Mortality not increased in patients with non-functional adrenal adenomas : a matched cohort study
(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
- Kjellbom, Albin LU ; Lindgren, Ola LU ; Danielsson, Malin ; Olsen, Henrik LU and Löndahl, Magnus LU
- organization
- publishing date
- 2023
- 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) (<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}}, }