Publication Summary

Cardiovascular events and mortality in patients with adrenal adenomas and excess cortisol secretion

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.