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Vol 74, No 6 (2023)
Original paper
Submitted: 2023-04-12
Accepted: 2023-08-31
Published online: 2023-11-20
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Could a nonfunctional adrenal incidentaloma be a risk factor for increased carotid intima-media thickness and 10-year cardiovascular mortality based on the SCORE algorithm? A study from a single centre in Poland

Magdalena Szychlińska1, Magdalena Rzeczkowska2, Wojciech Matuszewski1, Elżbieta Bandurska-Stankiewicz1
DOI: 10.5603/ep.95139
·
Pubmed: 37994583
·
Endokrynol Pol 2023;74(6).
Affiliations
  1. Clinic of Endocrinology, Diabetology, and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
  2. Department of Imaging, Provincial Specialist Hospital in Olsztyn, Olsztyn, Poland

open access

Vol 74, No 6 (2023)
Original Paper
Submitted: 2023-04-12
Accepted: 2023-08-31
Published online: 2023-11-20

Abstract

Introduction: Adrenal incidentaloma (AI) secreting small amounts of glucocorticoids may cause morphological and functional changes in the blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with AI. But it is unclear whether the nonfunctional adrenal incidentalomas (NFAI) may also be a risk factor for cardiovascular diseases. The aim of this study was to determine the relationship between NFAI, carotid intima-media thickness (CIMT), and cardiovascular risk (CVR) based on Systematic Coronary Risk Evaluation (SCORE) prediction models for Europe.

Material and methods: This study from a single centre in Poland included 48 NFAI patients and 44 individuals in the control group matched for age, sex, and body mass index (BMI). All participants underwent adrenal imaging, biochemical evaluation, measurement of CIMT, and assessment of the 10-year risk of cardiovascular mortality based on the SCORE algorithm. Hormonal evaluation was conducted in AI patients.

Results: The NFAI group showed significantly higher sodium (p = 0.02) and glucose levels in the 2-h oral glucose tolerance test (OGTT) (p = 0.04), a higher CIMT (p < 0.01), and a higher CVR calculated according to the SCORE algorithm (p = 0.03). The estimated glomerular filtration rate (eGFR) was higher in the NFAI group (p = 0.015). Hypertension (p < 0.01) and IGT (p = 0.026) were more common in the NFAI group. Statistically significant positive correlations were found between CIMT and age (r = 0.373, p = 0.003), waist circumference (r = 0.316, p = 0.029), diastolic blood pressure (r = 0.338, p = 0.019), and CVR based on the SCORE algorithm (r = 0.43, p = 0.004).
There was a statistically significant positive correlation between CIMT and serum cortisol levels after 1 mg dexamethasone suppression test (r = 0.33, p = 0.02).

Conclusion: Non-functional adrenal adenomas are associated with increased CIMT and CVR. Early stages of cardiovascular remodelling can be observed in asymptomatic NFAI patients.

Abstract

Introduction: Adrenal incidentaloma (AI) secreting small amounts of glucocorticoids may cause morphological and functional changes in the blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with AI. But it is unclear whether the nonfunctional adrenal incidentalomas (NFAI) may also be a risk factor for cardiovascular diseases. The aim of this study was to determine the relationship between NFAI, carotid intima-media thickness (CIMT), and cardiovascular risk (CVR) based on Systematic Coronary Risk Evaluation (SCORE) prediction models for Europe.

Material and methods: This study from a single centre in Poland included 48 NFAI patients and 44 individuals in the control group matched for age, sex, and body mass index (BMI). All participants underwent adrenal imaging, biochemical evaluation, measurement of CIMT, and assessment of the 10-year risk of cardiovascular mortality based on the SCORE algorithm. Hormonal evaluation was conducted in AI patients.

