Study IDs Cardiovascular Risk for 'Silent' Adrenal Tumors
(HealthDay News) — Patients with adrenal tumors of intermediate phenotype or subclinical Cushing's syndrome are at increased risk of cardiovascular events and mortality compared to those with stable non-secreting adrenal incidentalomas, according to a study published online January 29 in The Lancet Diabetes & Endocrinology.
Guido Di Dalmazi, MD, from the University Alma Mater in Bologna, Italy, and colleagues assessed 198 outpatients to examine the frequency of new cardiovascular events and mortality in patients with non-secreting adrenal incidentalomas, tumors of intermediate phenotype, or those causing subclinical Cushing's syndrome. Patients underwent assessment every 18–30 months for the first five years.
At the end of follow-up, 114 patients had stable non-secreting adrenal incidentalomas, 61 had stable intermediate phenotype or subclinical Cushing's syndrome, and 23 had a worsening secretion pattern. The researchers found that cardiovascular event incidence was higher in those with a stable intermediate phenotype or subclinical Cushing's syndrome (16.7%) and in those with worsened secreting patterns (28.4%) than among those with stable non-secreting adrenal incidentalomas (6.7%t; P=0.04 and 0.02, respectively). There was an independent correlation between cardiovascular events and cortisol concentrations post-dexamethasone suppression test (hazard ratio, 1.13; P=0.001). Lower survival rates were seen for all-cause mortality in patients with stable intermediate phenotype adrenal incidentalomas or subclinical Cushing's syndrome (57.0%) compared with those with stable non-secreting masses (91.2%; P=0.005).
"Even when clinical signs of overt hypercortisolism are not present, patients with adrenal incidentalomas and mild hypercortisolism have an increased risk of cardiovascular events and mortality," the authors write.