■最近的一项横断面研究表明,肾上腺偶发瘤(AI)患者的合并症和死亡率都与性别有关。然而,很少有纵向研究评估动脉高血压的发展,高血糖症,AI患者的血脂异常和骨损害。这项研究的目的是分析性别在长期随访中对这些合并症发展的影响。
■我们回顾性评估了189名患者(120名女性,69名男性)与AI,来自意大利和克罗地亚的四个转诊中心。临床特征,在基线和最后一次随访(LFUV)时评估1mg地塞米松抑制试验(1mgDST)后的合并症和皮质醇.中位随访时间为52个月(四分位数范围25-86个月)。
■随着时间的推移,女性动脉高血压和高血糖的发生率均增加(基线为65.8%,LFUV为77.8%,p=0.002;基线时为23.7%,LFUV时为39.6%,p<0.001;分别)和男性(基线为58.0%,LFUV为69.1%,p=0.035;基线为33.8%,LFUV为54.0%,p<0.001;分别)。在1-mgDST后,使用1.8µg/dl作为皮质醇的临界值对两组患者进行分层:非功能性肾上腺肿瘤(NFAT)和轻度自主皮质醇分泌(MACS)的肿瘤。在NFAT组中(99名患者,女性62.6%),在基线,我们没有观察到男性和女性之间的临床特征和合并症有任何差异。在LFUV,男性高血糖发生率高于女性(57.6%对33.9%,p=0.03)。在MACS组中(89名患者,女性64.0%),在基线,高血压的患病率,性别之间的高血糖和血脂异常相似,尽管女性年龄较小(60岁,IQR55-69对67.5岁,IQR61-73岁;p=0.01)。此外,女性骨损害发生率较高(89.3%对54.5%,p=0.02)比男性。在LFUV,观察到类似的性别相关模式.
患有AI的患者经常出现动脉高血压和高血糖症,应定期检查这些合并症。不管性别。在MACS患者中,尽管女性年龄较小,但性别之间在心脏代谢合并症的频率上缺乏差异,女性骨骼受损的频率更高,提示皮质醇的性别特异性效应。
UNASSIGNED: A recent cross-sectional study showed that both comorbidities and mortality in patients with adrenal incidentaloma (AI) are tied to sex. However, few longitudinal studies evaluated the development of arterial hypertension, hyperglycemia, dyslipidemia and bone impairment in patients with AI. The aim of this study is to analyze the impact of sex in the development of these comorbidities during long-term follow-up.
UNASSIGNED: We retrospectively evaluated 189 patients (120 females, 69 males) with AI, from four referral centers in Italy and Croatia. Clinical characteristics, comorbidities and cortisol after 1-mg dexamethasone suppression test (1-mg DST) were assessed at baseline and at last follow-up visit (LFUV). Median follow-up was 52 (Interquartile Range 25-86) months.
UNASSIGNED: The rates of arterial hypertension and hyperglycemia increased over time both in females (65.8% at baseline versus 77.8% at LFUV, p=0.002; 23.7% at baseline versus 39.6% at LFUV, p<0.001; respectively) and males (58.0% at baseline versus 69.1% at LFUV, p=0.035; 33.8% at baseline versus 54.0% at LFUV, p<0.001; respectively). Patients were stratified in two groups using 1.8 µg/dl as cut-off of cortisol following 1-mg DST: non-functional adrenal tumors (NFAT) and tumors with mild autonomous cortisol secretion (MACS). In the NFAT group (99 patients, females 62.6%), at baseline, we did not observe any difference in clinical characteristics and comorbidities between males and females. At LFUV, males showed a higher frequency of hyperglycemia than females (57.6% versus 33.9%, p=0.03). In the MACS group (89 patients, females 64.0%), at baseline, the prevalence of hypertension, hyperglycemia and dyslipidemia was similar between sexes, despite females were younger (60, IQR 55-69 versus 67.5, IQR 61-73, years; p=0.01). Moreover, females presented higher rates of bone impairment (89.3% versus 54.5%, p=0.02) than males. At LFUV, a similar sex-related pattern was observed.
UNASSIGNED: Patients with AI frequently develop arterial hypertension and hyperglycemia and should be periodically checked for these comorbidities, regardless of sex. In patients with MACS, the lack of difference between sexes in the frequency of cardiometabolic comorbidities despite that females are younger, and the higher frequency of bone impairment in females, suggest a sex-specific effect of cortisol.