Results: The NFAI group showed significantly higher sodium (p = 0.02) and glucose levels in the 2-h oral glucose tolerance test (OGTT) (p = 0.04), a higher CIMT (p < 0.01), and a higher CVR calculated according to the SCORE algorithm (p = 0.03). The estimated glomerular filtration rate (eGFR) was higher in the NFAI group (p = 0.015). Hypertension (p < 0.01) and IGT (p = 0.026) were more common in the NFAI group. Statistically significant positive correlations were found between CIMT and age (r = 0.373, p = 0.003), waist circumference (r = 0.316, p = 0.029), diastolic blood pressure (r = 0.338, p = 0.019), and CVR based on the SCORE algorithm (r = 0.43, p = 0.004).
There was a statistically significant positive correlation between CIMT and serum cortisol levels after 1 mg dexamethasone suppression test (r = 0.33, p = 0.02).

Conclusion: Non-functional adrenal adenomas are associated with increased CIMT and CVR. Early stages of cardiovascular remodelling can be observed in asymptomatic NFAI patients.

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Keywords

nonfunctional adrenal incidentaloma; intima-media thickness; cardiovascular risk

About this article
Title

Could a nonfunctional adrenal incidentaloma be a risk factor for increased carotid intima-media thickness and 10-year cardiovascular mortality based on the SCORE algorithm? A study from a single centre in Poland

Journal

Endokrynologia Polska

Issue

Vol 74, No 6 (2023)

Article type

Original paper

Published online

2023-11-20

Page views

517

Article views/downloads

172

DOI

10.5603/ep.95139

Pubmed

37994583

Bibliographic record

Endokrynol Pol 2023;74(6).

Keywords

nonfunctional adrenal incidentaloma
intima-media thickness
cardiovascular risk

Authors

Magdalena Szychlińska
Magdalena Rzeczkowska
Wojciech Matuszewski
Elżbieta Bandurska-Stankiewicz

