Mild autonomous cortisol secretion may accelerate aging in adrenal adenomas
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Adults with mild autonomous cortisol secretion have a higher frailty index score when compared with those with nonfunctioning adrenal adenomas, reflecting the possibility of cortisol secretion-induced accelerated aging, study data show.
“Our goal was to objectively quantify the overall health of patients with mild autonomous cortisol secretion, or MACS, beyond the well-known complications of MACS, such as cardiovascular risk factors,” Irina Bancos, MD, associate professor in the division of endocrinology at Mayo Clinic in Rochester, Minnesota, told Healio. “Frailty is a well-established marker of physiological reserve to characterize the overall health applied extensively to disorders outside endocrinology. Frailty index considers not only the patient’s comorbidities, but also symptoms and activities of daily living. Apart from an overall higher frailty score among adults with MACS, an interesting finding was a threefold higher tendency to fall and twofold higher complaint of sleeping difficulties among patients with MACS, possibly due to cortisol effect on body composition and sleep.”
In a proof-of-concept, retrospective study, Bancos and colleagues analyzed data from 443 adults with adrenal adenomas and no other adrenal disorders evaluated at Mayo Clinic between December 2003 and December 2018 and followed for at least 1 year. Cortisol was measured with an overnight, 1 mg dexamethasone suppression test. Frailty was assessed via a deficit accumulation model with 47 variables, such as symptoms, disabilities, activities of daily living, self-rated health and comorbidities. Primary outcome was frailty index score.
Within the cohort, 168 adults had MACS (38%; median age, 66 years) and 275 adults had nonfunctioning adrenal adenomas (62%; median age, 59 years).
In analyses adjusted for age, sex and BMI, individuals with MACS had a higher prevalence of most comorbidities vs. those with nonfunctioning adrenal adenomas, including hypertension (71.4% vs. 59.4%; P = .014), cardiac arrhythmias (49.7% vs. 39.8%; P = .049) and chronic kidney disease (25.3% vs. 16.9%; P = .044).
Compared with individuals with nonfunctioning adrenal adenomas, those with MACS also reported more symptoms of weakness (21% vs. 11%), falls (7% vs. 2%), and sleep difficulty (26% vs. 15%).
Age, sex and BMI-adjusted frailty index was higher among patients with MACS vs. patients with nonfunctioning adrenal adenomas (mean, 0.17 vs. 0.15; P = .009). Using a frailty index cutoff of 0.25, 24% of patients with MACS and 18% of those with nonfunctioning adrenal adenomas were considered frail (P = .028).
“In practice, it is difficult to assess the extent of hypercortisolism effect on patients’ health,” Sumitabh Singh, MD, research fellow in the division of endocrinology at Mayo Clinic in Rochester, Minnesota, told Healio. “Using the frailty index in the initial assessment as well as during follow-up may help decide on the aggressiveness of intervention in patients with MACS — deciding on adrenalectomy vs. conservative management.”
Singh said the next step is to design a prospective study of frailty among adults with MACS, including a subgroup of patients treated with adrenalectomy to assess whether frailty can be reversed.
For more information:
Irina Bancos, MD, can be reached at bancos.irina@mayo.edu; Twitter: @IrinaBancos. Sumitabh Singh, MD, can be reached at singh.sumitabh@mayo.edu; Twitter: @SumitabhS.
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