High prevalence of frailty in patients with adrenal adenomas and adrenocortical hormone excess: a cross-sectional multi-centre study with prospective enrolment
Open accessAbstract
Objective: Frailty, characterized by multi-system decline, increases vulnerability to adverse health outcomes and can be measured using Frailty Index (FI). We aimed to assess the prevalence of frailty in patients with adrenal disorders (based on hormonal sub-type) and examine association between FI and performance-based measures of physical function. Design: Multi-centre, cross-sectional study (March 2019-August 2022). Methods: Adult patients with adrenal disorders (non-functioning adrenal adenomas [NFA], mild autonomous cortisol secretion [MACS], Cushing syndrome [CS], primary aldosteronism [PA]) and referent subjects without adrenal disorders completed a questionnaire encompassing 47 health variables (comorbidities, symptoms, daily living activities). FI was calculated as the average score of all variables and frailty defined as FI ≥ 0.25. Physical function was assessed with hand grip, timed up-and-go test, chair rising test, 6-minute walk test, and gait speed. Results: Compared to referent subjects (n = 89), patients with adrenal disorders (n = 520) showed increased age, sex, and body mass index-adjusted prevalence of frailty (CS [odds ratio—OR 19.2, 95% confidence interval—CI 6.7-70], MACS [OR 12.5, 95% CI 4.8-42.9], PA [OR 8.4, 95% CI 2.9-30.4], NFA [OR 4.5, 95% CI 1.7-15.9]). Prevalence of frailty was similar to referent subjects when post-dexamethasone cortisol was <28 nmol/L and was higher when post-dexamethasone cortisol was 28-50 nmol/L (OR 4.6, 95% CI 1.7-16.5). FI correlated with all measures of physical function (P < .001). Conclusions: Whilst frailty prevalence was highest in patients with adrenocortical hormone excess, even patients with NFA demonstrated an increased prevalence compared to the referent population. Future longitudinal studies are needed to evaluate the impact of various management strategies on frailty.
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Although overt physical features may be absent, the subtle hypercortisolism seen in MACS has been associated with adverse cardiovascular and metabolic outcomes, including hypertension, diabetes, dyslipidemia, weight gain, osteoporosis, increased frailty, and increased mortality.
“Although overt physical features may be absent, the subtle hypercortisolism seen in MACS has been associated with adverse cardiovascular and metabolic outcomes, including hypertension, diabetes, dyslipidemia, weight gain, osteoporosis, increased frailty, and increased mortality (33, 34, 97-101).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [99]
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Self-citation
- Authors
- Dogra, P., Šambula, L., Saini, J., Thangamuthu, K., Athimulam, S., Delivanis, D. A., Baikousi, D. A., Nathani, R., Zhang, C. D., Genere, N., Salman, Z., Turcu, A. F., Ambroziak, U., Garcia, R. G., Achenbach, S. J., Atkinson, E. J., Singh, S., LeBrasseur, N. K., Kastelan, D., & Bancos, I.
- Affiliations
- Mayo Clinic (US)
- Department of Internal Medicine, General Hospital Koprivnica , Zeljka Selingera 1, 48000, Koprivnica , Croatia
- Henry Ford Health (US)
- Evangelismos Hospital (GR)
- Washington University in St. Louis (US)
- University of Michigan (US)
- Medical University of Warsaw (PL)
- The University of Texas Southwestern Medical Center (US)
- Department of Endocrinology, University Hospital Zagreb , Kispaticeva 12, 10000 Zagreb , Croatia
- Corresponding author
- Bancos, Irina
- ORCID
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-08-17
- Volume
- 189
- Issue
- 3
- Pages
- 318-326
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- PMC
- PMC10479159
- OpenAlex
- W4385968480
- Cited by
- 38
- References
- 35
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 11 · 2023: 1
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute of Aging
- National Institutes of Health (K23DK121888, R03DK132121, R03AG71934)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- frailty, adrenal adenoma, frailty index, Cushing's syndrome, primary aldosteronism, mild autonomous cortisol secretion, non-functioning adrenal adenoma, physical function, walking speed, Timed Up and Go test, 6-minute walk test, grip strength
- MeSH terms
- Frailty, Adenoma, Adult, Cross-Sectional Studies, Cushing Syndrome, Dexamethasone, Humans, Hydrocortisone, Prospective Studies, Prevalence, Adrenocortical Adenoma, Hand Strength
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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