Abstract
Background
The widespread use of ultrasound, computerized tomography, and magnetic resonance imaging has led to an increase in the number of incidental adrenal masses identified. Asymptomatic incidentally discovered adrenal masses may indicate that subclinical Cushing syndrome (SCS) is not uncommon. We aimed to evaluate the cardiovascular risk of patients with SCS before and after surgery.
Methods
An autonomous cortisol-producing tumor was detected in 11 of 94 patients with adrenal incidentaloma between 1995 and 2005. Twenty-eight patients suffering from classical Cushing syndrome (CS) associated with unilateral adrenocortical adenoma, who were treated at our department in the same period, served as a control group. Cardiovascular risk factors such as blood pressure, body mass index, and lipid profile were evaluated before and 1 year after surgery.
Results
The frequency of hypertension (61% versus 63%), obesity (46% versus 55%), diabetes mellitus (50% versus 36%), hypercholesterolemia (39% versus 36%), and low HDL cholesterol (28% versus 36%) were not significantly different between CS and SCS patients, respectively. Adverse cardiovascular risk profile improved 1 year after adrenalectomy in both groups, although the changes were not significant with respect to body mass index, frequency of diabetes, and hyperlipidemia in SCS patients. But frequency of systolic/diastolic hypertension decreased significantly in this group.
Conclusions
These findings indicate that the increased incidence of cardiovascular risk factors commonly observed in classical CS, is also present in SCS. Unilateral adrenalectomy does not always lead to significant improvements in cardiovascular risk profile in SCS.
Similar content being viewed by others
References
Ross NS. Epidemiology of Cushing’s syndrome and subclinical disease. Endocrinol Metab Clin North Am 1994;23:539–546
Terzolo M, Osella G, Alì A, et al. Subclinical Cushing’s syndrome in adrenal incidentaloma. Clin Endocrinol (Oxf) 1998;48:89–97
Siren J, Tervahartiala P, Sivula A, et al. Natural course of adrenal incidentalomas: seven-year follow-up-up study. World J Surg 2000;245:579–582
Terzolo M, Pia A, Alì A, et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab 2002;87:998–1003
Nawar R, Aron D. Adrenal incidentalomas—a continuing management dilemma. Endocr Relat Cancer 2005;12:585–598
Mansmann G, Lau J, Balk E, et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004;25:309–340
Braunstein GD. Management of the clinically inapparent adrenal mass. Ann Intern Med 2004;140:401–402
Copeland PM. Management of the clinically inapparent adrenal mass. Ann Intern Med 2004;140:401
Sippel RS, Chen H. Subclinical Cushing’s syndrome in adrenal incidentalomas. Surg Clin North Am 2004;84:875–885
Reincke M. Subclinical Cushing’s syndrome. Endocrinol Metab Clin North Am 2000;29:43–56
Bloom LS, Libertino JA. Surgical management of Cushing’s syndrome. Urol Clin North Am 1989;16:547–565
Barzon L, Fallo F, Sonino N, et al. Development of overt Cushing’s syndrome in patients with adrenal incidentaloma. Eur J Endocrinol 2002;146:61–66
Charbonnel B, Chatal JF, Ozanne P. Does the corticoadrenal adenoma with “pre-Cushing’s syndrome” exist? J Nucl Med 1981;22:1059–1061
Rossi R, Tauchmanova L, Luciano A, et al. Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 2000;85:1440–1448
Royal College of Physicians. Obesity. A report of the Royal College of Physicians. J R Coll Physicians Lond 1983;17:5–65
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults JAMA. 2001;285:2486–2497
Kaye TB, Crapo L. The Cushing’s syndrome: an update on diagnostic tests. Ann Intern Med 1990;112:434–444
Angeli A, Terzolo M. Adrenal incidentaloma—a modern disease with old complications. J Clin Endocrinol Metab 2002;87:4869–4871
Bernini G, Moretti A, Iacconi P, et al. Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery. Eur J Endocrinol 2003;148:213–219
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;88:2527–2533
Emral R, Uysal AR, Asik M, et al. Prevalence of subclinical Cushing’s syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes. Endocr J 2003;50:399–408
Torlontano M, Chiodini I, Pileri M, et al. Altered bone mass and turnover in female patients with adrenal incidentaloma: the effect of subclinical hypercortisolism. J Clin Endocrinol Metab 1999;84:2381–2385
Tauchmanova 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;87:4872–4878
Reincke M, Nieke J, Krestin GP, et al. Preclinical Cushing’s syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab 1992;75:826–832
Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab 2000;85:637–644
Mirallie E, Jafari M, Pattou F, et al. Outcome of non-operated adrenal masses in 126 patients observed from 1986 to 1999. Ann Chir 2001;126:212–220
Terzolo M, Reimondo G, Bovio S, et al. Subclinical Cushing’s syndrome. Pituitary 2004;7:217–223
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Erbil, Y., Ademoğlu, E., Özbey, N. et al. Evaluation of the Cardiovascular Risk in Patients with Subclinical Cushing Syndrome Before and After Surgery. World J. Surg. 30, 1665–1671 (2006). https://doi.org/10.1007/s00268-005-0681-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-0681-x