Skip to main content

Advertisement

SpringerLink
Log in

Lipid abnormalities in patients with adrenal incidentalomas: role of subclinical hypercortisolism and impaired glucose metabolism

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Background

Subclinical hypercortisolism (SH) has been associated with metabolic complications such as type 2 diabetes mellitus, obesity and dyslipidemia. Scarce data are available regarding the lipid pattern abnormalities in SH, in relation to insulin resistance and impaired glucose metabolism (IGM). We aimed to evaluate the possible influence of SH on lipid pattern in relation to the presence/absence of impaired glucose metabolism.

Methods

In 338 patients with adrenal incidentaloma, the presence of SH, hypertension, dyslipidemia and IGM was evaluated. According to the presence of SH and IGM the patients were divided into 4 groups (IGM+SH+, IGM+SH−, IGM−SH+, IGM−SH−). We recruited 98 subjects without IGM (IGM-) and 100 with IGM (IGM+) as control groups.

Results

The prevalence of dyslipidemia was comparable among Group IGM+SH+, Group IGM+SH− and IGM+ controls (57.9, 58.4, 56 %, P = NS). No difference in dyslipidemia prevalence among IGM− patients and IGM− controls was observed. The IGM+SH+ patients had a higher prevalence of dyslipidemia (57.9 %) than IGM−SH+ ones (29.1 %, P < 0.01). The IGM+SH− patients showed an increased prevalence of hypertension (76.6 vs 54.8 %, P < 0.01) and dyslipidemia (58.4 vs 23.8 %, P < 0.0001) as compared with IGM−SH− patients. Logistic regression analysis showed that only IGM was associated to dyslipidemia (OR 4.31, 95 % CI 2.61–7.12, P = 0.0001) regardless of age, SH and gender.

Conclusions

In the absence of alterations of glucose metabolism the presence of a subtle cortisol excess has no effect on lipid pattern. IGM seems to influence the lipid metabolism regardless of the presence of SH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ross NS, Aron DC (1990) Hormonal evaluation of the patient with an incidentally discovered adrenal mass. NEJM 323(20):1401–1405

    Article  CAS  PubMed  Google Scholar 

  2. Kloos RT, Gros MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16(4):460–484

    CAS  PubMed  Google Scholar 

  3. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M (2003) Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 149(4):273–285

    Article  CAS  PubMed  Google Scholar 

  4. Singh PK, Buch HN (2008) Adrenal incidentaloma: evaluation and management. J Clin Pathol 61(11):1168–1173. doi:10.1136/jcp.2006.044313

    Article  CAS  PubMed  Google Scholar 

  5. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, Giovagnetti M, Opocher G, Angeli A (2000) A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 85(2):637–644

    CAS  PubMed  Google Scholar 

  6. Reincke M, Nieke J, Krestin GP, Saeger W, Allolio B, Winkelmann W (2002) Preclinical Cushing’s syndrome in adrenal incidentalomas: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab 75(3):826–832

    Google Scholar 

  7. Tsagarakis S, Vassiliadi D, Thalassinos N (2006) Endogenous Subclinical hypercortisolism: diagnostic uncertainties and clinical implications. J Endocrinol Invest 29(5):471–482

    Article  CAS  PubMed  Google Scholar 

  8. Chiodini I, Guglielmi G, Battista C, Carnevale V, Torlontano M, Cammisa M, Trischitta V, Scillitani A (2004) Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effects of subclinical hypercortisolism and gonadal status. J Clin Endocrinol Metab 89(5):2237–2241

    Article  CAS  PubMed  Google Scholar 

  9. Chiodini I, Mascia ML, Muscarella S, Battista C, Minisola S, Arosio M, Santini SA, Guglielmi G, Carnevale V, Scillitani A (2007) Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med 147(8):541–548

    Article  PubMed  Google Scholar 

  10. Chiodini I, Torlontano M, Scillitani A, Arosio M, Bacci S, Di Lembo S, Epaminonda P, Augello G, Enrini R, Ambrosi B, Adda G, Trischitta V (2005) Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients. Eur J Endocrinol 153(6):837–844

    Article  CAS  PubMed  Google Scholar 

  11. Chiodini I, Morelli V, Masserini B, Salcuni AS, Eller-Vainicher C, Viti R, Coletti F, Guglielmi G, Battista C, Carnevale V, Iorio L, Beck-Peccoz P, Arosio M, Ambrosi B, Scillitani A (2009) Bone mineral density, prevalence of vertebral fractures and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian Multicenter Study. J Clin Endocrinol Metab 94(9):3207–3214. doi:10.1210/jc.2009-0468

    Article  CAS  PubMed  Google Scholar 

  12. Terzolo M, Pia A, Alì A, Osella G, Reimondo G, Bovio S, Daffara F, Procopio M, Paccotti P, Borretta G, Angeli A (2002) Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab 87(3):998–1003

    Article  CAS  PubMed  Google Scholar 

  13. Fernández-Real JM, Engel WR, Simó R, Salinas I, Webb SM (1998) Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma. Clin Endocrinol 49(1):53–61

    Article  Google Scholar 

  14. Tauchmanovà L, Rossi R, Biondi B, Pulcrano M, Nuzzo V, Palmieri EA, Fazio S, Lombardi G (2002) Patients with subclinical Cushing’s syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 87(11):4872–4878

    Article  PubMed  Google Scholar 

  15. Chiodini I (2011) Clinical review: diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab 96(5):1223–1236. doi:10.1210/jc.2010-2722

    Article  CAS  PubMed  Google Scholar 

  16. Rossi R, Tauchmanova L, Luciano A, Di Martino M, Battista C, Del Viscovo L, Nuzzo V, Lombardi G (2000) Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 85(4):1440–1448

    CAS  PubMed  Google Scholar 

  17. Ginsberg HN (2006) Efficacy and mechanism of action of statins in the treatment of diabetic dyslipidemia. J Clin Endocrinol Metab 91(2):383–392

    Article  CAS  PubMed  Google Scholar 

  18. Arnaldi G, Scandali VM, Trementino L, Cardinaletti M, Appolloni G, Boscaro M (2010) Pathophysiology of dyslipidemia in Cushing’s syndrome. Neuroendocrinology 92(Suppl 1):86–90. doi:10.1159/000314213

    Article  CAS  PubMed  Google Scholar 

  19. van Raalte DH, Ouwens DM, Diamant M (2009) Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options? Eur J Clin Invest 39(2):81–93. doi:10.1111/j.1365-2362.2008.02067.x

    Article  PubMed  Google Scholar 

  20. Mullugeta Yonas, Chawla Rajinder, Kebede Tedla, Worku Yesehak (2012) Dyslipidemia associated with poor glycemic control in type 2 diabetes mellitus and the protective effect of metformin supplementation. Indian J Clin Biochem 27(4):363–369

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Gatti A, Maranghi M, Bacci S, Carallo C, Gnasso A, Mandosi E, Fallarino M, Morano S, Trischitta V, Filetti S (2009) Poor glycemic control is an independent risk factor for low HDL cholesterol in patients with type 2 diabetes. Diabetes Care 32(8):1550–1552. doi:10.2337/dc09-0256

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285(19):2486–2497

    Article  Google Scholar 

  23. American Diabetes Association (2009) Diagnosis and classification of diabetes mellitus. Diabetes Care 32(Suppl 1):S62–S67. doi:10.2337/dc09-S062

    Article  PubMed Central  Google Scholar 

  24. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A; ESH-ESC Task Force on the Management of Arterial Hypertension (2007) 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension. J Hypertens 25(9):1751–1762

    Article  CAS  PubMed  Google Scholar 

  25. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment insulin resistance and beta cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–441

    Article  CAS  PubMed  Google Scholar 

  26. Morelli V, Reimondo G, Giordano R, Della Casa S, Policola C, Palmieri S, Salcuni AS, Dolci A, Mendola M, Arosio M, Ambrosi B, Scillitani A, Ghigo E, Beck-Peccoz P, Terzolo M, Chiodini I (2014) Long-term follow-up in adrenal incidentalomas: an Italian Multicenter Study. J Clin Endocrinol Metab 99(3):827–834

Download references

Conflict of interest

The authors have nothing to declare.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy

    B. Masserini, V. Morelli, S. Palmieri, C. Eller-Vainicher, V. Zhukouskaya, E. Cairoli, E. Orsi, P. Beck-Peccoz, A. Spada & I. Chiodini

Authors
  1. B. Masserini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Morelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Palmieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Eller-Vainicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Zhukouskaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Cairoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Orsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Beck-Peccoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Spada
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. I. Chiodini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Masserini.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Masserini, B., Morelli, V., Palmieri, S. et al. Lipid abnormalities in patients with adrenal incidentalomas: role of subclinical hypercortisolism and impaired glucose metabolism. J Endocrinol Invest 38, 623–628 (2015). https://doi.org/10.1007/s40618-014-0232-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-014-0232-0

Keywords

Search

Navigation