Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors

Prete, Alessandro; Subramanian, Anuradhaa; Bancos, Irina; Chortis, Vasileios; Tsagarakis, Stylianos; Lang, Katharina; Macech, Magdalena; Delivanis, Danae A.; Pupovac, Ivana D; Reimondo, Giuseppe; Marina, Ljiljana; Deutschbein, Timo; Balomenaki, Maria; O’Reilly, Michael; Gilligan, Lorna C; Jenkinson, Carl; Bednarczuk, Tomasz; Zhang, Catherine D; Dušek, Tina; Diamantopoulos, Aristidis; Asia, Miriam; Kondracka, Agnieszka; Li, Dingfeng; Masjkur, Jimmy; Quinkler, Marcus; Ueland, Grethe Åstrøm; Dennedy, Michael Conall; Beuschlein, Felix; Tabarin, Antoine; Fassnacht, Martin; Ivović, Miomira; Terzolo, Massimo; Kaštelan, Darko; Young, William F.; Manolopoulos, K.; Ambroziak, Urszula; Vassiliadi, Dimitra Argyro; Taylor, Angela E.; Sitch, Alice; Nirantharakumar, Krishnarajah; Arlt, Wiebke

doi:10.7326/m21-1737

Cited by 82 publications

(72 citation statements)

References 33 publications

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“…Third, this was a retrospective and cross-sectional study with long enrolling period. The number of overt CS was higher than the previous studies evaluating adrenal incidentaloma [ 9 , 12 , 13 ]. Then, the prevalence of OS/OP can be different from the studies evaluating MACS and nonfunctioning adrenal adenoma.…”

Section: Discussioncontrasting

confidence: 62%

“…Patients aged 20 to 90 who were diagnosed with MACS and overt CS originated from adrenal adenoma between January 2006 to December 2015 in 10 referral centers, including the National Center for Global Health and Medicine, National Hospital Organization Kyoto Medical Center, St. Marianna University Yokohama City Seibu Hospital, Tottori University Hospital, Tokyo Medical and Dental University, Osaka University Graduate School of Medicine, Kyoto University, Kanazawa University Graduate School of Medical Science, Tenri Hospital, and Saiseikai Yokohama-shi Tobu Hospital, were enrolled. Because all participating centers accept patients considered the indication of adrenalectomy, the proportion of overt CS was higher than previous reports enrolling adrenal incidentaloma [ 9 , 12 , 13 ]. Patients with ACTH-dependent CS and iatrogenic CS were not included in the study.…”

Section: Methodsmentioning

confidence: 81%

“…Recently, mild autonomous cortisol secretion (MACS), defined by a 1 mg overnight dexamethasone suppression test (1 mg DST) cortisol level >1.8 μ g/dL but without the classical symptoms and signs of overt CS, has been shown to be prevalent, affecting up to 45% of patients with adrenal adenomas [ 9 ]. The indication for adrenalectomy in MACS is decided based on the severity of CE and coexistent complications, including glucose impairment, hypertension, obesity, and dyslipidemia.…”

Section: Introductionmentioning

confidence: 99%

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Sex Difference in the Association of Osteoporosis and Osteopenia Prevalence in Patients with Adrenal Adenoma and Different Degrees of Cortisol Excess

Izawa

Matsumoto

Matsuzawa

et al. 2022

International Journal of Endocrinology

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Objective. Osteoporosis and osteopenia (OS/OP) are frequent in patients with adrenal adenomas associated with cortisol excess (CE). However, the relationship between OS/OP and CE severity considering sex differences is unknown. Design. A cross-sectional observational study from January 2006 to December 2015. Patients. 237 patients with adrenal adenoma associated with CE, including Cushing’s syndrome and mild autonomous cortisol secretion (MACS), diagnosed in 10 referral centers in Japan. MACS was defined by 1 mg overnight dexamethasone suppression test (DST) cortisol level >1.8 μg/dL. Measurements. Prevalence of fragility fractures, medication for osteoporosis, and bone mineral density. Results. In total, 112 of 237 patients, who were predominantly female ( P < 0.001 ) and had lower BMI ( P = 0.013 ), had OS/OP. Patients with OS/OP was significantly affected by CE ( P < 0.01 ) than those without. The adjusted odds ratio (OR) for predicting OS/OP was obtained in multivariate logistic regression analysis. Clinical measures of CE, 1 mg DST cortisol levels, were positively associated with OS/OP in total cases (OR 1.124, 95% CI: 1.070–1.181, P < 0.001 ) and the cases with MACS (OR 1.156, 95%CI: 1.046–1.278, P = 0.005 ). A cutoff value of 1 mg DST cortisol level >5.0 μg/dL was associated with OS/OP differently between men and women. OS/OP risk in men with MACS was significantly affected only by 1 mg DST cortisol levels. However, OS/OP risk in women with MACS was significantly affected by 1 mg DST cortisol levels and age. Conclusions. CE severity in adrenal adenoma is positively associated with OS/OP. However, the associated factors of OS/OP in the patients with MACS are different between men and women.

