Adrenal incidentalomas tied to increased risk for type 2 diabetes
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An analysis of unselected adults who underwent a CT scan suggests that those who had an unsuspected adrenal tumor were more likely to have type 2 diabetes, although it is unclear whether cortisol secretion influences any risk, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“It is biologically plausible that chronic exposure to low-grade cortisol excess resulting from autonomous adrenal secretion has clinical consequences, but previous studies are mostly retrospective and cannot definitively establish a cause and effect relationship,” Giuseppe Reimondo, MD, PhD, of the department of clinical and biological sciences at San Luigi Gonzaga Hospital and the University of Turin, Italy, and colleagues wrote in the study background. “An inherent bias of these studies is that diseased individuals are more likely to undergo imaging examinations than healthy ones, and therefore the association between adrenal incidentalomas and diseases such as diabetes, hypertension and metabolic syndrome may to some extent be explained by an ascertainment bias.”
In a prospective study, Reimondo and colleagues analyzed data from 601 unselected outpatients who underwent an abdominal CT scan between January 2017 and June 2018 (270 women; mean age, 64 years). Adults with known or suspected adrenal disease or malignancy were excluded. A radiologist evaluated all abdominal CT scans, and patients with adrenal incidentalomas underwent a 1 mg dexamethasone suppression test. Primary outcomes were the frequency of adrenal incidentalomas on abdominal CT among unselected patients and the frequency of comorbid conditions.
Within the cohort, 44 adults (7.3%) had an adrenal tumor (12 women; mean age, 66 years), with a mass size ranging between 10 mm to 55 mm. Tumors were bilateral in 29.5% of adults.
Those with an adrenal incidentaloma had higher BMI (P = .009) and waist circumference (P = .007) and were more likely to have diabetes (P = .0038) than those without.
In logistic regression analysis, diabetes was associated with the presence of adrenal incidentalomas (P = .003). Additionally, researchers observed autonomous cortisol secretion in 50% of patients who did not suppress less than 50 nmol/L cortisol after the 1 mg dexamethasone test.
“Since the prevalence of either type 2 diabetes or adrenal incidentalomas increases with age, it may be speculated that their association is an effect of aging,” the researchers wrote. “However, the correlation between the frequency of adrenal incidentalomas, diabetes and age was not fully linear. Moreover, patients with adrenal incidentalomas were not older than patients without, and age did not differ between patients bearing adrenal incidentalomas with or without diabetes.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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