title: Non-functioning adrenal incidentalomas are associated with elevated D-dimer levels.
abstract: OBJECTIVE
  Although the majority of adrenal incidentalomas (AI) are non-functioning, studies evaluating metabolic disturbances in this particular group are limited. The objective of this study is to investigate metabolic syndrome components and levels of plasma von Willebrand factor (VWF), fibrinogen, and D-dimer in subjects with non-functioning AI.
  
  
  METHODS
  Forty-five subjects without clinical and subclinical findings of hypercortisolism or other adrenal gland disorders and 37 healthy controls were enrolled. The patients and controls underwent hormonal evaluation including morning cortisol, ACTH, post-dexamethasone suppression test (DST), morning cortisol, DHEAS, and urinary free cortisol. Anthropometric and metabolic parameters and body composition were assessed and fibrinogen, D-dimer, and VWF were measured.
  
  
  RESULTS
  When compared with healthy controls, subjects with AI had significant elevations in several metabolic and anthropometric parameters, uric acid, post-DST cortisol, and D-dimer. When compared with body mass index-matched controls, blood pressure (p=0.004), uric acid (p=0.009), post-DST cortisol (p=0.014), and D-dimer (p=0.045) remained significantly elevated. We demonstrated weak correlations between D-dimer and other metabolic and anthropometric variables. Morning cortisol was demonstrated as an independent variable associated with homeostasis model assessment levels in subjects with AI (beta=410, p=0.004).
  
  
  CONCLUSIONS
  Individuals with clinically and hormonally inactive adrenal adenomas feature insulin resistance and a variety of metabolic disturbances. The subtle cortisol autonomy seems to be associated with insulin-resistant state. D-dimer elevation in AI group was a consequence of insulin-resistant state associated with subtle cortisol autonomy rather than a direct effect of cortisol secretion.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey. serkan.yener@deu.edu.tr
authors.forename: S
authors.initials: S
authors.lastname: Yener
authors.forename: A
authors.initials: A
authors.lastname: Comlekci
authors.forename: B
authors.initials: B
authors.lastname: Akinci
authors.forename: M
authors.initials: M
authors.lastname: Secil
authors.forename: T
authors.initials: T
authors.lastname: Demir
authors.forename: S
authors.initials: S
authors.lastname: Ertilav
authors.forename: S
authors.initials: S
authors.lastname: Yesil
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000175:diagnosis; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000933:Antifibrinolytic Agents / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D033162:Incidental Findings; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014841:von Willebrand Factor; D005340:Fibrinogen; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone