Adults diagnosed with mild autonomous cortisol secretion more likely to develop CKD
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Key takeaways:
- Advanced CKD was more common among adults with mild autonomous cortisol secretion vs. those with nonfunctioning adrenal adenoma.
- Improvements in kidney function were seen up to 42 months after adrenalectomy.
Adults with mild autonomous cortisol secretion are more likely to have advanced chronic kidney disease at adrenal adenoma diagnosis than adults with a nonfunctioning adrenal adenoma, according to study data.
“The findings of this study carry significant clinical implications for managing patients with mild autonomous cortisol secretion,” Irina Bancos, MD, associate professor of medicine in the division of endocrinology, metabolism and nutrition at Mayo Clinic, and Leili Rahimi, MD, an endocrinology fellow at Mayo Clinic, told Healio. “Firstly, we have identified CKD as a clear comorbidity associated with mild autonomous cortisol secretion, suggesting that CKD should be proactively screened for and monitored in patients with mild autonomous cortisol secretion who are being followed conservatively. Secondly, we demonstrated that post-dexamethasone suppression cortisol level is an independent factor associated with worsened kidney function. This implies that merely addressing other cardiovascular-associated comorbidities such as hypertension, dyslipidemia and diabetes will not suffice to prevent CKD progression in patients with mild autonomous cortisol secretion.”
Bancos, Rahimi and colleagues conducted a retrospective cohort study with data from 972 adults evaluated for an adrenal adenoma at Mayo Clinic from April 3, 1999, to March 17, 2020. Age, sex, BMI, comorbidities, therapy with statins, therapy with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, and adrenalectomy data were collected. Researchers calculated estimated glomerular filtration rate for each participant. Adults were considered to have advanced CKD if they had an eGFR of 59 mL/min/1.73 m2 or lower. Primary outcomes of the study were eGFR for adults diagnosed with mild autonomous cortisol secretion vs. nonfunctioning adrenal adenomas, and eGFR among adults who underwent an adrenalectomy.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
CKD prevalence at diagnosis
Of the study group, 44% were diagnosed with mild autonomous cortisol secretion and the remaining 56% had a nonfunctioning adrenal adenoma. Adults with mild autonomous cortisol secretion had a lower median eGFR (79.6 vs. 83.8 mL/min/1.73 m2; P < .001) and a higher prevalence of CKD (17.6% vs. 11.7%; P < .001) than those with a nonfunctioning adrenal adenoma.
In multivariable analysis, older age (estimate, –7.94; P = .001), the presence of hypertension (estimate, –2.72; P = .038) and higher post-dexamethasone cortisol (estimate, –1.01; P = .017) were associated with lower eGFR.
“Readers may find it surprising that our study found a higher post-dexamethasone suppression cortisol level is associated with lower eGFR, even after adjusting for CV comorbidities and other factors,” Bancos and Rahimi said. “This suggests a direct impact of cortisol on kidney function, independent of the CV comorbidities associated with mild autonomous cortisol secretion that can also affect kidney function.”
Adrenalectomy improves kidney function
There were 204 adults who underwent an adrenalectomy, of whom 76% were diagnosed with mild autonomous cortisol secretion. Among the adrenalectomy subgroup, those diagnosed with mild autonomous cortisol secretion had a higher prevalence of hypertension (71% vs. 53.1%; P = .02) and a higher percentage of people receiving therapy with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (37.4% vs. 20.4%; P = .028) than those with a nonfunctional adrenal adenoma.
After adrenalectomy, adults with mild autonomous cortisol secretion had a mean eGFR increase of 4.9 points from baseline to follow-up at 18 to 30 months and of 8.1 points from baseline to follow-up at 30 to 42 months. Younger age (estimate, –2.7; P = .004), those with a lower eGFR before adrenalectomy (estimate, –0.27; P < .001) and participants with a longer duration of follow-up (estimate, 1.9; P = .001) had a greater eGFR increase after adrenalectomy.
Bancos and Rahimi said the improvement in kidney function after an adrenalectomy should be factored into the patient-provider decision-making when discussing how to manage mild autonomous cortisol secretion.
“Moving forward, additional research is needed to evaluate the causality between mild autonomous cortisol secretion and CV comorbidities such as CKD, as well as to conduct clinical trials assessing the impact of adrenalectomy on these associated comorbidities,” Bancos and Rahimi said. “Moreover, further research is needed to identify nonsurgical, effective strategies for managing kidney function decline in patients with adrenal adenoma, such as mineralocorticoid receptor antagonists or SGLT2 inhibitors.”
For more information:
Irina Bancos, MD, can be reached at bancos.irina@mayo.edu.
Leili Rahimi, MD, can be reached at rahimi.leili@mayo.edu.
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