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Mortality not increased in patients with non-functional adrenal adenomas : a matched cohort study

Kjellbom, Albin LU orcid ; Lindgren, Ola LU ; Danielsson, Malin ; Olsen, Henrik LU orcid and Löndahl, Magnus LU (2023) In The Journal of clinical endocrinology and metabolism 108(8). p.536-541
Abstract

CONTEXT: Mild autonomous cortisol secretion (MACS) is associated with increased mortality in patients with adrenal incidentalomas (AI), but little is known regarding the potential risk associated with non-functional adrenal adenomas (NFAA), which constitute the majority of AI.

OBJECTIVE: Compare mortality risk in patients with NFAA, and different levels of MACS, to matched controls.

METHOD: This was a retrospective matched cohort study. All patients referred to two endocrine centres in southern Sweden because of an AI between 2005 and 2015 were enrolled. Controls (3:1) matched for sex, age, and residency were included. Primary endpoint was all-cause mortality. Outcome data was obtained from the Cause of Death Register.... (More)

CONTEXT: Mild autonomous cortisol secretion (MACS) is associated with increased mortality in patients with adrenal incidentalomas (AI), but little is known regarding the potential risk associated with non-functional adrenal adenomas (NFAA), which constitute the majority of AI.

OBJECTIVE: Compare mortality risk in patients with NFAA, and different levels of MACS, to matched controls.

METHOD: This was a retrospective matched cohort study. All patients referred to two endocrine centres in southern Sweden because of an AI between 2005 and 2015 were enrolled. Controls (3:1) matched for sex, age, and residency were included. Primary endpoint was all-cause mortality. Outcome data was obtained from the Cause of Death Register. Patients were grouped according to cortisol level post 1-mg dexamethasone suppression test (cortisolDST) (<50 (NFAA), 50-82, 83-137, and ≥138 nmol/L).

RESULTS: 1154 patients and 3462 matched controls were included. During a median follow-up of 6.6 years, 210 patients and 505 controls died. There were no statistically significant differences in mortality between patients with NFAA and their controls (HR 1.13 (0.87-1.46)) whereas mortality was increased compared to controls in patients with cortisolDST 83-137 (HR 1.99 (1.38-2.88)) and ≥138 nmol/L (HR 4.09 (2.41-6.93)). Likewise, the mortality risk was increased inpatients younger than 65 years with cortisolDST 50-82 nmol/L compared to controls (HR 2.33 (1.30-4.17)).

CONCLUSION: NFAA does not seem to pose a clinically relevant risk for increased mortality in patients with AI while patients with MACS, and especially younger patients and those with cortisolDST ≥83 nmol/L, have significantly increased mortality risk compared to matched controls.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of clinical endocrinology and metabolism
volume
108
issue
8
pages
536 - 541
publisher
Oxford University Press
external identifiers
  • scopus:85164843058
  • pmid:36800277
ISSN
1945-7197
DOI
10.1210/clinem/dgad074
language
English
LU publication?
yes
id
5842a617-204e-4101-b8d6-d0b169ee08fc
date added to LUP
2023-04-13 11:58:02
date last changed
2024-06-15 01:52:34
@article{5842a617-204e-4101-b8d6-d0b169ee08fc,
  abstract     = {{<p>CONTEXT: Mild autonomous cortisol secretion (MACS) is associated with increased mortality in patients with adrenal incidentalomas (AI), but little is known regarding the potential risk associated with non-functional adrenal adenomas (NFAA), which constitute the majority of AI.</p><p>OBJECTIVE: Compare mortality risk in patients with NFAA, and different levels of MACS, to matched controls.</p><p>METHOD: This was a retrospective matched cohort study. All patients referred to two endocrine centres in southern Sweden because of an AI between 2005 and 2015 were enrolled. Controls (3:1) matched for sex, age, and residency were included. Primary endpoint was all-cause mortality. Outcome data was obtained from the Cause of Death Register. Patients were grouped according to cortisol level post 1-mg dexamethasone suppression test (cortisolDST) (&lt;50 (NFAA), 50-82, 83-137, and ≥138 nmol/L).</p><p>RESULTS: 1154 patients and 3462 matched controls were included. During a median follow-up of 6.6 years, 210 patients and 505 controls died. There were no statistically significant differences in mortality between patients with NFAA and their controls (HR 1.13 (0.87-1.46)) whereas mortality was increased compared to controls in patients with cortisolDST 83-137 (HR 1.99 (1.38-2.88)) and ≥138 nmol/L (HR 4.09 (2.41-6.93)). Likewise, the mortality risk was increased inpatients younger than 65 years with cortisolDST 50-82 nmol/L compared to controls (HR 2.33 (1.30-4.17)).</p><p>CONCLUSION: NFAA does not seem to pose a clinically relevant risk for increased mortality in patients with AI while patients with MACS, and especially younger patients and those with cortisolDST ≥83 nmol/L, have significantly increased mortality risk compared to matched controls.</p>}},
  author       = {{Kjellbom, Albin and Lindgren, Ola and Danielsson, Malin and Olsen, Henrik and Löndahl, Magnus}},
  issn         = {{1945-7197}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{536--541}},
  publisher    = {{Oxford University Press}},
  series       = {{The Journal of clinical endocrinology and metabolism}},
  title        = {{Mortality not increased in patients with non-functional adrenal adenomas : a matched cohort study}},
  url          = {{http://dx.doi.org/10.1210/clinem/dgad074}},
  doi          = {{10.1210/clinem/dgad074}},
  volume       = {{108}},
  year         = {{2023}},
}