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Prevalence and incidence of type 2 diabetes mellitus in patients with adrenal incidentalomas: a study of 709 cases

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Abstract

Aim

To evaluate the prevalence and incidence of type 2 diabetes in patients with nonfunctioning adrenal incidentalomas (NFAI) or adrenal incidentalomas (AI) with autonomous cortisol secretion (ACS).

Methods

In this single-center retrospective study, all patients with adrenal incidentalomas ≥1 cm and ACS or NFAI studied between 2013 and 2020 were included. ACS was defined by a post-dexamethasone suppression test (DST) serum cortisol concentration ≥1.8 μg/dl, in the absence of signs of hypercortisolism, and NFAI was defined as a DST < 1.8 μg/dl without biochemical evidence of hypersecretion of other hormones.

Results

Inclusion criteria were met by 231 patients with ACS and 478 with NFAI. At diagnosis, type 2 diabetes was present in 24.3% of patients. No differences were found in the prevalence of type 2 diabetes (27.7 vs. 22.6%, P = 0.137) between patients with ACS and NFAI. However, fasting plasma glucose values and glycated hemoglobin levels were significantly higher in patients with ACS than with NFAI (112 ± 35.6 vs. 105 ± 29 mg/dl, P = 0.004; and 6.5 ± 1.4 vs. 6.1 ± 0.9%, P = 0.005, respectively). Furthermore, patients with type 2 diabetes had higher urinary free cortisol (P = 0.039) and late-night salivary cortisol levels (P = 0.010) than those without type 2 diabetes. After a median follow-up of 28 months, no differences were found in the incidence of type 2 diabetes between the groups (HR 1.17, 95% 0.52–2.64).

Conclusion

Type 2 diabetes was present in one fourth of our cohort. We found no differences in its prevalence or incidence between the groups. However, glycemic control might be worse among diabetic patients with ACS. Higher concentrations of urinary and salivary cortisol were found in patients with than without type 2 diabetes.

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Funding

Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019, Sociedad de Endocrinología, Nutrición y Diabetes de la Comunidad de Madrid (SENDIMAD). Convocatoria intramural de ayudas a proyectos de investigación de investigadores noveles, investigadores clínicos asociados y/o grupos emergentes del Hospital Universitario Ramón y Cajal 2019, IRYCIS.

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Authors and Affiliations

  1. Department of Endocrinology & Nutrition. Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

    Noemi Brox-Torrecilla, Pablo Valderrábano & Marta Araujo-Castro

  2. Department of Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Ana M. García Cano

  3. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain

    Alejandra Quintero Tobar

  4. Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain

    Héctor F. Escobar-Morreale

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  1. Noemi Brox-Torrecilla
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Correspondence to Marta Araujo-Castro.

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The authors declare no competing interests.

Ethical approval

All procedures performed in the participants of the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Hospital Universitario Ramón y Cajal on February 14 of 2019.

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The Ethical committee of Hospital Universitario Ramón y Cajal approved the waiver for informed consent given the retrospective nature of the study.

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Brox-Torrecilla, N., García Cano, A.M., Valderrábano, P. et al. Prevalence and incidence of type 2 diabetes mellitus in patients with adrenal incidentalomas: a study of 709 cases. Endocrine 81, 484–491 (2023). https://doi.org/10.1007/s12020-023-03396-6

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