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Echocardiographic alterations in patients with non-functioning adrenal incidentaloma

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Abstract

Objective: While left ventricular (LV) dysfunction has been described in patients with Cushing’s syndrome (CS), data concerning morphologic and functional cardiac alterations in patients with incidentally discovered adrenal masses [adrenal “incidentaloma” (AI)], without overt hypercortisolism, are lacking. In this study the echocardiographic characteristics of patients with AI were evaluated and then compared with those of lean and obese normotensive subjects. Subjects and methods: Twenty-one patients with AI, without clinical or subclinical hypercortisolism, 18 normotensive obese subjects matched for gender and body mass index (BMI) and 20 normotensive lean subjects were studied. Echocardiography was performed in all subjects. In all patients plasma ACTH, serum cortisol, and DHEA-S levels were measured. Results: Patients with AI showed greater impairment of several echocardiographic indices of LV hypertrophy and diastolic dysfunction compared to normotensive lean subjects (p<0.05), but did not differ from those in obese subjects. Hypertensive AI patients showed a greater alteration of echocardiographic parameters (p<0.05) and higher BMI (p<0.01) and cortisol values (p<0.05) than normotensive ones. Plasma ACTH and serum cortisol were similar in AI patients and in obese controls, while DHEA-S levels were lower in AI (p<0.05). No correlations between cortisol secretion and echocardiographic parameters were found. Conclusion: In patients with non-functioning AI there is an impairment of cardiac morphology and function. These data suggest that patients with AI should be carefully screened also by means of echocardiographic studies.

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References

  1. Barzon L, Sonino N, Fallo F, Palù G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003, 149: 273–85.

    Article  PubMed  CAS  Google Scholar 

  2. Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004, 25: 309–40.

    Article  PubMed  Google Scholar 

  3. Terzolo M, Osella G, Ali A, et al. Subclinical Cushing’s syndrome in adrenal incidentaloma. Clin Endocrinol (Oxf) 1998, 48: 89–97.

    Article  CAS  Google Scholar 

  4. Terzolo M, Pia A, Ali A, et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab 2002, 87: 998–03.

    Article  PubMed  CAS  Google Scholar 

  5. Tauchmanovà L, Rossi R, Biondi B, et al. Patients with subclinical Cushing’s syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 2002, 87: 4872–8.

    Article  PubMed  CAS  Google Scholar 

  6. Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000, 85: 637–44.

    PubMed  CAS  Google Scholar 

  7. Terzolo M, Bovio S, Pia A, et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma. Eur J Endocrinol 2005, 153: 307–15.

    Article  PubMed  CAS  Google Scholar 

  8. Sugihara N, Shimizu M, Kita Y, et al. Cardiac characteristics and postoperative courses in Cushing’s syndrome. Am J Cardiol 1992, 69: 1475–80.

    Article  PubMed  CAS  Google Scholar 

  9. Fallo F, Budano S, Sonino N, Muiesan ML, Agabiti Rosei E, Boscaro M. Left ventricular structural characteristics in Cushing’s syndrome. J Hum Hypertens 1994, 8: 509–13.

    PubMed  CAS  Google Scholar 

  10. Muiesan ML, Lupia M, Salvetti M, et al. Left ventricular structural and functional characteristics in Cushing’s sindrome. J Am Coll Cardiol 2003, 41: 2275–9.

    Article  PubMed  Google Scholar 

  11. Faggiano A, Pivonello R, Spiezia S, et al. Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing’s disease during active disease and 1 year after disease remission. J Clin Endocrinol Metab 2003, 88: 2527–33.

    Article  PubMed  CAS  Google Scholar 

  12. Qi D, Rodrigues B. Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism. Am J Physiol Endocrinol Metab 2007, 292: 654–67.

    Article  CAS  Google Scholar 

  13. Boscaro M, Barzon L, Sonino N. The diagnosis of Cushing’s syndrome: atypical presentations and laboratory shortcomings. Arch Intern Med 2000, 60: 3045–53.

