Cardiovascular complications of mild autonomous cortisol secretion

Carmen Aresta, Vittoria Favero, Valentina Morelli, Luca Giovanelli, Chiara Parazzoli, Alberto Falchetti, Flavia Pugliese, Luigi Gennari, Fabio Vescini, Antonio Salcuni, Alfredo Scillitani, Luca Persani, Iacopo Chiodini

Research output: Contribution to journalReview articlepeer-review

Abstract

Adrenal incidentalomas (AI) may be associated with a mild autonomous cortisol secretion (MACS) in up to one third of cases. There is growing evidence that MACS patients actually present increased risk of cardiovascular disease and higher mortality rate, driven by increased prevalence of known cardiovascular risk factors, as well as accelerated cardiovascular remodelling. Adrenalectomy seems to have cardiometabolic beneficial effects in MACS patients but their management is still a debated topic due to the lack of high-quality studies. Several studies suggested that so called “non-functioning” AI may be actually “functioning” with an associated increased cardiovascular risk. Although the individual cortisol sensitivity and peripheral activation have been recently suggested to play a role in influencing the cardiovascular risk even in apparently eucortisolemic patients, to date the degree of cortisol secretion, as mirrored by the cortisol levels after dexamethasone suppression test remains the best predictor of an increased cardiovascular risk in AI patients. However, whether or not the currently used cut-off set at 50 nmol/L for cortisol levels after dexamethasone suppression could be considered completely reliable in ruling out hypercortisolism remains unclear.

Original languageEnglish
Article number101494
JournalBest Practice and Research: Clinical Endocrinology and Metabolism
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • adrenal incidentaloma
  • cardiovascular disease
  • diabetes mellitus
  • hypercortisolism
  • hypertension
  • mild autonomous cortisol secretion

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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