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Section: Discussioncontrasting

confidence: 62%

Section: Methodsmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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Sex Difference in the Association of Osteoporosis and Osteopenia Prevalence in Patients with Adrenal Adenoma and Different Degrees of Cortisol Excess

Izawa

Matsumoto

Matsuzawa

et al. 2022

International Journal of Endocrinology

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“…Patrova and colleagues discovered that patients with cortisol levels over 50 nmol/L (1.8 µg/dL) in 1 mg DST are more affected by CVD and AH [50]. In the work by Prete et al, the prevalence and severity (usage of ≥ 3 antihypertensive drugs) of AH increased in patients with cortisol levels > 138 nmol/L in 1 mg DST [51]. However, in the study performed by Zhang et al, there were no differences in the prevalence and incidence of cardiometabolic disease when comparing non-functioning adrenal tumour patients with patients having mACS [52].…”

Section: Cardiovascular Diseases and Arterial Hypertension (Ah)mentioning

confidence: 99%

Comorbidities in Mild Autonomous Cortisol Secretion – A Clinical Review of Literature

Czapla-Iskrzycka

Świątkowska−Stodulska

Sworczak

2022

Exp Clin Endocrinol Diabetes

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Mild autonomous cortisol secretion (mACS) is a state of cortisol excess usually associated with existence of adrenal incidentaloma. Because of the lack of symptoms of the disease, the biochemical evaluation is the most important to determine a diagnosis. However, scientific societies have different diagnostic criteria for mACS, which makes the treatment of this disease and using results of original papers in daily practice more difficult. Chronic hypercortisolemic state, even if mild, may lead to diseases that are mostly connected with overt Cushing’s syndrome. Some of them can cause a higher mortality of patients with mACS and those problems need to be addressed. In this review we describe the comorbidities associated with mACS: cardiovascular disorders, arterial hypertension, diabetes mellitus, insulin resistance, dyslipidemia, obesity, metabolic syndrome, non-alcoholic fatty liver disease, vertebral fractures and osteoporosis. The point of this paper is to characterise them and determine if and how these conditions should be managed. Two databases – PubMed and Web of Science were searched. Even though the evidence are scarce, this is an attempt to lead clinicians through the problems associated with this enigmatic condition.

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“…These and evidence of other potential complications have been carefully reviewed ( 12 ). Similarly, mild autonomous cortisol secretion by adrenal adenomas is associated with an increased risk for hypertension and type 2 diabetes mellitus ( 17 ). Although associations do not prove cause and effect, these findings are concerning.…”

Section: Potential Complications Of Glucocorticoid Overreplacementmentioning

confidence: 99%

Daily Glucocorticoid Replacement Dose in Adrenal Insufficiency, a Mini Review

Caetano

Malchoff

2022

Front. Endocrinol.

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The Endocrine Society Guidelines and recent reviews of adrenal insufficiency (AI) recommend a daily glucocorticoid replacement dose of 15 to 25 mg with a midpoint of 20 mg of hydrocortisone (HC) (alternatively 3 to 5 mg prednisolone) in divided doses in otherwise healthy individuals with AI. In contrast, a daily glucocorticoid replacement dose of 4.3 to 26 mg/d HC with a midpoint of 15 mg/d is predicted from current measurements of daily cortisol production rates and oral HC bioavailability. The higher HC doses recommended in the current guidelines may result in glucocorticoid overtreatment of some AI patients and associated long-term adverse outcomes. A titration method for determination of the individual patient’s daily glucocorticoid replacement dose and the impact of lower doses are reviewed. Future related research questions are identified.

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Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors

Cited by 82 publications

References 33 publications

Sex Difference in the Association of Osteoporosis and Osteopenia Prevalence in Patients with Adrenal Adenoma and Different Degrees of Cortisol Excess

Sex Difference in the Association of Osteoporosis and Osteopenia Prevalence in Patients with Adrenal Adenoma and Different Degrees of Cortisol Excess

Comorbidities in Mild Autonomous Cortisol Secretion – A Clinical Review of Literature

Daily Glucocorticoid Replacement Dose in Adrenal Insufficiency, a Mini Review

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