背景:类似于分泌皮质醇的肾上腺肿瘤,无功能肾上腺肿瘤(NFAT)也可能与心血管风险增加相关.我们在NFAT患者中评估:(i)高血压(HT),糖尿病(DM),肥胖(OB),血脂异常(DL)和心血管事件(CVE)和皮质醇分泌;(ii)皮质醇分泌参数的截止值,用于识别心脏代谢特征较差的NFAT患者。
方法:在615名NFAT患者中(在1mg过夜地塞米松抑制试验后,皮质醇水平,F-1mgDST<1.8µg/dL[50nmol/L])F-1mgDST和促肾上腺皮质激素(ACTH)水平和HT数据,DM,OB,回顾性收集DL和CVEs患病率。
结果:HT,DM和HT加DM与F-1mgDST水平相关(ROC曲线下面积分别为:0.588±0.023、0.610±0.028、0.611±0.033,所有比较的p<0.001),但与ACTH无关。确定患有HT或DM或HT加DM的患者的临界值设定为≥1.2µg/dL(33nmol/L)。与F-1mgDST<1.2µg/dL(n=289)的患者相比,F-1mgDST1.2-1.79µg/dL(33-49.4nmol/L)(n=326)的患者ACTH水平较低(17.7±11.9vs15.3±10.1pg/mL,分别,p=0.008),年龄较大(57.5±12.3vs62.5±10.9岁,分别,p<0.001),HT患病率较高(38.1%vs52.5%,p<0.001),DM(13.1%vs23.3%,分别,p=0.001),HT加DM(8.3%对16.9%,分别,p<0.002)和CVE(3.2%对7.3%,分别,p=0.028)。F-1mgDST1.2-1.79µg/dL与任一HT相关(奇数比率,OR,1.55,95%置信区间,调整年龄后,95%CI1.08-2.23,p=0.018)或DM(OR1.60,95%CI1.01-2.57,p=0.045),性别,OB,DL,和DM(用于HT)或HT(用于DM),并且在调整年龄后存在HT加DM(OR1.96,95%CI1.12-3.41,p=0.018),性别,OB和DL。
结论:在NFAT患者中,F-1mgDST1.2-1.79µg/dL似乎与较高的HT和DM患病率以及较差的心脏代谢谱相关。即使这些关联的准确性较差,也表明在解释这些结果时应谨慎.
Similarly to cortisol-secreting adrenal tumors, also non-functioning adrenal tumors (NFAT) may be associated with an increased cardiovascular risk. We assessed in NFAT patients: (i) the association between hypertension (HT), diabetes mellitus (DM), obesity (OB), dyslipidemia (DL) and cardiovascular events (CVE) and cortisol secretion; (ii) the cut-off of the cortisol secretion parameters for identifying NFAT patients with a worse cardiometabolic profile.
In 615 NFAT patients (with cortisol levels after 1 mg overnight dexamethasone suppression test, F-1mgDST < 1.8 µg/dL [50 nmol/L]) F-1mgDST and adrenocorticotroph hormone (ACTH) levels and data on HT, DM, OB, DL and CVEs prevalence were retrospectively collected.
HT, DM and HT plus DM were associated with F-1mgDST levels (area under the ROC curve: 0.588 ± 0.023, 0.610 ± 0.028, 0.611 ± 0.033, respectively, p < 0.001 for all comparisons) but not with ACTH. The cut-off for identifying patients with either HT or DM or HT plus DM was set at ≥ 1.2 µg/dL (33 nmol/L). As compared with patients with F-1mgDST < 1.2 µg/dL (n = 289), patients with F-1mgDST 1.2-1.79 µg/dL (33-49.4 nmol/L) (n = 326) had lower ACTH levels (17.7 ± 11.9 vs 15.3 ± 10.1 pg/mL, respectively, p = 0.008), older age (57.5 ± 12.3 vs 62.5 ± 10.9 years, respectively, p < 0.001), and higher prevalence of HT (38.1% vs 52.5% respectively p < 0.001), DM (13.1% vs 23.3%, respectively, p = 0.001), HT plus DM (8.3% vs 16.9%, respectively, p < 0.002) and CVE (3.2% vs 7.3%, respectively, p = 0.028). F-1mgDST 1.2-1.79 µg/dL was associated with either HT (odd ratio, OR, 1.55, 95% confidence interval, 95% CI 1.08-2.23, p = 0.018) or DM (OR 1.60, 95% CI 1.01-2.57, p = 0.045) after adjusting for age, gender, OB, DL, and DM (for HT) or HT (for DM), and with the presence of HT plus DM (OR 1.96, 95% CI 1.12-3.41, p = 0.018) after adjusting for age, gender, OB and DL.
In NFAT patients, F-1mgDST 1.2-1.79 µg/dL seems to be associated with a higher prevalence of HT and DM and a worse cardiometabolic profile, even if the poor accuracy of these associations suggests caution in interpreting these results.