Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis

Tuna, Mazhar Müslüm; Imga, Narin Nasiroglu; Doğan, Berçem Ayçıçek; Yılmaz, Fatma Meriç; Topçuoğlu, Canan; Akbaba, Gülhan; Berker, Dilek; Güler, Serdar

doi:10.1007/s40618-014-0106-5

Cited by 59 publications

(37 citation statements)

References 17 publications

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“…However, emerging evidence suggests that even apparent NFAT have a higher cross-sectional association with cardiometabolic derangements, such as insulin resistance, when compared with matched controls without adrenal tumors (17–19), possibly because NFAT secrete low-levels of glucocorticoids (17, 20). Although the size of these aforementioned studies was small and lacked longitudinal follow-up, collectively they suggest that NFAT, defined by our current clinical practice guidelines (1, 2, 15, 16, 21), may not be “non-functional” after all; they may impart cardiometabolic risk by secreting inappropriate amounts of adrenal hormones that evade our traditional clinical criteria and detection capabilities.…”

Section: Introductionmentioning

confidence: 99%

“Nonfunctional” Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes

et al. 2016

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Background Adrenal tumors are commonly discovered on abdominal imaging. The majority of adrenal tumors are classified as “non-functional” and considered to pose no health risk, whereas a minority will be considered “functional” because they secrete hormones that increase risk for metabolic and cardiovascular diseases. Objective To evaluate the hypothesis that “non-functional” adrenal tumors (NFAT) increase risk for developing cardiometabolic outcomes when compared with having no adrenal tumor. Design Cohort study. Setting Integrated hospital system. Participants Exposed participants with benign NFAT (n=242) and unexposed participants with no adrenal tumor (n=1237). Measurements Medical records were reviewed from the time of abdominal imaging for development of incident outcomes (hypertension, composite diabetes [pre-diabetes or type 2 diabetes], hyperlipidemia, cardiovascular events, chronic kidney disease) (mean 7.7 years). Primary analyses evaluated independent associations between exposure status and incident outcomes using adjusted generalized linear models. Secondary analyses evaluated relationships between NFAT and cortisol physiology. Results NFAT were associated with significantly higher risk for incident composite diabetes when compared with no adrenal tumor (adjusted RR=1.87, 95% CI: 1.17, 2.98; absolute risk: 30/110 vs. 72/615, 15.6%). No significant associations between NFAT and other outcomes were observed. Higher “normal” post-dexamethasone cortisol levels (<1.8 mcg/dL) associated with larger NFAT size and a higher prevalence of type 2 diabetes. Limitations Potential bias in the selection of participants and ascertainment of outcomes. Conclusions Participants with NFAT had a significantly higher risk of developing diabetes when compared to participants without adrenal tumors. These results prompt a re-assessment of whether the classification of benign adrenal tumors as “non-functional” adequately reflects the continuum of hormone secretion and metabolic risk they may harbor.

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Section: Introductionmentioning

confidence: 99%

“Nonfunctional” Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes

et al. 2016

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“…Based on the findings of recent studies, patients with AI have increased cardiovascular risk (3, 7). Patients with AI have increased prevalence of metabolic syndrome and impaired endothelial function (9, 10).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AI have increased prevalence of metabolic syndrome and impaired endothelial function (9, 10). Patients with incidentalomas have higher hypertension prevalence and higher risk of atherosclerosis measured as increased CIMT (3). Iacobellis et al showed early LV structural changes in asymptomatic non-functioning AI, such as increased left ventricular mass (6).…”

Section: Discussionmentioning

confidence: 99%

“…Although AI are considered hormonally inactive, previous studies have shown that adrenal incidentalomas may be related to increased incidence of cardiovascular conditions (1). Patients with AI can have metabolic disturbances with high prevalence of dyslipidemia, hypertension, impaired glucose tolerance and metabolic syndrome (2, 3). These cardiovascular conditions tend to be more frequent in patients with subclinical cushing’s syndrome (SCS); though, they can also be found in patients with nonfunctioning adrenal masses (1).…”

