title: Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas.
abstract: BACKGROUND
  Incidental benign adrenocortical adenomas, adrenal incidentalomas are found in 4.5% of abdominal computed tomography scans, with the incidence increasing to 10% in patients older than 70 years of age. These incidentalomas frequently show evidence of excess cortisol secretion but without overt Cushing's syndrome. The mortality rate is increased in Cushing's syndrome.
  
  
  OBJECTIVE
  This study sought to investigate whether patients with adrenal incidentalomas have an increased mortality.
  
  
  METHODS
  This was a retrospective, longitudinal cohort study.
  
  
  METHODS
  The study was carried out in an Endocrine Investigation Unit in a University Teaching Hospital.
  
  
  METHODS
  Two hundred seventy-two consecutive patients with an incidental adrenal mass underwent a dedicated diagnostic protocol, which included dexamethasone testing for hypercortisolism between 2005 and 2013. Overall survival was assessed in 206 patients with a benign, adrenocortical adenoma.
  
  
  METHODS
  Survival analysis was carried out by using Kaplan-Meier curves and the effect of dexamethasone cortisol estimated by Cox-regression analysis. Cause-specific mortality was ascertained from death certificates and compared with local and national data.
  
  
  RESULTS
  Eighteen of 206 patients died and the mean time (SD) from diagnosis to death was 3.2 (1.7) years. Seventeen of 18 patients who died had a post dexamethasone cortisol >1.8 μg/dL and there was a significant decrease in survival rate with increasing dexamethasone cortisol levels (P = .001). Compared with the <1.8 μg/dL group, the hazard ratio (95% confidence interval) for the 1.8-5 μg/dL group was 12.0 (1.6-92.6) whereas that of the >5 μg/dL group was 22.0 (2.6-188.3). Fifty percent and 33% of deaths were secondary to circulatory or respiratory/infective causes, respectively.
  
  
  CONCLUSIONS
  PATIENTS with adrenal incidentalomas and a post-dexamethasone serum cortisol >1.8 μg/dL have increased mortality, mainly related to cardiovascular disease and infection.
authors.affiliation: Academic Unit of Endocrinology, Department of Human Metabolism (M.D., R.J.R., J.N.-P.), University of Sheffield, South Yorkshire S10 2RX, United Kingdom; Medical Statistics and Clinical Trials Research Unit (M.Br.), The School of Health and Related Research, University of Sheffield, South Yorkshire S1 4DA, United Kingdom; The Departments of Endocrinology (M.D., R.J.R., J.N.-P.), Radiology (M.Bu.), and Endocrine Surgery (B.H.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, South Yorkshire S10 2JF, United Kingdom.
authors.forename: Miguel
authors.initials: M
authors.lastname: Debono
authors.forename: Mike
authors.initials: M
authors.lastname: Bradburn
authors.forename: Matthew
authors.initials: M
authors.lastname: Bull
authors.forename: Barney
authors.initials: B
authors.lastname: Harrison
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ross
authors.forename: John
authors.initials: J
authors.lastname: Newell-Price
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood* / Q000401:mortality*; D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D003907:Dexamethasone; D006854:Hydrocortisone