Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery

Abstract

Objective: To compare clinical and humoral parameters before and after surgery in patients with incidental adrenocortical adenomas. Design: Six patients with subclinical Cushing's syndrome and nine with non-functioning adenomas were investigated before and 12 months after removal of the mass. Methods: Anthropometric (body weight, body mass index and waist to hip ratio), haemodynamic (blood pressure and heart rate), metabolic (lipids and oral glucose tolerance test (OGTT)), hormonal (cortisol, plasma renin activity, aldosterone, androgens and catecholamines) and bone metabolism (hydroxyproline, parathyroid hormone, osteocalcin and ostase) parameters were evaluated. Results: In the whole group, a significant decrease in body weight ð69:7^3:5 vs 70:8^3:5 kg; P , 0:03Þ; in systolic ð135:3^5:1 vs 145:6^4:9 mmHg; P , 0:009Þ and diastolic ð83:7^1:9 vs 91:0^3:5 mmHg; P , 0:03Þ blood pressure and in glucose levels in response to OGTT ð106:4^9:6 vs 127:5^6:5 mg=dl; P , 0:05Þ was observed after surgery. All other parameters examined did not change significantly. This trend was also found in both groups separately. Analytical data showed a high frequency of overweight/obesity (66.6%), hypertension (66.6%) and impaired glucose profile (26.6%) in our patients, with a greater prevalence of these cardiovascular risk factors in the subclinical Cushing's syndrome group. After surgery, values normalized or improved in eight out of ten hypertensive patients and in three out of four patients with impaired glucose profile. Conclusions: Solid adrenocortical incidentalomas are associated with some cardiovascular risk factors which may be corrected after removal of the mass. Therefore, surgery may be an appropriate choice in patients with subclinical Cushing's syndrome but also in those with solid non-functioning adenomas and coexistent cardiovascular risk factors.

Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures

“…4 Finally, patients with SH showed a higher prevalence of hypertension and diabetes as compared to patients without SH. These findings confirm the observations from several previous studies, [23][24][25] and reinforce the idea that the condition of subtle cortisol excess, even if 'subclinical', may cause the same consequences of overt cortisol excess. However, the cross-sectional design of our study allows us to show association but not causality.…”

“…2 In fact, in spite of the definition of 'subclinical' hypercortisolism, this condition of subtle cortisol excess has been described to be associated with the presence of classic, even not specific, complications of overt cortisol excess as obesity, type 2 diabetes, hypertension and bone loss. [4][5][6][7][8][9][10][11][12][23][24][25] Regarding bone involvement in the presence of SH, no data are reported so far regarding vertebral fractures in male patients. Thus, the most important finding of the present investigation is that in male patients with AI and SH the proportion of vertebral fractures is increased.…”

Bilateral adrenal incidentalomas differ from unilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications

“…In addition, patients with intermittent cortisol secretion may present with adverse effects; however, they can have normal adrenal function at a single evaluation. This is a plausible explanation for the improvement in arterial hypertension, type 2 diabetes, and insulin sensitivity after adrenalectomy, reported in adrenal incidentaloma patients with (7,8,29,30,31,32) and without SCS (8,31,32). This might also be the case for transient adrenal insufficiency after adrenalectomy, considered as an indirect proof of cortisol hypersecretion, described in patients with and without SCS (8,32).…”

The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

“…Many patients with incidental nonfunctioning adrenal adenoma have increased risk of obesity, impaired glucose tolerance and dyslipidemia (11)(12)(13). We aimed to investigate the relationship between thyroid function, serum lipids and insulin resistance in patients with nonfunctioning adrenal incidentaloma.…”