Publication: Nonfonksiyone Adrenal Adenom ve Subklinik Cushing Sendromu Saptanan Adrenal Adenomlarda Klinik, Hormonal, Metabolik Parametreler ve Kardiyovasküler Risk Değerlendirmesi
Abstract
Giriş ve Amaç: Hormonal olarak aktivite göstermeyen adrenal lezyonlar, nonfonksiyone adrenal adenom (NFAA) olarak kabul edilir ve çoğunlukla klinik takibe alınır. Subklinik Cushing Sendromu (SCS), Cushing Sendromunun (CS) klinik semptom ve bulguları olmaksızın otonom kortizol hipersekresyonu ile karakterize bir sendromdur ve insidentalomalarla ilişkilendirilir. Bu durumlar, obezite, insülin direnci, dislipidemi, vertebral fraktür ve hipertansiyon gibi metabolik sorunlara yol açar ve kardiyovasküler hastalıklar için bir risk faktörü olarak kabul edilir. Bu çalışmada NFAA ve SCS tanılı olguların demografik, metabolik, hormonal parametreleri ve kardiyovasküler risk profilleri retrospektif olarak değerlendirilmiştir., Gereç ve Yöntem: 15 Aralık 2020 ve 15 Aralık 2023 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Endokrinoloji Kliniğinde yatırılıp takip edilen NFAA ve SCS tanılı 18 yaş üstü 386 olgu çalışmaya dahil edildi. Tüm olgularda yaş, cinsiyet, boy, kilo, vücut kitle indeksi (VKİ), bel çevresi, kalça çevresi, bel/kalça oranı (BKO), sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB) gibi demografik veriler tanımlayıcı ve karşılaştırılmalı olarak değerlendirildi. Tanı sırasında kullanılan bilgisayarlı tomografi (BT) veya magnetik rezonans görüntüleme (MRG) sonucunda tespit edilen adenom boyutu ve bilateral veya unilateral olup olmadığı kaydedildi. Bunlar dışında olguların takip edilme veya cerrahi yapılma durumları değerlendirildi. Komorbidite olarak prediyabet, metabolik sendrom (MS), diabetes mellitus (DM), hipertansiyon (HT), obezite, dislipidemi, kardiyovasküler hastalık (KVH), kronik kalp yetmezliği (KKY) ve osteoporoz değerlendirildi. Tüm veriler iki grup arasında karşılaştırıldı. Bulgular: Olguların 291'i (%75,4) kadın, 95'i (%24,6) erkekti. VKİ ortalama 31,6 (±6,4) kg/m2, bel çevresi 106,06 (±14,38) cm ve BKO 0,93 (±0,08) idi. Tüm olguların 324'ü (%83,9) NFAA, 62'si (%16,1) SCS idi. Her iki grubun yaş, cinsiyet ve metabolik özellikleri benzerdi. NFAA grubunda 38 (%12), SCS grubunda ise 17 (%28) olgunun adrenal kitlesi bilateraldi (p=0,002). NFAA grubunda 3 (%1), SCS grubunda 12 (%19) olguya cerrahi operasyon uygulandı (p<0,001). Adenom boyutu ortanca (IQR) değeri NFAA grubunda 20,00 (13,00) mm, SCS grubunda 26,50 (15,00) mm idi (p<0,001). Glukoz ortanca (IQR) değeri NFAA grubunda 99,60 (24,95) mg/dl, SCS grubunda 107,15 (55,28) mg/dl idi. (p=0,019). ACTH NFAA grubunda 15,9 (12,08) pg/ml, SCS grubunda 9,3 (9,53) pg/ml idi (p<0,001). DHEAS, NFAA grubunda 62,40 (61,75) µg/dl, SCS grubunda 33,50 (40,38) µg/dl idi (p=0,042). HT, NFAA grubunda 193 (%60), SCS grubunda 46 (%74) olguda mevcuttu (p<0,001). SCS tanılı 62 olgunun 50'si (%80,64) takip edilmiş, 12'sine (%19,36) operasyon uygulanmıştı. Adrenal kitle boyut ortanca (IQR) değeri takip grubunda 25,00 (9,00) mm, operasyon grubunda 41,50 (11,00) mm idi (p=0,035). Glukoz ortanca (IQR) değeri takip grubunda 103,10 (48,40) mg/dl, operasyon grubunda 127,05 (39,05) mg/dl idi (p=0,022). Obezite, takip grubunda 16 (%32,0), operasyon grubunda 8 (%66,7) olguda mevcuttu (p=0,046). Sonuç: NFAA ve SCS tanılı olgularda klinik, hormonal ve metabolik parametreler ile kardiyovasküler risk faktörleri karşılaştırıldığında SCS grubunda glukoz değeri, HT sıklığı, opere olan olgu sayısı ve adenom boyutu daha yüksek, ACTH ve DHEAS değeri daha düşük saptandı. SCS grubunda opere olan olgular ve olmayanlar kıyaslandığında ise opere olan grupta, adenom boyutu, glukoz değeri, AST değeri ve obezite sıklığı daha yüksek saptandı. Bu bulgular bize SCS'li olguların NFAA'lı olgulara göre metabolik ve kardiyovasküler açıdan daha fazla risk altında olduğunu gösterdi. Anahtar Kelimeler: Adrenal adenom, nonfonksiyone adrenal adenom, Subklinik Cushing Sendromu, operasyon
