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Cardiovascular and metabolic risk factors in patients with subclinical Cushing

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Abstract

Purpose

Adrenal incidentalomas (AI) are discovered after work-up unrelated to adrenal gland diseases; up to 30% of AI show subclinical endogenous cortisol excess (SH), frequently associated to hypertension, obesity, metabolic disorders and increased incidence of cardiovascular events (CVEs).

Methods

We analysed 628 AI patients divided into two groups: 471 non-functional adrenal adenoma (NFA) and 157 SH. All patients underwent complete examinations, 24-h ambulatory blood pressure monitoring, biohumoral parameters and vascular damage markers, such as c-IMT and ankle brachial index. After long-term follow-up, we registered newly onset of CVEs such as myocardial infarction (MI), percutaneous stenting and surgical bypass (PTA/CABG), stroke, overall/cardiovascular mortality. Moreover, SH patients underwent to surgical (SSH) or pharmacological treatment (MSH).

Results

SH patients showed higher prevalence of metabolic syndrome, diabetes mellitus, and previous CVEs respect NFA at baseline. After follow-up MSH group showed higher recurrence of major CV events compared with NFA and SSH (RR 2.27 MSH vs NFA for MI; RR 2.30 MSH vs NFA for PTA/CABG; RR 2.41 MSH vs NFA for stroke). In SSH there was a significant reduction of the number of antihypertensive medications needed to reach target blood pressure levels (2.3 ± 1.0 to 1.5 ± 0.4 drugs). None differences were found in SH patients, distinguished in relation to cortisol plasma levels after dexamethasone suppression test (1.8–5 µg/dL, above 5 µg/dL).

Conclusions

SH is linked to relevant cardiovascular and metabolic alterations, leading to worsen clinical outcomes. In eligible patients, adrenalectomy is valid and safe option to treat SH, reducing cardiometabolic abnormalities.

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Authors and Affiliations

  1. Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

    Luigi Petramala, Federica Olmati, Antonio Concistrè, Riccardo Russo, Martina Mezzadri, Maurizio Soldini, Gino Iannucci & Claudio Letizia

  2. Department of Radiology, Nuclear Medicine Section, “Sapienza” University of Rome, Rome, Italy

    Giuseppe De Vincentis

  3. “Pietro Valdoni” Surgery Department, “Sapienza” University of Rome, Rome, Italy

    Giorgio De Toma

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  1. Luigi Petramala
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  2. Federica Olmati
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  9. Giorgio De Toma
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L.P., C.L., G.D.T., and G.I.: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. L.P. and C.L.: protocol/project development and manuscript writing/editing. F.O., R.R., and A.C.: manuscript writing/editing. G.D.V., M.S., and L.P.: data analysis. F.O., R.R., and A.C.: data collection or management and data analysis. M.S., G.I., and G.D.V.: data collection or management.

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Correspondence to Claudio Letizia.

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Petramala, L., Olmati, F., Concistrè, A. et al. Cardiovascular and metabolic risk factors in patients with subclinical Cushing. Endocrine 70, 150–163 (2020). https://doi.org/10.1007/s12020-020-02297-2

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