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Cortisol Secretion, Mortality Link Explored in Adrenal Incidentalomas

About twofold and threefold increase in mortality seen with cortisolDST of 83 to 137 nmol/L and cortisolDST of 138 nmol/L or higher

WEDNESDAY, May 26, 2021 (HealthDay News) — For patients with adrenal incidentalomas, autonomous cortisol secretion is associated with mortality at a plasma cortisol level after a 1-mg dexamethasone suppression test (cortisolDST) of 83 nmol/L or higher, according to a study published online May 25 in the Annals of Internal Medicine.

Albin Kjellbom, M.D., from Skåne University Hospital in Lund, Sweden, and colleagues measured the association between mortality and levels of autonomous cortisol secretion in a retrospective cohort study involving patients with adrenal incidentalomas from two hospitals in southern Sweden. Patients were grouped according to cortisolDST and were followed for up to 14 years.

The researchers found that 170 of the 1,048 patients died during a median follow-up of 6.4 years. A cortisolDST of 50 to 82 nmol/L was not associated with increased mortality compared with a cortisolDST of <50 nmol/L (hazard ratio, 1.15; 95 percent confidence interval, 0.78 to 1.70). However, an association with increased mortality was seen with a cortisolDST of 83 to 137 nmol/L and 138 nmol/L or higher, with hazard ratios of 2.30 (95 percent confidence interval, 1.52 to 3.49) and 3.04 (95 percent confidence interval, 1.86 to 4.98), respectively. The association between cortisolDST and mortality was linear up to a cortisolDST of 200 nmol/L, based on analyses using restricted cubic splines.

“We suggest treatment of known cardiovascular risk factors in these patients and incorporation of our results in the decision about which patients to recommend for adrenalectomy,” the authors write.

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