Circadian blood pressure profile in patients with adrenal incidentalomas and mild hypercortisolism
Adrenal incidentalomas are clinically silent masses discovered inadvertently during diagnostic imaging procedures performed for unrelated reasons. Radiological studies report a frequency of these masses around 3% in the age of 50 years, which increases up to 10% in the elderly. Mild hypercortisolism, recently redefined as possible autonomous cortisol secretion (pACS), is characterized by an incomplete suppression of the hypothalamic-pituitary-adrenal axis without the typical signs of overt cortisol hypersecretion (1,2). It is well known that overt hypercortisolism (Cushing's Syndrome) is associated with cardiovascular disease and in particular with left ventricular hypertrophy and hypertension, typically not presenting nocturnal blood pressure-dipping (3). Current retrospective data revealed that even asymptomatic patients with adrenal incidentalomas and pACS suffer from a higher rate of cardiovascular events and mortality than patients with normal HPA-axis suppression (4). Our group recently described on European Journal of Endocrinology that mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, showing that both mean left ventricular mass index and prevalence of left ventricular hypertrophy was higher in pACS than in non-functioning adenomas patients (5). Despite hypertension is one of the most common clinical features of patients with mild hypercortisolism, prospective studies documenting circadian blood pressure profile in these patients are lacking. The aim of this study is to assess 24-h ambulatory blood pressure monitoring (ABPM) in patients with adrenal incidentalomas and mild hypercortisolism, focusing on the impact of dipping and non-dipping profiles.
(1) Debono M et al. Curr Opin Endocrinol Diabetes Obes 2015
(2) Fassnacht M et al.Eur J Endocrinol 2016
(3) Pivonello R, Isidori AM et al.Lancet Diabetes Endocrinol 2016
(4) Morelli V, et al. Eur J Endocrinol 2017
(5) Sbardella E. Minnetti M. et al. Eur J Endocrinol 2018