Introduction and Aim: Adrenal lesions that show no hormonal activity are considered nonfunctioning adrenal adenomas (NFAAs) and are usually followed clinically. Subclinical Cushing's Syndrome (SCS) is a syndrome characterized by autonomic cortisol hypersecretion without the clinical symptoms and signs of Cushing's Syndrome (CS) and is associated with incidentalomas. These conditions lead to metabolic problems such as obesity, insulin resistance, dyslipidemia, vertebral fracture and hypertension and are considered a risk factor for cardiovascular diseases. In this study, demographic, metabolic, hormonal parameters and cardiovascular risk profiles of patients with NFAA and SCS were evaluated retrospectively. Materials and Methods: Three hundred and eighty six patients aged ≥18 years with NFAA and SCS who were hospitalized and followed up in the Endocrinology Clinic of Ondokuz Mayıs University Faculty of Medicine between December 15, 2020 and December 15, 2023, were included in the study. Demographic data including age, gender, height, weight, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) were evaluated descriptively and comparatively. The size of the adenoma detected by computed tomography (CT) or magnetic resonance imaging (MRI) and whether it was bilateral or unilateral were recorded. In addition, the follow-up or surgical status of the patients were evaluated. Comorbidities included prediabetes, metabolic syndrome (MS), diabetes mellitus (DM), hypertension (HT), obesity, dyslipidemia, cardiovascular disease (CVD), chronic heart failure (CHF) and osteoporosis. All data were compared between the two groups. Results: Of all the patients, 291 (75.4%) were female and 95 (24.6%) were male. The mean BMI was 31.6 (±6.4) kg/m2, waist circumference was 106.06 (±14.38) cm and BMI was 0.93 (±0.08). Of the 386 patients, 324 (83.9%) were NFAA and 62 (16.1%) were SCS. Age, gender and metabolic characteristics were similar in both groups. Adrenal masses were bilateral in 38 (12%) patients in the NFAA group and 17 (28%) patients in the SCS group (p=0.002). Surgical operation was performed in 3 (1%) patients in the NFAA group and 12 (19%) patients in the SCS group (p<0.001). The median (IQR) adrenal mass size was 20.00 (13.00) mm in the NFAA group and 26.50 (15.00) mm in the SCS group (p<0.001). The median (IQR) glucose value was 99.60 (24.95) mg/dl in NFAA group and 107.15 (55.28) mg/dl in SCS group (p=0.019), ACTH was 15.9 (12.08) pg/ml in NFAA group and 9.3 (9.53) pg/ml in SCS group (p<0.001), DHEAS was 62.40 (61.75) µg/dl in NFAA group and 33.50 (40.38) µg/dl in SCS group (p=0.042). Normetanephrine was lower in the SCS group. HT was present in 193 (60%) patients in the NFAA group and 46 (74%) patients in the SCS group (p<0.001). Of the 62 patients diagnosed with SCS, 50 (80.64%) were followed up and 12 (19.36%) underwent surgery. The median (IQR) adrenal mass size was 25.00 (9.00) mm in the follow-up group and 41.50 (11.00) mm in the operation group, and the adenoma size was larger in the operation group (p=0.035). The median (IQR) glucose value was 103.10 (48.40) mg/dl in the follow- up group and 127.05 (39.05) mg/dl in the operation group (p=0.022). Obesity was present in 16 (32.0%) patients in the follow-up group and 8 (66.7%) patients in the operation group (p=0.046). Conclusion: When clinical, hormonal and metabolic parameters and cardiovascular risk factors were compared between patients with NFAA and SCSAge, Although glucose levels, percentage of patients with HT, percentage of patients who underwent surgery and adenoma size were higher and ACTH and DHEAS levels were lower in the SCS group. In the SCS group, adenoma size, glucose value, AST value and percentage of patients with obesity were found to be higher in the operated group compared to the non-operated group. These results show that patients with SCS have higher metabolic and cardiovascular risk than patients with NFAA. Keywords: Adrenal adenoma, nonfunctioning adrenal adenoma, Subclinical Cushing's Syndrome, operation
