High Cortisol Secretion Seen in Some Patients With Nonfunctioning Adrenal Tumors

Cortisol levels of 1.2 to 1.79 ug/dL measured via 1 mg overnight dexamethasone suppression testing (F-1mgDST) in patients with nonfunctioning adrenal tumors (NFAT) may be associated with higher rates of hypertension and diabetes and worse cardiometabolic profile, according to study results published in Cardiovascular Diabetology.

Adrenal incidentalomas may be associated with mild autonomous cortisol secretion, defined as hypercortisolism without the classic signs and symptoms suggestive of cortisol excess.

Researchers conducted a retrospective cross-sectional study to assess the potential relationship between cardiometabolic consequences known to be associated with increased cortisol secretion, such as hypertension, diabetes, obesity, dyslipidemia, and CV events, among patients with NFAT. The cut-off of hypothalamic-pituitary-adrenal axis activity parameters with the ability to identify NFAT among patients with metabolic consequences was also assessed.

A total of 615 patients (mean age, 60.15 years) with adrenal incidentalomas were included in the final analysis. The researchers collected data on age, sex, BMI, and cardiometabolic comorbidities. Patients’ basal morning adrenocorticotroph hormone and F-1mgDST levels were assessed at least once within a 1- to 3-month evaluation timeframe.

The researchers reported a significant association between F-1mgDST levels and cardiometabolic comorbidities. Patients with F-1mgDST levels below 1.2 μg/dL (n=289) vs between 1.2 and 1.79 μg/dL (n=326) had significantly higher rates of hypertension alone (38.1% vs 52.5%; P <.001), diabetes alone (13.1% vs 23.3%; P =.001), hypertension plus diabetes (8.3% vs 16.9%; P <.002), and CV events (3.2% vs 7.3%; P =.028).

After adjusting for age, sex, obesity, and dyslipidemia, the researchers noted F-1mgDST levels between 1.2 and 1.79 μg/dL (1.46±0.19; 95% CI, 1.20-1.80) were significantly associated with increased risk for hypertension alone (odd ratio, [OR], 1.55; 95% CI 1.08-2.23; P =.018), diabetes alone (OR, 1.60; 95% CI, 1.01-2.57; P =.045), and both hypertension plus diabetes (OR, 1.96; 95% CI, 1.12-3.41; P =.018). Of note, age was the only factor significantly associated with CV event occurrence (OR, 1.08; 95% CI, 1.03-1.13; P =.02).

Study limitations include its retrospective and cross-sectional design, the short follow-up period, and the lack of an age- and gender-matched control group. The researchers also noted that some patients may have been affected by mild hyperaldosteronism, potentially influencing cardiometabolic complications.

According to the researchers, “[T]he present data may, therefore, encourage large longitudinal studies aimed to better understand if some NFAT patients may have a relatively increased autonomous secretion of cortisol and/or of its precursors…”