References (48)
  1. Bovio S, Cataldi A, Reimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006; 29(4): 298–302.
    CrossRefPubMed
  2. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008; 190(5): 1163–1168.
    CrossRefPubMed
  3. Zeiger MA, Thompson GB, Duh QY, et al. American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009; 15(5): 450–453.
    CrossRefPubMed
  4. Bednarczuk T, Bolanowski M, Sworczak K, et al. Adrenal incidentaloma in adults — management recommendations by the Polish Society of Endocrinology. Endokrynol Pol. 2016; 67(2): 234–258.
    CrossRefPubMed
  5. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016; 175(2): G1–G34.
    CrossRefPubMed
  6. Kebebew E, Kebebew E, Lee JA, et al. Observation or laparoscopic adrenalectomy for adrenal incidentaloma? A surgical decision analysis. Med Sci Monit. 2006; 12(9): CR355–CR362.
    PubMed
  7. Terzolo M, Pia A, Alì A, et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab. 2002; 87(3): 998–1003.
    CrossRefPubMed
  8. Altieri B, Tirabassi G, Della Casa S, et al. Adrenocortical tumors and insulin resistance: What is the first step? Int J Cancer. 2016; 138(12): 2785–2794.
    CrossRefPubMed
  9. Samsel R, Papierska L, Nowak K, et al. Adrenal "nonadenoma" - clinical characteristics and risk of malignancy. Endokrynol Pol. 2021; 72(5): 492–497.
    CrossRefPubMed
  10. Terzolo M, Bovio S, Pia A, et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma. Eur J Endocrinol. 2005; 153(2): 307–315.
    CrossRefPubMed
  11. Berrabeh S, Bentebbaa F, Elmehraoui O. Adrenal incidentaloma: metabolic profile of non-secretory adrenal adenomas. In: Endocrine Abstracts Vol 81 Bioscientifica 2022.
  12. Krzyżewska K, Niemczuk E, Myśliwiec BJ, et al. Glucose metabolism disorders in patients with non-functioning adrenal adenomas - single-centre experience. Endokrynol Pol. 2017; 68(4): 416–421.
    CrossRefPubMed
  13. Isidori AM, Graziadio C, Paragliola RM, et al. ABC Study Group. The hypertension of Cushing's syndrome: controversies in the pathophysiology and focus on cardiovascular complications. J Hypertens. 2015; 33(1): 44–60.
    CrossRefPubMed
  14. Yiu KH, Marsan NA, Delgado V, et al. Increased myocardial fibrosis and left ventricular dysfunction in Cushing's syndrome. Eur J Endocrinol. 2012; 166(1): 27–34.
    CrossRefPubMed
  15. Di Dalmazi G, Vicennati V, Rinaldi E, et al. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur J Endocrinol. 2012; 166(4): 669–677.
    CrossRefPubMed
  16. Anagnostis P, Karras SN, Athyros VG, et al. Subclinical Cushing's syndrome and cardiovascular disease. Lancet Diabetes Endocrinol. 2014; 2(5): 361.
    CrossRefPubMed
  17. Piepoli MF, Hoes AW, Agewall S, et al. Authors/Task Force Members:, Authors/Task Force Members, Additional Contributor: Simone Binno (Italy), Document Reviewers:, ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381.
    CrossRefPubMed
  18. SCORE2-Diabetes Working Group and the ESC Cardiovascular Risk Collaboration, SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021; 42(25): 2439–2454.
    CrossRefPubMed
  19. Iwakiri T, Yano Y, Sato Y, et al. Usefulness of carotid intima-media thickness measurement as an indicator of generalized atherosclerosis: findings from autopsy analysis. Atherosclerosis. 2012; 225(2): 359–362.
    CrossRefPubMed
  20. Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007; 115(4): 459–467.
    CrossRefPubMed
  21. Naqvi TZ, Lee MS. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging. 2014; 7(10): 1025–1038.
    CrossRefPubMed
  22. de Groot E, van Leuven SI, Duivenvoorden R, et al. Measurement of carotid intima-media thickness to assess progression and regression of atherosclerosis. Nat Clin Pract Cardiovasc Med. 2008; 5(5): 280–288.
    CrossRefPubMed
  23. Juonala M, Kähönen M, Laitinen T, et al. Effect of age and sex on carotid intima-media thickness, elasticity and brachial endothelial function in healthy adults: the cardiovascular risk in Young Finns Study. Eur Heart J. 2008; 29(9): 1198–1206.
    CrossRefPubMed
  24. Sandrock M, Hansel J, Schulze J, et al. Sequentially based analysis versus image based analysis of Intima Media Thickness in common carotid arteries studies - do major IMT studies underestimate the true relations for cardio- and cerebrovascular risk? Cardiovasc Ultrasound. 2008; 6: 32.
    CrossRefPubMed
