Concomitant alterations of metabolic parameters, cardiovascular risk factors and altered cortisol secretion in patients with adrenal incidentalomas during prolonged follow-up

Abstract

Objective

Adrenal incidentalomas (AI) are associated with metabolic and hormonal abnormalities, most commonly autonomous cortisol secretion (ACS). Data regarding alterations of insulin resistance (IR), and ACS after prolonged follow-up are limited. We investigated the evolution of IR, cortisol secretion and ACS development in patients with AI during prolonged follow-up.

Design

Prospective study in a tertiary hospital.

Patients and Measurements

Seventy-one patients with AI, (51 non-functioning [NFAI], 20 ACS), and 5.54±1.7 year follow-up underwent testing for autonomous cortisol secretion, Oral Glucose Tolerance Test to determine IR indices and adrenal imaging.

Results

At follow-up, 16/51 (31%) NFAI patients converted to ACS, while 2 with previous ACS reverted to NFAI; 21% (7/33) of patients who did not covert to ACS exhibited high urinary free cortisol (H-UFC) levels. All AI patients developed deterioration of IR irrespective of their cortisol secretory status. Eight patients developed newly diagnosed type 2 diabetes (9.8% NFAI and 15% ACS, respectively) and 14 IR (17.6% NFAI and 25% ACS, respectively). Adenoma size increased from 2.1±0.8 to 2.3±0.8cm, whereas IR correlated with post-dexamethasone cortisol level and adenoma size increase. IR showed an incremental continuum trend from normal UFC (Ν-UFC), to H-UFC, to C-ACS and ACS patients.

Conclusions

New-onset ACS developed in 31% patients with NFAI whereas 21% of NFAI patients had H-UFC levels. All AI patients as a group and the subgroups of N-UFC, H-UFC, C-ACS and ACS patients developed deterioration of metabolic parameters during follow-up that was more prominent in ACS patients.

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