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Cited by 89Adrenal and Paraganglionic TumorsHormonal Regulation and HypertensionAdrenal Hormones and Disorders

Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma

Terzolo, Massimo, Bovio, Silvia, Pia, Anna, Conton, Pier Antonio, Reimondo, Giuseppe, Dall’Asta, Chiara, Bemporad, Donatella, Angeli, Alberto +4 more·2005·European Journal of Endocrinology
DOI 10.1530/eje.1.01959
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Abstract

OBJECTIVE: There is scant information on the morbidity associated with subclinical Cushing's syndrome in patients with a clinically inapparent adrenal adenoma. In the present study, we have determined the prevalence of alterations of the hypothalamic-pituitary-adrenal axis in such patients and examined whether any correlation between endocrine data and the clinical phenotype exists. DESIGN AND METHODS: A multi-institutional retrospective study was carried out on 210 patients (135 women and 75 men aged 19-81 years) with an adrenal adenoma detected serendipitously between 1996 and 2000 in four referral centers in Italy. RESULTS: Hypertension was observed in 53.8%, obesity in 21.4% and hyperglycemia in 22.4% of patients. The 47 patients with midnight serum cortisol >5.4 microg/dl, a value corresponding to the 97th centile of 100 controls, were older and displayed greater fasting glucose (120.4+/-52.2 mg/dl vs 105.1+/-39.2 mg/dl, P = 0.04) and systolic blood pressure (148.3+/-14.6 mmHg vs 136.4+/-16.2 mmHg, P = 0.0009) than the 113 patients with normal cortisol levels. The difference in systolic blood pressure remained statistically significant (P = 0.009) when age was used as a covariate. The percentage of hypertensive patients undergoing treatment was not different between the two groups (90.5 and 97.1%) but the percentage of patients with controlled hypertension was significantly lower among the hypercortisolemic patients (12.5 vs 32.4%, P = 0.04). Glycated haemoglobin (HbA1c) levels were higher in the hypercortisolemic diabetic patients (8.9+/-1.1% vs 7.1+/-1.3%, P = 0.005). CONCLUSIONS: Elevated midnight cortisol concentration is a reliable test to select a subgroup of patients with a clinically inapparent adrenal adenoma with an adverse cardiovascular risk profile.

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  • Autonomous cortisol secretion in patients with adrenal incidentaloma has been associated with hypertension, insulin resistance, type 2 diabetes mellitus, obesity, metabolic syndrome, and increased mortality.

    “Despite the absence of florid signs and symptoms, ACS in patients AI has been associated with hypertension (215), insulin resistance (216), type 2 diabetes mellitus (217), obesity (218), metabolic syndrome (219), and increased mortality (75).”

    From Adrenal incidentaloma (2020) · cites this paper as [218]

  • Chronic mild cortisol secretion abnormality may be associated with classic metabolic and cardiovascular complications of hypercortisolism.

    “A chronic mild cortisol secretion abnormality may be associated with classic metabolic and cardiovascular complications of hypercortisolism (, -).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [213]

  • In patients with adrenal incidentalomas, cortisol secretion forms a continuum from normal to clearly increased and varies greatly within the same person.

    “particularly in AI patients, cortisol secretion is a continuum from completely normal to clearly increased levels, and it is highly variable in the same individual (3,22).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [22]

  • Midnight serum cortisol is a promising tool for diagnosing subclinical hypercortisolism, but its use is limited by the need for hospital admission.

    “Even if midnight serum cortisol (MSeC) has been shown to be a promising tool for diagnosing SH (22), its use is limited by the need of the hospital admission for the cumbersome procedure, and it could be used as a confirmative test in selected patients (60).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [22]

  • Difficulties in defining a follow-up protocol relate to the variability of cortisol secretion, because even a 2-year follow-up may be too short to ascertain subclinical hypercortisolism.

    “The difficulties in defining a protocol are related to the variability of cortisol secretion in these patients (3,22) because even a 2-yr follow-up may be too short to ascertain the presence of SH (79).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [22]

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Authors
Terzolo, M., Bovio, S., Pia, A., Conton, P. A., Reimondo, G., Dall’Asta, C., Bemporad, D., Angeli, A., Opocher, G., Mannelli, M., Ambrosi, B., & Mantero, F.
Affiliations
  • University of Turin (IT)
  • University of Padua (IT)
  • University of Milan (IT)
  • University of Florence (IT)
  • Istituto Oncologico Veneto (IT)
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2005-08
Volume
153
Issue
2
Pages
307-315
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje.1.01959
OpenAlex
W2156326115
Cited by
89
References
63
Citations by year
2025: 2 · 2024: 1 · 2023: 7 · 2022: 2 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 9 · 2015: 5 · 2014: 6 · 2013: 3 · 2012: 7
FWCI
3.50
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
Ministero dell'Università e della Ricerca
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
subclinical Cushing's syndrome, adrenal adenoma, hypothalamic-pituitary-adrenal axis, cardiovascular risk, hypertension, hypercortisolism, diabetes mellitus, HbA1c, obesity, hyperglycemia
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Circadian Rhythm, Female, Humans, Hydrocortisone, Hypertension, Male, Middle Aged, Phenotype, Retrospective Studies, Risk Factors, Biomarkers, Prevalence, Dehydroepiandrosterone Sulfate

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