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DOI: 10.1055/a-0754-6464
Metabolic Syndrome as a Predictor of Adrenal Functional Status: A Discriminant Multivariate Analysis Versus Logistic Regression Analysis
Publication History
received 22 May 2018
accepted 02 October 2018
Publication Date:
07 November 2018 (online)
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Abstract
Patients harboring adrenal tumors are characterized by higher prevalence of metabolic syndrome (MetS) components and a higher incidence of cardiovascular complications, especially in cases of subclinical or overt hormonal hypersecretion. Early detection and referral of those patients in tertiary centers could prevent unfavorable outcomes. In this cross-sectional, retrospective study, we evaluated 111 consecutive patients with adrenal incidentalomas and 14 patients with known hypersecretory adrenal lesions (autonomous cortisol secretion, primary aldosteronism, and pheochromocytoma), who were investigated in our clinic. Based on the different distribution of MetS components in patients with non-functional and functional adrenal lesions we introduced a predictive model of hormonal hypersecretion using those components. We performed multivariate discriminant analysis and compared predictive results with conventional multiple logistic regression analysis. Diabetes, impaired glucose tolerance, impaired fasting glucose, hypertension, body mass index, HDL-cholesterol levels, triglyceride levels, drug treatment for lipid disorder (statins, fenofibrate, and fish oils, alone or in combination), and maximal adrenal lesion diameter were used as discriminating covariates. Multivariate discriminant function exhibited a sensitivity of 77.27% and specificity of 73.08% in predicting adrenal hormonal hypersecretion. Receiver operating characteristic curve of discriminant predictive function had an area under the curve value of 0.785, S.E. 0.04. Logistic function delivered comparable results. MetS components exhibit a good predictive feature of hormonal hypersecretion in patients with adrenal tumors. Predictive functions may help in the search for an easy and generally available algorithm to validly predict the functional activity of adrenal masses.
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References
- 1 Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2016; 175: G1-G34
- 2 Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, Harris EL, Lee JK, Oertel YC, Posner MC, Schlechte JA, Wieand HS. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 2003; 138: 424-429
- 3 Barth E, Albuszies G, Baumgart K, Matejovic M, Wachter U, Vogt J, Radermacher P, Calzia E. Glucose metabolism and catecholamines. Crit Care Med 2007; 35: S508-S518
- 4 Diamanti-Kandarakis E, Zapanti E, Peridis MH, Ntavos P, Mastorakos G. Insulin resistance in pheochromocytoma improves more by surgical rather than by medical treatment. Hormones (Athens) 2003; 2: 61-66
- 5 Holmang A, Bjorntorp P. The effects of cortisol on insulin sensitivity in muscle. Acta Physiol Scand 1992; 144: 425-431
- 6 Andrews RC, Walker BR. Glucocorticoids and insulin resistance: Old hormones, new targets. Clin Sci (London) 1999; 96: 513-523
- 7 Lastra G, Dhuper S, Johnson MS, Sowers JR. Salt, aldosterone, and insulin resistance: Impact on the cardiovascular system. Nat Rev Cardiol 2010; 7: 577-584
- 8 Colussi G, Catena C, Lapenna R, Nadalini E, Chiuch A, Sechi L. Insulin resistance and hyperinsulinemia are related to plasma aldosterone levels in hypertensive patients. Diabetes Care 2007; 30: 2349-2354
- 9 Quinkler M, Born-Frontsberg E, Fourkiotis VG. Comorbidities in primary aldosteronism. Horm Metab Res 2010; 42: 429-434
- 10 Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A. Participants of the German Conn's R. Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry. Eur J Endocrinol 2015; 173: 665-675
- 11 La Batide-Alanore A, Chatellier G, Plouin PF. Diabetes as a marker of pheochromocytoma in hypertensive patients. J Hypertens 2003; 21: 1703-1707
- 12 Alberti KG, Zimmet P, Shaw J. Group IETFC . The metabolic syndrome—A new worldwide definition. Lancet 2005; 366: 1059-1062
