Nonfunctioning Adrenal Incidentaloma

A Novel Predictive Factor for Metabolic Syndrome

Emanuela M. Ribeiro Cavalari; Marcela P. de Paula; Mariana Arruda; Nathália Carraro; Arthur Martins; Kamila de Souza; Maria C. Coelho; Nathalie Anne de Oliveira e Silva de Morais; Aline B. Moraes; Leonardo Vieira Neto

Disclosures

Clin Endocrinol. 2018;89(5):586-595. 

In This Article

Abstract and Introduction

Abstract

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.

Introduction

A nonfunctioning adrenal incidentaloma (NFAI) is an adrenal incidentaloma (AI) with benign radiological characteristics and absence of clinical and laboratory evidence of hormonal hypersecretion.[1] NFAI is the most common subtype and represents approximately 70% of AI cases.[2]

Cortisol excess, endogenous and exogenous, is related to metabolic complications. Several classifications of metabolic syndrome have been proposed over the years by different entities and are shown to be related to an increased risk of cardiovascular disease (CVD).[3] Despite the metabolic syndrome frequency has been studied in autonomous cortisol secretion (ACS), the same does not occur with NFAI.[4–6] To date, there are no studies evaluating NFAI patients by different metabolic syndrome classifications, which have been defined by the most important recognized institutions in this field, and comparing them to controls without adrenal lesions on imaging examination.

Due to this gap in the literature regarding evaluation of this important risk factor for CVD in patients with the most common subtype of AI, the aim of this study was to evaluate the frequency of metabolic syndrome using several criteria classifications from World Health Organization (WHO),[7] National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III),[8,9] American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE)[10] and International Diabetes Federation (IDF)[11] in NFAI patients and compare it to controls without adrenal adenoma.

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