Cardiovascular events in patients with mild autonomous cortisol secretion: analysis with artificial neural networks

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BACKGROUND: The independent role of mild autonomous cortisol secretion (ACS) in influencing the cardiovascular event (CVE) occurrence is a topic of interest. We investigated the role of mild ACS in the CVE occurrence in patients with adrenal incidentaloma (AI) by standard statistics and artificial neural networks (ANNs).

METHODS: We analyzed a retrospective record of 518 AI patients. Data regarding cortisol levels after 1 mg dexamethasone suppression (1 mg DST) and the presence of obesity (OB), hypertension (AH), type-2 diabetes (T2DM), dyslipidemia (DL), familial CVE history, smoking habit and CVE were collected.

RESULTS: The receiver-operating characteristic curve analysis suggested that 1 mg DST, at a cut-off of 1.8 µg/dL, had the best accuracy for detecting patients with increased CVE risk. In patients with 1 mg-DST ≥1.8 µg/dL (DST+,n = 223), age and prevalence of AH, T2DM, DL and CVE (66 years, 74.5, 25.9, 41.4 and 26.8% respectively) were higher than that of patients with 1 mg-DST ≤1.8 µg/dL (61.9 years, 60.7, 18.5, 32.9 and 10%, respectively,P < 0.05 for all). The CVE were associated with DST+ (OR: 2.46, 95% CI: 1.5-4.1,P = 0.01), regardless of T2DM, AH, DL, smoking habit, gender, observation period and age. The presence of at least two among AH, T2DM, DL and OB plus DST+ had 61.1% sensitivity in detecting patients with CVE. By using the variables selected by ANNs (familial CVE history, age, T2DM, AH, DL and DST+) 78.7% sensitivity was reached.

CONCLUSIONS: Cortisol after 1 mg-DST is independently associated with the CVE occurrence. The ANNs might help for assessing the CVE risk in AI patients.

Original languageEnglish
Pages (from-to)73-83
Number of pages11
JournalEuropean Journal of Endocrinology
Issue number1
Publication statusPublished - Jul 2017


  • Adrenal Gland Neoplasms
  • Adult
  • Age Factors
  • Aged
  • Cardiovascular Diseases
  • Dexamethasone
  • Diabetes Mellitus, Type 2
  • Dyslipidemias
  • Female
  • Humans
  • Hydrocortisone
  • Hypertension
  • Male
  • Middle Aged
  • Neural Networks (Computer)
  • Obesity
  • Prevalence
  • Retrospective Studies
  • Smoking
  • Journal Article
  • Multicenter Study
  • Observational Study


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