Cardiovascular and metabolic risk factors in patients with subclinical Cushing

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ORIGINAL ARTICLE

Cardiovascular and metabolic risk factors in patients with subclinical Cushing Luigi Petramala1 Federica Olmati1 Antonio Concistrè1 Riccardo Russo1 Martina Mezzadri1 Maurizio Soldini1 Giuseppe De Vincentis2 Gino Iannucci1 Giorgio De Toma3 Claudio Letizia1 ●

















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Received: 13 January 2020 / Accepted: 28 March 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020

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. Keywords Subclinical Cushing Cardiovascular risk Glucose metabolism Metabolic syndrome Atherosclerosis ●



Introduction The incidentally discovered adrenal mass during exams not strictly related to adrenal disorders is defined “adrenal incidentaloma” (AI) [1, 2]. High availability and routinely use of radiological imaging leads to discover AI in more than 10% of adults, up to 30% in subjects older than

* Claudio Letizia [email protected] 1

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

2

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

3

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





80 years [2, 3]. Standardized and widespread hormonal evaluation allowed to find in more than 30% of AI an autonomous overp