Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center
Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center
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DOI：
10.1007/s12020-017-1400-8
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发表时间：
2017-11-01
期刊：
影响因子：
3.7
通讯作者：
Falhammar, Henrik
中科院分区：
文献类型：
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作者：
Patrova, Jekaterina;Kjellman, Magnus;Falhammar, Henrik
比较肾上腺偶发瘤（AIs）患者对1mg地塞米松抑制试验（DST）的反应的长期结局。连续检查“非功能性”AIs患者（n = 365）。排除有明显激素过量、肾上腺皮质癌和已知恶性肿瘤的患者。将患者分为正常皮质醇分泌组（n = 204, DST 50 nmol/l）、可能自主皮质醇分泌组（n = 128, DST 51 ~ 138 nmol/l）和自主皮质醇分泌组（n = 33, DST 138 nmol/l）。37例（10.1%）患者在随访期间（5.2 +/- 2.3年）死亡：无分泌组16例（7.8%）（诊断至死亡时间：3.9 +/- 2.9年），可能自主皮质醇分泌组15例（11.7%,3.2 +/- 1.8年），自主皮质醇分泌组6例（18.2%,2.3 +/- 1.5年），差异有统计学意义（P = 0.019）。多变量分析只发现与年龄和肿瘤大小有显著关联，但如果将dst后的皮质醇水平作为一个连续变量进行分析，它也是显著的。自主皮质醇分泌组的所有死亡都是由于与肾上腺无关的癌症。高血压、心血管疾病和药物治疗在可能和自主皮质醇分泌组中更为常见，尤其是前者。后两组的双侧人工智能较多，人工智能尺寸较大。自主皮质醇分泌患者的死亡率高于无功能AIs患者，尽管dst后的皮质醇水平作为一个连续变量，年龄和肿瘤大小可以更好地预测死亡率。心血管疾病和骨质疏松药物似乎在可能和自主皮质醇分泌组更普遍，尤其是在前者。
To compare long-term outcomes in patients with adrenal incidentalomas (AIs) with the response to a 1 mg overnight dexamethasone suppression test (DST).Consecutive patients with "non-functional" AIs (n = 365) were examined. Patients with overt hormone excess, adrenocortical cancer and known malignancy had been excluded. Patients were classified to normal cortisol secretion group (n = 204, DST 50 nmol/l), possible autonomous cortisol secretion group (n = 128, DST 51-138 nmol/l) and autonomous cortisol secretion group (n = 33, DST 138 nmol/l).Thirty-seven patients (10.1%) deceased during the follow-up period (5.2 +/- 2.3 years): 16(7.8%) in the non-secreting group (time from diagnosis to death: 3.9 +/- 2.9 years), 15 in the possible autonomous cortisol secretion group (11.7%, 3.2 +/- 1.8 years) and 6 in the autonomous cortisol secretion group (18.2%, 2.3 +/- 1.5 years), respectively (P = 0.019). Multivariate analysis only found significant association with age and the tumour size but if cortisol levels post-DST were analysed as a continuous variable it was significant as well. All deaths in autonomous cortisol secretion group were due to cancer not related to adrenal glands. Hypertension, cardiovascular disease and medications were more common in the possible and autonomous cortisol secretion group, especially in the former. More bilateral AIs and larger AI size were found in the two latter groups.Patients with autonomous cortisol secretion had higher mortality than those with non-functioning AIs though cortisol levels post-DST as a continuous variable, age and tumour size were better predictor of mortality. Cardiovascular disease and osteoporosis medication seemed more prevalent in the possible and autonomous cortisol secretion groups, especially in the former.