Higher levels of cortisol secretion from adrenal incidentalomas are associated with an increased risk of cardiovascular disease and death, new research shows. "Cortisol after dexamethasone suppression at 83 nmol/L or higher in patients with adrenal incidentalomas is associated with a 2-to-3-fold increase in mortality. This increase in cortisol after dexamethasone is present in approximately 20% of patients with adrenal incidentalomas," Dr. Henrik Olsen of Skaane University Hospital, in Lund, Sweden, told Reuters Health by email. "We suggest treatment of known cardiovascular risk factors in these patients and incorporation of our results in the decision about which patients to recommend for adrenalectomy," Dr. Olsen said. It's known that autonomous cortisol secretion in patients with adrenal tumors discovered incidentally on imaging (adrenal incidentalomas) is associated with increased mortality, but how specific levels of cortisol secretion affect mortality risk was unclear, he and his colleagues note in Annals of Internal Medicines. The team studied 1,048 consecutive patients (median age, 65 years; 59% women) with adrenal incidentalomas identified between 2005 and 2015 at two hospitals in Sweden. The patients were grouped according to plasma cortisol levels after a 1-mg dexamethasone suppression test (cortisolDST) of < 50 nmol/L (575 patients, 55%), 50 to 82 nmol/L (272 patients, 26%), 83 to 137 nmol/L (119 patients, 11%), and 138 nmol/L and higher (82 patients, 8%). During a median follow-up of 6.4 years, 170 patients died (16.2%). Compared with a cortisolDST below 50, a cortisolDST of 50 to 82 nmol/L was not associated with increased mortality. However, a cortisolDST of 83 to 137 nmol/L was associated with a greater than two-fold increased risk of dying during follow-up (hazard ratio, 2.30; 95% confidence interval, 1.52 to 3.49). Patients with a cortisolDST of 138 nmol/L or higher had a three-fold increased risk of death (HR, 3.04; 95% CI, 1.86 to 4.98). The association between cortisolDST and mortality was linear up to a cortisolDST of 200 nmol/L. Cardiovascular disease was the most common cause of death, indicating that it is the main contributor to increased mortality with higher levels of autonomous cortisol secretion. Based on their observations, the researchers say it's important to treat known cardiovascular risk factors in these patients and use the findings to aid in decisions about whether or not to perform surgery. However, "the beneficial effects of adrenalectomy on mortality need to be proven before it can be recommended on a wider scale," Dr. Olsen told Reuters Health. —Megan Brooks Source
