Elif Seray Korkmaz, Birsen Öztürk Gökçe, Medine Nur Kebapçı
Post-DST cortisol levels were associated with a graded pattern of cardiometabolic risk among patients with adrenal incidentaloma. Patients with post-DST cortisol levels of 0.91-1.79 µg/dL exhibited an intermediate cardiometabolic phenotype, with significant abnormalities in several cardiometabolic parameters compared with patients with more complete cortisol suppression. These findings suggest that patients below the current MACS threshold may not represent a metabolically homogeneous or uniformly benign population and support further prospective investigation of cardiometabolic risk across the continuum of post-DST cortisol levels.
PURPOSE: Although post-dexamethasone suppression test (DST) cortisol levels ≤ 1.8 µg/dL are generally considered compatible with nonfunctioning adrenal tumors, accumulating evidence suggests that cardiometabolic risk may vary even below the threshold for mild autonomous cortisol secretion (MACS). This study aimed to evaluate cardiometabolic risk across different post-DST cortisol levels in patients with adrenal incidentaloma using conventional metabolic parameters and atherogenic indices.
METHODS: In this retrospective cross-sectional study, 156 patients with adrenal incidentaloma were classified into three groups according to post-DST cortisol levels: ≤0.9 µg/dL (Group 1, n = 48), 0.91-1.79 µg/dL (Group 2, n = 60), and ≥ 1.8 µg/dL (Group 3, n = 48). Demographic characteristics, blood pressure, glucose metabolism parameters, lipid profiles, and cardiometabolic risk indices, including the triglyceride-glucose (TyG) index, plasma atherogenic index (PAI), and Castelli Risk Indices I and II, were compared among groups. Correlations between post-DST cortisol levels and cardiometabolic parameters were evaluated using Spearman correlation analysis.
RESULTS: Blood pressure and the prevalence of hypertension increased significantly across post-DST cortisol categories. Notably, Group 2 already differed significantly from Group 1 in systolic and diastolic blood pressure and hypertension prevalence. Diabetes mellitus was also more prevalent in Group 2 than in Group 1. Fasting glucose, HbA1c, total cholesterol, LDL cholesterol, and non-HDL cholesterol differed significantly among the three groups, with Group 2 showing significantly higher HbA1c and LDL cholesterol than Group 1. The TyG index and Castelli Risk Indices I and II also differed significantly across cortisol categories, although pairwise differences for these indices were primarily observed between Groups 1 and 3. Overall, Group 2 exhibited an intermediate cardiometabolic pattern between Groups 1 and 3. Post-DST cortisol levels were positively correlated with blood pressure, glucose metabolism parameters, atherogenic lipid parameters, and several atherogenic indices.
CONCLUSION: Post-DST cortisol levels were associated with a graded pattern of cardiometabolic risk among patients with adrenal incidentaloma. Patients with post-DST cortisol levels of 0.91-1.79 µg/dL exhibited an intermediate cardiometabolic phenotype, with significant abnormalities in several cardiometabolic parameters compared with patients with more complete cortisol suppression. These findings suggest that patients below the current MACS threshold may not represent a metabolically homogeneous or uniformly benign population and support further prospective investigation of cardiometabolic risk across the continuum of post-DST cortisol levels.