Guido Di Dalmazi, Valentina Vicennati, Silvia Garelli, et al. Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes Endocrinol. 2014;2:396-405.
The discovery of adrenal adenomas associated with hypercortisolism has increased over the last few years. It’s a common finding for patients with these adrenal adenomas to have autonomous cortisol secretion with lack of Cushingoid features, also referred to as less severe hypercortisolism when compared with classically described overt Cushing syndrome.* Although metabolic alterations and increased cardiovascular risk have been noted in patients who have autonomous cortisol secretion with lack of Cushingoid features, incidence of cardiovascular events and mortality in the long term have not been assessed.
To date, no studies have been done to assess cardiovascular risk and mortality in patients with adrenal adenomas and less severe hypercortisolism. To bridge this gap, a retrospective study was conducted using data from 1995 to 2010 to analyze the correlation between excess autonomous cortisol secretion, cardiovascular issues, and mortality. The 15-year study looked at the frequency of new cardiovascular events and mortality in patients with adrenal adenomas and hypercortisolism. These were categorized based on post-dexamethasone suppression test (DST) cortisol levels.† The analysis, which excluded patients with classically described overt Cushing syndrome, found that cardiovascular events, as well as mortality rates, were higher in patients with increased cortisol levels over a period of time. Additionally, post-DST amounts of cortisol are related to all-cause mortality independently of all potential risk factors considered.*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 upper limit of normal; low adrenocorticotropic hormone (ACTH <10/pg/mL); or post-DST cortisol levels greater than the 3 μg/dL.
Incidence of New Cardiovascular Events at End of Follow-Up*
Patients whose post-DST cortisol levels increased were considered “worsened” and were 4 times more likely to have a cardiovascular event.
Survival Rates for All-Cause Mortality at End of Follow-Up
Even when clinical signs of classically described overt Cushing syndrome are not present, patients with adrenal adenomas and less severe hypercortisolism showed an increased risk of cardiovascular events and mortality.