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Published on: September 15, 2017
Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas
Miguel Debono1, Mike Bradburn, Matthew Bull
1Academic Unit of Endocrinology, Department of Human Metabolism (M.D., R.J.R., J.N.-P.), University of Sheffield, South Yorkshire S10 2RX, United Kingdom; Medical Statistics and Clinical Trials Research Unit (M.Br.), The School of Health and Related Research, University of Sheffield, South Yorkshire S1 4DA, United Kingdom; The Departments of Endocrinology (M.D., R.J.R., J.N.-P.), Radiology (M.Bu.), and Endocrine Surgery (B.H.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, South Yorkshire S10 2JF, United Kingdom.
Context:
Incidental benign adrenocortical adenomas, adrenal incidentalomas are found in 4.5% of abdominal computed tomography scans, with the incidence increasing to 10% in patients older than 70 years of age. These incidentalomas frequently show evidence of excess cortisol secretion but without overt Cushing's syndrome. The mortality rate is increased in Cushing's syndrome.
Objective:
This study sought to investigate whether patients with adrenal incidentalomas have an increased mortality.
Design:
This was a retrospective, longitudinal cohort study.
Setting:
The study was carried out in an Endocrine Investigation Unit in a University Teaching Hospital.
Patients:
Two hundred seventy-two consecutive patients with an incidental adrenal mass underwent a dedicated diagnostic protocol, which included dexamethasone testing for hypercortisolism between 2005 and 2013. Overall survival was assessed in 206 patients with a benign, adrenocortical adenoma.
Main Outcome Measures:
Survival analysis was carried out by using Kaplan-Meier curves and the effect of dexamethasone cortisol estimated by Cox-regression analysis. Cause-specific mortality was ascertained from death certificates and compared with local and national data.
Results:
Eighteen of 206 patients died and the mean time (SD) from diagnosis to death was 3.2 (1.7) years. Seventeen of 18 patients who died had a post dexamethasone cortisol >1.8 microg/dL and there was a significant decrease in survival rate with increasing dexamethasone cortisol levels (P = .001). Compared with the <1.8 microg/dL group, the hazard ratio (95% confidence interval) for the 1.8-5 microg/dL group was 12.0 (1.6-92.6) whereas that of the >5 microg/dL group was 22.0 (2.6-188.3). Fifty percent and 33% of deaths were secondary to circulatory or respiratory/infective causes, respectively.
Conclusions:
PATIENTS with adrenal incidentalomas and a post-dexamethasone serum cortisol >1.8 microg/dL have increased mortality, mainly related to cardiovascular disease and infection.
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