Secretion of autonomous cortisol linked to mortality in adrenal incidentalomas patients: Study

Sweden: Autonomous cortisol secretion is associated with a 2- to 3-fold increased risk for cardiovascular disease and death in patients with adrenal incidentalomas, according to a recent study in Annals of Internal Medicine. The findings would be useful for informing decisions about patients to be recommended for adrenalectomy.

Autonomous cortisol secretion in adrenal incidentalomas patients is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available.

Researchers from Skane University Hospital, Sweden, studied consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 at two hospitals in Sweden to measure the association between mortality and levels of autonomous cortisol secretion. Patients were grouped according to plasma cortisol levels of less than 50, 50 to 82, 83 to 137, or 138 nmol/L and higher. Data were collected from national registers for up to 14 years.

The researchers found that the risk for mortality increased linearly until cortisol levels reached 200 nmol/L. A cortisolDST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisolDST of 138 nmol/L or higher was associated with a 3-fold increase in mortality. A cortisol level in the 50 to 82 nmol/L range was not associated with an increased death risk within 5 to 10 years.

Based on these results, the authors recommend that clinicians treat known cardiovascular risk factors in these patients and incorporate findings in treatment decisions, including whether or not to perform surgery.

"The association between mortality and cortisolDST increased linearly until cortisolDST reached 200 nmol/L. A cortisolDST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisolDST of 138 nmol/L or higher was associated with a 3-fold increase in mortality," they wrote. "Additional studies should be done, and until those studies are completed some clinicians may consider these findings when deciding which patients to recommend for surgery."

Reference:

The study titled, "Association Between Mortality and Levels of Autonomous Cortisol Secretion by Adrenal Incidentalomas," is published in Annals of Internal Medicine.

DOI: https://www.acpjournals.org/doi/10.7326/M20-7946