title: "Nonfunctional" Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes: A Cohort Study.
abstract: BACKGROUND
  Benign adrenal tumors are commonly discovered on abdominal imaging. Most are classified as nonfunctional and are considered to pose no health risk, but some are considered functional because they secrete hormones that increase risk for metabolic and cardiovascular diseases.
  
  
  OBJECTIVE
  To evaluate the hypothesis that nonfunctional adrenal tumors (NFATs) increase risk for cardiometabolic outcomes compared with absence of adrenal tumors.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Integrated hospital system.
  
  
  METHODS
  Participants with benign NFATs ("exposed"; n = 166) and those with no adrenal tumor ("unexposed"; n = 740), with at least 3 years of follow-up.
  
  
  METHODS
  Medical records were reviewed from the time of abdominal imaging for development of incident outcomes (hypertension, composite diabetes [prediabetes or type 2 diabetes], hyperlipidemia, cardiovascular events, and chronic kidney disease) (mean, 7.7 years). Primary analyses evaluated independent associations between exposure status and incident outcomes by using adjusted generalized linear models. Secondary analyses evaluated relationships between NFATs and cortisol physiology.
  
  
  RESULTS
  Participants with NFATs had significantly higher risk for incident composite diabetes than those without adrenal tumors (30 of 110 [27.3%] vs. 72 of 615 [11.7%] participants; absolute risk, 15.6% [95% CI, 6.9% to 24.3%]; adjusted risk ratio, 1.87 [CI, 1.17 to 2.98]). No significant associations between NFATs and other outcomes were observed. Higher "normal" postdexamethasone cortisol levels (≤50 nmol/L) were associated with larger NFAT size and higher prevalence of type 2 diabetes.
  
  
  CONCLUSIONS
  Potential bias in the selection of participants and ascertainment of outcomes.
  
  
  CONCLUSIONS
  Participants with NFATs had a significantly higher risk for diabetes than those without adrenal tumors. These results should prompt a reassessment of whether the classification of benign adrenal tumors as "nonfunctional" adequately reflects the continuum of hormone secretion and metabolic risk they may harbor.
  
  
  BACKGROUND
  National Institutes of Health and Doris Duke Charitable Foundation.
authors.affiliation: From Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Clinical Research Institute, Boston, Massachusetts; London School of Hygiene & Tropical Medicine, London, United Kingdom; and University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Diana
authors.initials: D
authors.lastname: Lopez
authors.affiliation: From Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Clinical Research Institute, Boston, Massachusetts; London School of Hygiene & Tropical Medicine, London, United Kingdom; and University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Luque-Fernandez
authors.affiliation: From Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Clinical Research Institute, Boston, Massachusetts; London School of Hygiene & Tropical Medicine, London, United Kingdom; and University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Steele
authors.affiliation: From Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Clinical Research Institute, Boston, Massachusetts; London School of Hygiene & Tropical Medicine, London, United Kingdom; and University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Gail K
authors.initials: GK
authors.lastname: Adler
authors.affiliation: From Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Clinical Research Institute, Boston, Massachusetts; London School of Hygiene & Tropical Medicine, London, United Kingdom; and University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
authors.affiliation: From Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Clinical Research Institute, Boston, Massachusetts; London School of Hygiene & Tropical Medicine, London, United Kingdom; and University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Anand
authors.initials: A
authors.lastname: Vaidya
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D000308:Adrenocortical Hyperfunction / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006854:Hydrocortisone