Morbidity and Mortality in Autonomous Cortisol Secretion

Benign enlargements of the adrenal glands (adrenal adenomas) are frequent in adults. In the general population these adenomas are rare in subjects below 40 years of age but at the age of 60 and 80 years the prevalence is 6 and 8-10 % respectively. Since these adenomas do not causes obvious symptoms they are almost exclusively found incidentally in patients examined radiologically for other reasons than suspected adrenal disease. These enlargements are thus termed adrenal incidentalomas (AI). AI may secrete cortisol and more than 25 percent of patients with an AI have increased cortisol levels called autonomous cortisol secretion (ACS). Such increased secretion of cortisol may cause metabolic complications such as hypertension, high cholesterol, diabetes and cardiovascular disease. Studies have shown that ACS may cause increased mortality. These studies are however small and have not adequately taking other conditions into account which most likely influences the result. The investigators hypothesis is that ACS is linked to increased mortality as the previous studies have shown. The aim is to perform a larger study on patients with adrenal incidentalomas, both with and without ACS, and compare the mortality rates with a control group matched for age and sex. This study may more precisely describe the cardiovascular risk for ACS and define the risk at different levels of ACS.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

Patients with adrenal incidentalomas examined at Skane University Hospital and Helsingborg Hospital during the period from January 1, 2005 to September 15, 2015.

Exclusion Criteria:

1. Size of incidentaloma below 1 cm
2. Malignant disease with metastases,
3. Incidentaloma not an adenoma but for example malignancy, myelolipoma and bleedings
4. Pheochromocytomas
5. Primary aldosteronism
6. Continuous treatment with systemic glucocorticoid under the last 3 months.
7. Cushing Syndrome
8. Medication affecting dexamethasone metabolism.
9. Treatment with systemic estrogen

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• BACKGROUNDOlsen H, Kjellbom A, Londahl M, Lindgren O. Suppressed ACTH Is Frequently Unrelated to Autonomous Cortisol Secretion in Patients With Adrenal Incidentalomas. J Clin Endocrinol Metab. 2019 Feb 1;104(2):506-512. doi: 10.1210/jc.2018-01029. PMID 30265354
• DERIVEDKjellbom A, Lindgren O, Danielsson M, Olsen H, Londahl M. Mortality Not Increased in Patients With Nonfunctional Adrenal Adenomas: A Matched Cohort Study. J Clin Endocrinol Metab. 2023 Jul 14;108(8):e536-e541. doi: 10.1210/clinem/dgad074.