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Plasma Steroid Profiling Between Patients With and Without Diabetes Mellitus in Nonfunctioning Adrenal Incidentalomas
Yui Nakano1, Maki Yokomoto-Umakoshi1, Kohta Nakatani2
1Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Journal of the Endocrine Society
|August 15, 2024
Summary
Nonfunctioning adrenal incidentalomas (NFAI) are linked to diabetes mellitus (DM). In men with NFAI, elevated 11β-hydroxytestosterone levels correlate with hyperglycemia and pancreatic beta-cell dysfunction, independent of cortisol.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Steroid Biochemistry
Background:
- Adrenal incidentalomas (AI), including nonfunctioning adrenal incidentalomas (NFAI), are frequently observed in patients with diabetes mellitus (DM).
- While NFAI diagnosis excludes overt hormone excess, subtle cortisol hypersecretion or involvement of other steroid metabolites in DM pathogenesis remains unclear.
- Investigating steroid profiles in NFAI patients may elucidate novel mechanisms linking adrenal function to metabolic dysfunction.
Purpose of the Study:
- To investigate the association between plasma steroid metabolites and diabetes mellitus (DM) in patients diagnosed with nonfunctioning adrenal incidentalomas (NFAI).
- To identify specific steroid profiles that differentiate NFAI patients with and without DM.
Main Methods:
- Plasma samples from 68 NFAI patients (31 men, 37 women) were analyzed for 22 steroid metabolites using liquid chromatography-tandem mass spectrometry.
- Data were adjusted for age and analyzed using discriminant analysis and Bayesian kernel machine regression.
- Serum cortisol levels post-dexamethasone suppression test were used as a confounder for adjustment.
Main Results:
- Plasma steroid profiles significantly discriminated between men with and without DM, but not in women.
- 11β-hydroxytestosterone, an adrenal-derived androgen, was significantly higher in men with DM and was the primary discriminant factor.
- 11β-hydroxytestosterone showed positive correlations with fasting plasma glucose and HbA1c, and a negative correlation with pancreatic β-cell function (HOMA2-B), independent of cortisol levels.
Conclusions:
- Plasma steroid profiles differ between men with and without DM among NFAI patients.
- Elevated 11β-hydroxytestosterone is associated with hyperglycemia and impaired pancreatic β-cell function in men with NFAI, suggesting a role beyond cortisol in DM development.
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