Section: Introductionmentioning

confidence: 99%

“…Whether this relationship also exists in patients with AI requires further investigations. Previous data demonstrated an increased rate of atherosclerosis indicators, such as higher levels of adipocytokines, insulin resistance and increased carotid intima-media thickness (CIMT) in patients with AI (3, 5). …”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Increased Epicardial Fat Thickness and Left Ventricular Hypertrophy and Carotid Intima-Media Thickness in Patients With Nonfunctional Adrenal Incidentaloma

Imga

Elalmış

Tuna

et al. 2016

Int J Endocrinol Metab

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BackgroundEmerging evidences indicate that patients diagnosed with Adrenal Incidentaloma (AI) may present cardiovascular complications. Epicardial fat thickness (EFT) has recently been described as a new risk factor and an active player in metabolic syndrome and cardiovascular disease.ObjectivesWe aimed to evaluate the relationship between EFT and left ventricular hypertrophy and carotid intima-media thickness, which are both strong predictors of cardiovascular morbity and mortality, in patients with nonfunctioning AI.Patients and MethodsWe evaluated 51 patients (36 females and 15 males) diagnosed with AI and 35 (29 females, 6 males) age, gender and body mass index (BMI) matched healthy controls in terms of cardiovascular risk parameters. Epicardial fat was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium.ResultsEpicardial fat thickness was significantly higher in patients with AI when compared to the control group (0.89 ± 0.32 cm vs. 0.74 ± 0.26 cm; P = 0.023). left ventricular (LV) mass index and median carotid intima-media thickness (CIMT) were also higher in subjects with AI than in controls (99.8 g/m2 vs. 86.9 g/m2; P = 0.024 and 7.5 mm (5.5 - 11.5) vs. 6.5 mm (4.5 - 9.5); P = 0.017). There was a positive correlation between EFT, LV mass index, EFT and CIMT (r = 0.315, P = 0.004; r = 0.363, P < 0.001; respectively).ConclusionsIn this study we showed that EFT, measured by echocardiography is higher in subjects with AI when compared to healthy controls. epicardial fat thickness had the best independent correlation with AI in multiple logistic regression analysis. Incidentaloma is also associated with increased left ventricular mass index and CIMT. Adrenal incidentaloma patients may show early cardiac changes, such as increased left ventricular mass and increased CIMT.

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The improvement of postoperative blood pressure and associated factors in patients with hormone‐negative adrenal adenoma and hypertension

Sun,

Dong,

Wang

et al. 2024

Journal of Surgical Oncology

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ObjectiveTo investigate the effect of adrenal surgery on blood pressure (BP) improvements in patients with hormone‐negative adrenal adenoma (HNA) concomitant with hypertension and analyze associated prognostic factors.MethodsWe retrospectively reviewed the clinical data of patients with HNA and hypertension and patients with aldosterone‐producing adenoma (APA) and hypertension who underwent adrenal surgery at our center between 2019 and 2022. Hypertension outcomes were evaluated in all patients and subjects were divided into three groups according to follow‐up BP and the administration of anti‐hypertensive agents: a clinical curation group, an improvement group, and a no‐improvement group. Logistic regression analysis was performed to predict factors associated with clinical curation in patients with HNA post‐surgery.ResultsOf the 182 patients with HNA, clinical curation was achieved in 58 patients (31.9%), improvement in 72 (39.5%), and no improvement in 52 (28.6%). The clinical curation, improvement and no improvement rates in patients with APA were 64.8% (n = 118), 15.9% (n = 29), and 19.2% (n = 35). Multivariate logistic regression analysis indicated that a duration of hypertension ≤6 years and a plasma aldosterone level >160 pg/ml were both independent factors for the clinical curation of hypertension in patients with HNA after adrenal surgery.ConclusionAdrenal surgery can cure or improve hypertension in most patients with HNA, especially in a short duration of hypertension and high plasma levels of aldosterone.

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Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis

Cited by 59 publications

References 17 publications

“Nonfunctional” Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes

“Nonfunctional” Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes

The Relationship Between Increased Epicardial Fat Thickness and Left Ventricular Hypertrophy and Carotid Intima-Media Thickness in Patients With Nonfunctional Adrenal Incidentaloma

The improvement of postoperative blood pressure and associated factors in patients with hormone‐negative adrenal adenoma and hypertension

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