Adrenal adenomata displaying mild autonomous cortisol secretion: a service evaluation of cardiometabolic profile routinely screened patients.

Abstract

Introduction: A proportion of adrenal adenomata exhibit autonomous cortisol secretion, now termed mild autonomous cortisol secretion (MACS), as defined by post-1mg overnight dexamethasone suppression test (ONDST) cortisol 51-137 nmol/l. Here, we characterized the cardiometabolic profile of MACS.

Methods: Clinical records of 98 individuals with adrenal adenomata were examined. Subcategorization into MACS1 (ONDST cortisol of 50-137 nmol/l) and MACS2 (ONDST cortisol of >137 nmol/l was created to take account of individuals with ONDST cortisol of more than 137 nmol/l and no diagnosis of Cushing's syndrome.

Results: Diagnosis of MACS1 associated with a higher diagnosis rate of cardiovascular disease (CVD) (17.7% MACS1) vs. non-MACS = nonfunctioning adenoma (NFA) (3.7%) (P = 0.009) and higher rates of prescription of lipid-lowering agents (51.6%) vs. (29.6%) (P = 0.01). ONDST cortisol levels in MACS1 patients correlated with a more adverse lipid profile (for higher low-density lipoprotein cholesterol, r ² = 0.404, P = 0.007; high-density lipoprotein cholesterol r ² = -0.346, P = 0.023; for higher serum triglycerides r ² = 0.282, P = 0.02) in spite of higher rates of statin prescribing. There was a gradient of increasing numbers of antihypertensives prescribed, going from non-MACS NFA to MACS1 to MACS2. Dunn's post hoc analysis indicated an overall more adverse lipid profile in MACS1.

Conclusion: The positive direction of associations between serum cortisol and lipid measures highlights that MACS carries a metabolically adverse lipid profile. Diagnosis of MACS was associated with a higher diagnosis rate of CVD and appropriately higher rates of prescription of lipid-lowering agents and a greater number of antihypertensive agents prescribed. The question remains about whether a specific directed treatment of MACS should be offered beyond risk-factor-mitigating management.