Valentina Morelli, Giuseppe Reimondo, Roberta Giordano, et al. Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab. 2014;99(3):827-834.
The long-term consequences of less severe hypercortisolism in patients with adrenal adenomas are unknown.* During routine clinical testing, many patients exhibit biochemical evidence of excess cortisol secretion, but without the associated features of classically described overt Cushing syndrome.† This is referred to as hypercortisolism without Cushingoid features or less severe hypercortisolism. Less severe hypercortisolism has been linked to several health complications, including obesity, arterial hypertension, dyslipidemia, osteoporosis, and type 2 diabetes mellitus. Despite these known associations, appropriate long-term management remains unclear.
To analyze the long-term health risks associated with excess cortisol secretion, a retrospective multicenter study evaluated 206 patients with adrenal adenomas and no signs of classically described overt Cushing syndrome. Over the course of ≥5 years, patients were observed for adrenocortical function, metabolic changes, incident cardiovascular events, and adenoma size. Study results concluded that patients with adenomas ≥2.4 cm had an increased risk of developing hypercortisolism over time. Additionally, the incidence of cardiovascular events was more common in patients with less severe hypercortisolism than in those without. The findings suggested that long-term follow-up is needed for patients with adrenal adenomas ≥2.4 cm in order to monitor the risk of cardiovascular events and the development of hypercortisolism. The study also highlighted the importance of considering the increased risk of cardiovascular events when choosing treatment options for patients with less severe hypercortisolism.*In this study, patients were considered to have less severe hypercortisolism if post-dexamethasone suppression test (DST) cortisol levels were >5 μg/dL, or if they had at least 2 of the following: urinary-free cortisol greater than the upper limit of normal; low adrenocorticotropic hormone (ACTH <10/pg/mL); or post-DST cortisol levels >3 μg/dL.
Development of Hypercortisolism Based on Adrenal Adenoma Size
Adenoma diameter ≥2.4 cm and DST cortisol >1.8 μg/dL confer elevated risk of hypercortisolism.
Relative Risk of Prevalent Cardiovascular Events
In patients with adrenal adenomas ≥2.4 cm, clinical and biochemical follow-up are required due to the potential development of hypercortisolism and its related consequences.