    Article  Google Scholar 

  14. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet 2006, 13: 1605–17.

    Article  CAS  Google Scholar 

  15. Libè R, Dall’Asta C, Barbetta L, BaccarelliZ A, Beck-Peccoz P, Ambrosi B. Long-term follow-up study of patients with adrenal incidentalomas. Eur J Endocrinol 2002, 147: 489–94.

    Article  PubMed  Google Scholar 

  16. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of HypertensionEuropean Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21: 1011–53.

    Article  Google Scholar 

  17. Malavazos AE, Cereda E, Morricone L, Coman C, Corsi MM, Ambrosi B. Monocyte chemoattractant protein 1: a possible link between visceral adipose tissue-associated inflammation and subclinical echocardiographic abnormalities in uncomplicated obesity. Eur J Endocrinol 2005, 153: 871–7.

    Article  PubMed  CAS  Google Scholar 

  18. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977, 55: 613–8.

    Article  PubMed  CAS  Google Scholar 

  19. de Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992, 20: 1251–60.

    Article  PubMed  Google Scholar 

  20. Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodelling in arterial hypertension. J Am Coll Cardiol 1992, 19: 1550–8.

    Article  PubMed  CAS  Google Scholar 

  21. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man Diabetologia 1985, 28: 412–9.

    CAS  Google Scholar 

  22. Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf) 2001, 54: 797–804.

    Article  CAS  Google Scholar 

  23. Garrapa GG, Pantanetti P, Arnaldi G, Mantero F, Faloia E. Body composition and metabolic features in women with adrenal incidentaloma or Cushing’s syndrome. J Clin Endocrinol Metab 2001, 86: 5301–6.

    PubMed  CAS  Google Scholar 

  24. de Simone G, Palmieri V, Bella JN, et al. Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study. J Hypertens 2002, 20: 323–31.

    Article  PubMed  Google Scholar 

  25. Morricone L, Malavazos AE, Coman C, Donati C, Hassan T, Caviezel F. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res 2002, 10: 489–98.

    Article  PubMed  Google Scholar 

  26. Whitworth JA, Mangos GJ, Kelly JJ. Cushing, cortisol and cardiovascular disease. Hypertension 2000, 36: 912–6.

    Article  PubMed  CAS  Google Scholar 

  27. Bella JN, Devereux RB, Roman MJ, et al. Relations of left ventricular mass to fat-free and adipose body mass: the strong heart study. Circulation 1998, 98: 2538–44.

    Article  PubMed  CAS  Google Scholar 

  28. Savastano S, Valentino R, Belfiore A, et al. Early carotid atherosclerosis in normotensive severe obese premenopausal women with low DHEA(S). J Endocrinol Invest 2003, 26: 236–43.

    Article  PubMed  CAS  Google Scholar 

  29. Alwardt CM, Yu Q, Brooks HL, et al. Comparative effects of dehydroepiandrosterone sulfate on ventricular diastolic function with young and aged female mice. Am J Physiol Regul Integr Comp Physiol 2006, 290: R251–6.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Endocrinology Unit, Department of Medical and Surgical Sciences, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, MI, Italy

    F. Ermetici, C. Dall’Asta, A. E. Malavazos, L. Morricone & B. Ambrosi MD

  2. Department of Medicine, Surgery and Dentistry, A.O. San Paolo, Milan

    C. Dall’Asta

  3. Echocardiographic Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    C. Coman & V. Montericcio

Authors
  1. F. Ermetici
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  2. C. Dall’Asta
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  3. A. E. Malavazos
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  4. C. Coman
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  5. L. Morricone
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  6. V. Montericcio
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  7. B. Ambrosi MD
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Correspondence to B. Ambrosi MD.

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These authors contributed equally to this publication.

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Ermetici, F., Dall’Asta, C., Malavazos, A.E. et al. Echocardiographic alterations in patients with non-functioning adrenal incidentaloma. J Endocrinol Invest 31, 573–577 (2008). https://doi.org/10.1007/BF03346410

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  • DOI: https://doi.org/10.1007/BF03346410

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