on the advantages of robotic surgery for adrenal resection; however, there is controversy regarding the hemodynamic stability of patients during these procedures especially with patient suspected to have pheochromocytoma. We included literature reviews on the role of robotics and use of laparoscopy for adrenalectomy and the anesthetic considerations in these procedures aiming to raise awareness and draw attention to this increasingly emerging disease entity.

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Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship?

Cited by 84 publications

References 30 publications

Metabolic comorbidities in Cushing's syndrome

Metabolic comorbidities in Cushing's syndrome

Adipose Tissue and Adrenal Glands: Novel Pathophysiological Mechanisms and Clinical Applications

Adrenal incidentaloma: Anesthetic management, the challenge and the outcome

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