RESUMO
CONTEXT: Although metabolic syndrome has been studied in patients with autonomous cortisol secretion, there are limited data for those with nonfunctioning adrenal incidentaloma (NFAI). OBJECTIVE: To assess metabolic syndrome frequency in NFAI patients and controls without adrenal adenoma according to World Health Organization (WHO), National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) and International Diabetes Federation (IDF) criteria. DESIGN: Retrospective and transversal study. PATIENTS: Seventy-four NFAI and 90 controls were evaluated. NFAI diagnosis was established according to current guidelines. The control group was selected based on normal adrenal imaging examinations. MEASUREMENTS: Subjects were categorized by metabolic syndrome presence according to WHO, NCEP-ATP III, AACE/ACE and IDF. RESULTS: Age, gender, ethnicity, body mass index, smoking, menopause, statin and fibrate use were comparable between patients and controls. The frequency of prediabetes, dyslipidaemia and hypertension as well as waist circumference were significantly higher in the NFAI patients compared to the controls. The metabolic syndrome frequency in the NFAI group was significantly higher compared to the normal adrenal group: WHO: 69.2% × 31.0% (P < 0.001); NCEP-ATP III: 81.7% × 44.9% (P < 0.001); AACE/ACE: 77.1% × 31.9% (P < 0.001); IDF: 78.6% × 45.5% (P < 0.001). Logistic regression analysis showed that NFAI was a predictor of metabolic syndrome according to WHO (P = 0.001), NCEP-ATP III (P = 0.005) and AACE/ACE (P = 0.007). CONCLUSIONS: Metabolic syndrome is frequently found in patients with NFAI, and this frequency is higher in NFAI patients than in those with normal adrenal imaging.
Assuntos
Neoplasias das Glândulas Suprarrenais/epidemiologia , Síndrome Metabólica/epidemiologia , Neoplasias das Glândulas Suprarrenais/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Síndrome Metabólica/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
There are limited data regarding the frequency of hypertension in nonfunctioning adrenal incidentaloma (NFAI). Our objectives were to investigate rates of hypertension and resistant hypertension in NFAI patients, and compare them to a control group without adrenal adenoma. We also aimed to evaluate the relationship between cortisol levels after 1 mg-dexamethasone suppression test (DST) and hypertension in NFAI patients. We selected 40 patients with NFAI and 40 control patients over the age of 18 without adrenal lesions on abdominal imaging. Data regarding hypertension, resistant hypertension, number, and type of antihypertensive drugs were collected from each subject. Blood samples for C-reactive protein (CRP), plasma adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEA-S) were also collected from the patients. Age, gender, race, smoking status, menopause status and BMI were comparable between patient and control groups. Patients with NFAI had a higher frequency of hypertension (72.5 vs. 47.5%; p = 0.04), resistant hypertension (37.9 vs. 11.1%; p = 0.04) and took three or more antihypertensive drugs (33.3 vs. 5.2%; p = 0.002) when compared to the controls, respectively. NFAI patients with hypertension had higher mean cortisol levels after 1 mg-DST when compared to NFAI patients without hypertension (1.3 ± 0.3 vs. 1.0 ± 0.4; p = 0.03, respectively). We found a negative correlation between cortisol levels after 1 mg-DST DHEA-S levels (r = -0.61; p < 0.001) and a positive correlation with CRP levels (r = 0.44; p = 0.02). In conclusion, NFAI patients presented a higher frequency of hypertension, resistant hypertension and used more antihypertensive medications when compared to the control group. We found an association between hypertension in NFAI patients and cortisol levels after 1 mg-DST.