  25. Willeit P, Thompson SG, Agewall S, et al. PROG-IMT study group. Inflammatory markers and extent and progression of early atherosclerosis: Meta-analysis of individual-participant-data from 20 prospective studies of the PROG-IMT collaboration. Eur J Prev Cardiol. 2016; 23(2): 194–205.
    CrossRefPubMed
  26. O'Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999; 340(1): 14–22.
    CrossRefPubMed
  27. van Popele NM, Grobbee DE, Bots ML, et al. Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke. 2001; 32(2): 454–460.
    CrossRefPubMed
  28. Fan J, Tang J, Fang J, et al. Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions. Med Sci Monit. 2014; 20: 2132–2141.
    CrossRefPubMed
  29. Coca Payeras A, Williams B, Mancia G, et al. Authors/Task Force Members:, ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
    CrossRefPubMed
  30. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7): 412–419.
    CrossRefPubMed
  31. American Diabetes Association. Abridged for Primary Care Providers. Clin Diabetes. 2020; 38(1): 10–38.
    CrossRefPubMed
  32. Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986; 74(6): 1399–1406.
    CrossRefPubMed
  33. Szychlińska M, Baranowska-Jurkun A, Matuszewski W, et al. Markers of Subclinical Cardiovascular Disease in Patients with Adrenal Incidentaloma. Medicina (Kaunas). 2020; 56(2).
    CrossRefPubMed
  34. Lupoli R, Ambrosino P, Tortora A, et al. Markers of atherosclerosis in patients with Cushing's syndrome: a meta-analysis of literature studies. Ann Med. 2017; 49(3): 206–216.
    CrossRefPubMed
  35. Tauchmanovà L, Rossi R, Biondi B, et al. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab. 2002; 87(11): 4872–4878.
    CrossRefPubMed
  36. Androulakis II, Kaltsas GA, Kollias GE, et al. Patients with apparently nonfunctioning adrenal incidentalomas may be at increased cardiovascular risk due to excessive cortisol secretion. J Clin Endocrinol Metab. 2014; 99(8): 2754–2762.
    CrossRefPubMed
  37. Tuna MM, Imga NN, Doğan BA, et al. Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis. J Endocrinol Invest. 2014; 37(8): 765–768.
    CrossRefPubMed
  38. Imga NN, Ucar Elalmis O, Muslum Tuna M, et al. The Relationship Between Increased Epicardial Fat Thickness and Left Ventricular Hypertrophy and Carotid Intima-Media Thickness in Patients With Nonfunctional Adrenal Incidentaloma. Int J Endocrinol Metab. 2016; 14(3): e37635.
    CrossRefPubMed
  39. Evran M, Akkuş G, Berk Bozdoğan İ, et al. Carotid Intima-Media Thickness as the Cardiometabolic Risk Indicator in Patients with Nonfunctional Adrenal Mass and Metabolic Syndrome Screening. Med Sci Monit. 2016; 22: 991–997.
    CrossRefPubMed
  40. Emral R, Aydoğan Bİ, Köse AD, et al. Could a nonfunctional adrenal incidentaloma be a risk factor for increased carotid intima-media thickness and metabolic syndrome. Endocrinol Diabetes Nutr (Engl Ed). 2019; 66(7): 402–409.
    CrossRefPubMed
  41. Cansu GB, Sarı R, Yılmaz N, et al. Markers of Subclinical Cardiovascular Disease in Nonfunctional Adrenal Incidentaloma Patients without Traditional Cardiovascular Risk Factors. Exp Clin Endocrinol Diabetes. 2017; 125(1): 57–63.
    CrossRefPubMed
  42. Di Dalmazi G, Vicennati V, Rinaldi E, et al. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur J Endocrinol. 2012; 166(4): 669–677.
    CrossRefPubMed
  43. Saruta T, Sato A, Funder JW, et al. Increased expression of vascular angiotensin II type 1A receptor gene in glucocorticoid-induced hypertension. J Hypertens. 1994; 12(5): 511–516.
    PubMed
  44. Wang J, Zhu Y, Wang Z, et al. Hypertension Resolution after Laparoscopic Adrenal Tumor Resection in Patients of Adrenal Incidentaloma with Normal Hormone Levels. Urol Int. 2023; 107(2): 193–201.
    CrossRefPubMed
  45. Iacobone M, Citton M, Viel G, et al. Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing's syndrome. Surgery. 2012; 152(6): 991–997.
    CrossRefPubMed
  46. Mitchell IC, Auchus RJ, Juneja K, et al. "Subclinical Cushing's syndrome" is not subclinical: improvement after adrenalectomy in 9 patients. Surgery. 2007; 142(6): 900–5; discussion 905.e1.
    CrossRefPubMed
  47. Bancos I, Alahdab F, Crowley RK, et al. Therapy of Endocrine Disease: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing's syndrome: a systematic review and meta-analysis. Eur J Endocrinol. 2016; 175(6): R283–R295.
    CrossRefPubMed
  48. Raffaelli M, De Crea C, D'Amato G, et al. Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome. Surgery. 2017; 161(1): 264–271.
    CrossRefPubMed

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