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Concomitant alterations of metabolic parameters, cardiovascular risk factors and altered cortisol secretion in patients with adrenal incidentalomas during prolonged follow‐up
Author(s) -
Papanastasiou Labrini,
Alexandraki Krystallenia Ι.,
Androulakis Ioannis I.,
Fountoulakis Stelios,
Kounadi Theodora,
Markou Athina,
Tsiavos Vaios,
Samara Christianna,
Papaioannou Theodoros G.,
Piaditis George,
Kaltsas Gregory
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13294
Subject(s) - medicine , adrenal adenoma , endocrinology , concomitant , insulin resistance , diabetes mellitus , gastroenterology , adrenocortical adenoma , adenoma
Summary Objective Adrenal incidentalomas ( AI ) are associated with metabolic and hormonal abnormalities, most commonly autonomous cortisol secretion ( ACS ). Data regarding alterations of insulin resistance ( IR ) and ACS after prolonged follow‐up are limited. We investigated the evolution of IR , cortisol secretion and ACS development in patients with AI during prolonged follow‐up. Design Prospective study in a tertiary hospital. Patients and measurements Seventy‐one patients with AI [51 nonfunctioning ( NFAI ) and 20 ACS ] and 5·54 ± 1·7 years follow‐up underwent testing for ACS and oral glucose tolerance test to determine IR indices and adrenal imaging. Results At follow‐up, 16/51 (31%) NFAI patients converted to ACS , while two with previous ACS reverted to NFAI ; 21% (7/33) of patients who did not covert to ACS exhibited high urinary‐free cortisol (H‐ UFC ) levels. All AI patients developed deterioration of IR irrespective of their cortisol secretory status. Eight patients developed newly diagnosed type 2 diabetes (9·8% NFAI and 15% ACS , respectively) and 14 IR (17·6% NFAI and 25% ACS , respectively). Adenoma size increased from 2·1 ± 0·8 to 2·3 ± 0·8 cm, whereas IR correlated with postdexamethasone cortisol level and adenoma size increase. IR showed an incremental continuum trend from normal UFC (Ν‐ UFC ), to H‐ UFC , C‐ ACS and ACS patients. Conclusions New‐onset ACS developed in 31% patients with NFAI , whereas 21% of NFAI patients had H‐ UFC levels. All AI patients as a group and the subgroups of N‐ UFC , H‐ UFC , C‐ ACS and ACS patients developed deterioration of metabolic parameters during follow‐up that was more prominent in ACS patients.