Cardiovascular Risk in Patients With Non-Functional Adrenal Incidentaloma
Condition: Adrenal Cortex Neoplasms
MeSH terms: Adrenocortical Adenoma; Adrenal Cortex Neoplasms
Study type: Observational

Summary: 
      Between September 2006 and September 2008, 35 patients (32 women and 3 men; mean age 49years
      with adrenal incidentaloma (AI) were prospectively evaluated at the Department of
      Endocrinology and General Surgery of Istanbul University, Istanbul Medical Faculty.

      All patients with AI underwent physical examination, including waist circumference. Body mass
      Index (BMI) was calculated as weight (kg)/ height (m) squared. A BMI > 30 was considered an
      index of obesity. A waist circumference > 88 cm in women and > 95 cm in men was considered
      the cutoff for visceral obesity in accordance to the Adult Treatment Panel III (ATP III)
      metabolic syndrome criteria. Systolic blood pressure (SBP) and diastolic blood pressure (DBP)
      were measured from the right brachial artery of the patients in a supine position after 10
      minutes of rest by using a pneumatic sphygmomanometer by the same doctor.
    

Detailed description: 
      None of the patients with AI showed specific signs and/or symptoms of hormone excess and none
      were on hormonal therapy. All patients underwent the following endocrine workup aimed to
      study the hypothalamic-pituitary-adrenal axis. Serum cortisol, and plasma corticotropin
      (ACTH) were determined in basal conditions. All patients underwent an overnight 1-mg
      dexamethasone test. The suppression was adequate when morning cortisol fell below 1.8 lg/dL
      [21]. If inadequate, a two-day low-dose dexamethasone (DXM) suppression test was performed (2
      mg, four times a day for 2 days). Suppressibility was indicated when morning cortisol fell
      below 1.8 g/dL after the last dose of dexamethasone. In all patients, urinary metanephrine,
      and normetanephrine excretion were within normal limits and upright plasma aldosterone to
      plasma renin activity ratio was lower than 20, excluding pheochromocytoma and primary
      aldosteronism.

      Metabolic syndrome criteria Metabolic syndrome criteria were determined according to the ATP
      III and IDF 2005 guideline and modified as follows; (1) a waist circumference > 88 cm in
      women and > 94 cm in men, (2) fasting glucose concentrations >100 mg/dl, (3) triglyceride
      concentrations >150 mg/dl, (4) HDL cholesterol <40 mg/dl in men and <50 mg/dl in women, (5)
      patients with hypertensive or on antihypertensive medication. Presence of waist criteria plus
      at least two other criteria were accepted as sufficient for the presence of metabolic
      syndrome. According to the IDF 2005 guideline, population-specific waist circumferences were
      also used to evaluate abdominal obesity and metabolic syndrome. For this purpose, a waist
      circumference of > 83 cm for women and > 95 cm for men were regarded as cut-offs for the
      presence of abdominal obesity.

      Cardiovascular Risk Parameters Cardiovascular Risk Parameters were as follows according to
      ATP III; (1) family history of premature ischemic heart disease (ischemic heart disease in
      male first-degree relatives < 55 years, in female first degree relatives < 65 years (2) for
      male patients age > 45 years, for female patients age > 55 years or being in menopausal
      state, (3) HDL cholesterol <40 mg/dl in men and <50 mg/dl in women (4) patients with
      hypertensive or on antihypertensive medication, (5) patients regarded as diabetic (6) current
      smokers.
    

Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Study parameters at the patients with AI (group 1) were compared with and control subjects.

        Thirty-five subjects comparable for sex, age, and BMI were enrolled as a control group
        (group 2). The other control group (group 3) of 35 healthy individuals matched for sex,
        age, BMI, metabolic syndrome criteria.
      
Keywords: adrenal incidentaloma; cardiovascular risk