12326 Is Non-functional Adrenal Incidentaloma (AI) Benign Or A Long-haul Culprit?
Authors: Pun Mehta Jyoti , Ahmad Rauf Faateh , Salafia Carolyn , Salam Sanna , Kay Trousdale Rhonda , Sachmechi Issac 
Published: October 2024

Disclosure: J. Mehta: None. F. Rauf: None. C. Salafia: None. S. Salam: None. R.K. Trousdale: None. I. Sachmechi: None.

Introduction: Patients with non-functional AI have adrenal tumors that are incidentally discovered during abdominal imaging performed for clinical indications unrelated to adrenal glands and their AM serum cortisol post overnight 1 mg dexamethasone suppression test (DST) are ≤1.8µg/dL. There has been emerging evidence that non-functional AI may pose cardiometabolic risks. Hypothesis: Patients considered to have non-functional AI have increased cardiometabolic risks as compared to patients without AI. Methodology: A cohort study via retrospective chart review utilizing electronic medical records across NYC Health and Hospitals sites. The data collection was from 1/1/2000 to 7/31/2022 and 2965 records were reviewed. Primary composite outcome assessed was the presence of at least one out of hypertension, peripheral vascular disease, coronary artery disease, transient ischemic attack or cerebral vascular accident. Target had patients considered to have non-functional AI and ≥5-year follow-up, and the three target cohorts categorized based on AM serum cortisol post 1mg overnight DST were: Target Cohort 1: 0 to 1µg/dL (lower limit inclusive and upper limit exclusive), Target Cohort 2: 1 to 1.5µg/dL, and Target Cohort 3:1.5 to 1.8µg/dL. Control had patients from general adult population with absence of adrenal incidentaloma, absence of pregnancy during the time points of chart review and presence of ≥5-year follow-up. Two by two comparisons were made between target (N=76) versus control (N=100) at baseline and ≥5-year follow-up. The target cohorts were also compared individually against control at baseline and ≥5-year follow-up. Results: Mean age for target and control at follow-up were 64.4 (±12.1) and 56.2 (±14.2) years respectively (association between age and target versus control status of p=0.001). 54% of target had primary outcome at baseline, compared to 36% of control (p=0.017). When target cohorts were compared individually against control at baseline, 70% of Target Cohort 2 had primary outcome compared to 36% of control (p=0.0003). At follow-up, 68% of Target Cohort 2 had primary outcome compared to 47% of control (p=0.028). Discussion and Conclusion: Patients considered to have non-functional AI show correlations between target status and age, and target status and primary outcome. This study’s results clearly show that patients considered to have non-functional AI are not free of their cortisol’s adverse cardiometabolic effects. Non-functional AI, along with Cushing’s and subclinical Cushing’s syndromes, may present a continuum of cortisol secretion that poses cardiometabolic risks. Current clinical guidelines may require re-evaluation such that patients considered to have non-functional AI are monitored regularly for an early diagnosis, prevention and management of cardiometabolic outcomes.

Presentation: 6/3/2024