Introduction and Aim: Adrenal lesions that show no hormonal activity are considered nonfunctioning adrenal adenomas (NFAAs) and are usually followed clinically. Subclinical Cushing's Syndrome (SCS) is a syndrome characterized by autonomic cortisol hypersecretion without the clinical symptoms and signs of Cushing's Syndrome (CS) and is associated with incidentalomas. These conditions lead to metabolic problems such as obesity, insulin resistance, dyslipidemia, vertebral fracture and hypertension and are considered a risk factor for cardiovascular diseases. In this study, demographic, metabolic, hormonal parameters and cardiovascular risk profiles of patients with NFAA and SCS were evaluated retrospectively. Materials and Methods: Three hundred and eighty six patients aged ≥18 years with NFAA and SCS who were hospitalized and followed up in the Endocrinology Clinic of Ondokuz Mayıs University Faculty of Medicine between December 15, 2020 and December 15, 2023, were included in the study. Demographic data including age, gender, height, weight, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) were evaluated descriptively and comparatively. The size of the adenoma detected by computed tomography (CT) or magnetic resonance imaging (MRI) and whether it was bilateral or unilateral were recorded. In addition, the follow-up or surgical status of the patients were evaluated. Comorbidities included prediabetes, metabolic syndrome (MS), diabetes mellitus (DM), hypertension (HT), obesity, dyslipidemia, cardiovascular disease (CVD), chronic heart failure (CHF) and osteoporosis. All data were compared between the two groups. Results: Of all the patients, 291 (75.4%) were female and 95 (24.6%) were male. The mean BMI was 31.6 (±6.4) kg/m2, waist circumference was 106.06 (±14.38) cm and BMI was 0.93 (±0.08). Of the 386 patients, 324 (83.9%) were NFAA and 62 (16.1%) were SCS. Age, gender and metabolic characteristics were similar in both groups. Adrenal masses were bilateral in 38 (12%) patients in the NFAA group and 17 (28%) patients in the SCS group (p=0.002). Surgical operation was performed in 3 (1%) patients in the NFAA group and 12 (19%) patients in the SCS group (p<0.001). The median (IQR) adrenal mass size was 20.00 (13.00) mm in the NFAA group and 26.50 (15.00) mm in the SCS group (p<0.001). The median (IQR) glucose value was 99.60 (24.95) mg/dl in NFAA group and 107.15 (55.28) mg/dl in SCS group (p=0.019), ACTH was 15.9 (12.08) pg/ml in NFAA group and 9.3 (9.53) pg/ml in SCS group (p<0.001), DHEAS was 62.40 (61.75) µg/dl in NFAA group and 33.50 (40.38) µg/dl in SCS group (p=0.042). Normetanephrine was lower in the SCS group. HT was present in 193 (60%) patients in the NFAA group and 46 (74%) patients in the SCS group (p<0.001). Of the 62 patients diagnosed with SCS, 50 (80.64%) were followed up and 12 (19.36%) underwent surgery. The median (IQR) adrenal mass size was 25.00 (9.00) mm in the follow-up group and 41.50 (11.00) mm in the operation group, and the adenoma size was larger in the operation group (p=0.035). The median (IQR) glucose value was 103.10 (48.40) mg/dl in the follow- up group and 127.05 (39.05) mg/dl in the operation group (p=0.022). Obesity was present in 16 (32.0%) patients in the follow-up group and 8 (66.7%) patients in the operation group (p=0.046). Conclusion: When clinical, hormonal and metabolic parameters and cardiovascular risk factors were compared between patients with NFAA and SCSAge, Although glucose levels, percentage of patients with HT, percentage of patients who underwent surgery and adenoma size were higher and ACTH and DHEAS levels were lower in the SCS group. In the SCS group, adenoma size, glucose value, AST value and percentage of patients with obesity were found to be higher in the operated group compared to the non-operated group. These results show that patients with SCS have higher metabolic and cardiovascular risk than patients with NFAA. Keywords: Adrenal adenoma, nonfunctioning adrenal adenoma, Subclinical Cushing's Syndrome, operation
Description
Citation
WoS Q
Scopus Q
Source
Volume
Issue
Start Page
End Page
76