- 13 Lazurova I, Spisakova D, Wagnerova H, Habalova V, Dravecka I, Darina P, Drahovska I, Pundova L. Clinically silent adrenal adenomas – their relation to the metabolic syndrome and to GNB3 C825T gene polymorphism. Wiener Klin Wochensch 2011; 123: 618-622
- 14 Terzolo M, Pia A, Ali A, Osella G, Reimondo G, Bovio S, Daffara F, Procopio M, Paccotti P, Borretta G, Angeli A. Adrenal incidentaloma: A new cause of the metabolic syndrome?. J Clin Endocrinol Metab 2002; 87: 998-1003
- 15 Erbil Y, Ozbey N, Barbaros U, Unalp HR, Salmaslioglu A, Ozarmagan S. Cardiovascular risk in patients with nonfunctional adrenal incidentaloma: Myth or reality?. World J Surg 2009; 33: 2099-2105
- 16 Peppa M, Koliaki C, Raptis SA. Adrenal incidentalomas and cardiometabolic morbidity: An emerging association with serious clinical implications. J Intern Med 2010; 268: 555-566
- 17 Muscogiuri G, Sorice GP, Prioletta A, Mezza T, Cipolla C, Salomone E, Giaccari A, Pontecorvi A, Della Casa S. The size of adrenal incidentalomas correlates with insulin resistance. Is there a cause-effect relationship?. Clin Endocrinol (Oxf) 2011; 74: 300-305
- 18 Peppa M, Boutati E, Koliaki C, Papaefstathiou N, Garoflos E, Economopoulos T, Hadjidakis D, Raptis SA. Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: A cause-effect relationship?. Metab Clin Exp 2010; 59: 1435-1441
- 19 Iacobone M, Citton M, Viel G, Boetto R, Bonadio I, Mondi I, Tropea S, Nitti D, Favia G. Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing's syndrome. Surgery 2012; 152: 991-997
- 20 Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin Endocrinol (Oxf) 2001; 54: 797-804
- 21 Sereg M, Szappanos A, Toke J, Karlinger K, Feldman K, Kaszper E, Varga I, Glaz E, Racz K, Toth M. Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: A long-term follow-up study. Eur J Endocrinol 2009; 160: 647-655
- 22 Brown JM, Robinson-Cohen C, Luque-Fernandez MA, Allison MA, Baudrand R, Ix JH, Kestenbaum B, De Boer IH, Vaidya A. The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension: A Cohort Study. Ann Intern Med 2017; 167: 630-641
- 23 Kapoor A, Morris T, Rebello R. Guidelines for the management of the incidentally discovered adrenal mass. Can Urol Assoc J 2011; 5: 241-247
- 24 Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young Jr. WF. Endocrine S. Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99: 1915-1942
- 25 Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young Jr. WF. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
- 26 Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing's syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2008; 93: 1526-1540
- 27 Morelli V, Reimondo G, Giordano R, Della Casa S, Policola C, Palmieri S, Salcuni AS, Dolci A, Mendola M, Arosio M, Ambrosi B, Scillitani A, Ghigo E, Beck-Peccoz P, Terzolo M, Chiodini I. Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab 2014; 99: 827-834
- 28 Kastelan D, Kraljevic I, Dusek T, Knezevic N, Solak M, Gardijan B, Kralik M, Poljicanin T, Skoric-Polovina T, Kastelan Z. The clinical course of patients with adrenal incidentaloma: Is it time to reconsider the current recommendations?. Eur J Endocrinol 2015; 173: 275-282
- 29 Mosconi C, Vicennati V, Papadopoulos D, Dalmazi GD, Morselli-Labate AM, Golfieri R, Pasquali R. Can imaging predict subclinical cortisol secretion in patients with adrenal adenomas? A ct predictive score. Am J Roentgenol 2017; 209: 122-129
- 30 Tabuchi Y, Otsuki M, Kasayama S, Kosugi K, Hashimoto K, Yamamoto T, Tsugawa M, Mineo I, Yamada Y, Kurebayashi S, Ohashi M, Umayahara Y, Kouhara H, Nakamura T, Taki H, Matsuoka TA, Imagawa A, Funahashi T, Shimomura I. Clinical and endocrinological characteristics of adrenal incidentaloma in Osaka region, Japan. Endocr J 2016; 63: 29-35
- 31 Lu Y, Li P, Gan W, Zhao X, Shen S, Feng W, Xu Q, Bi Y, Guo H, Zhu D. Clinical and pathological characteristics of hypertensive and normotensive adrenal pheochromocytomas. Exp Clin Endocrinol Diabetes 2016; 124: 372-379
- 32 Eisenhofer G, Lenders JW, Goldstein DS, Mannelli M, Csako G, Walther MM, Brouwers FM, Pacak K. Pheochromocytoma catecholamine phenotypes and prediction of tumor size and location by use of plasma free metanephrines. Clin Chem 2005; 51: 735-744
- 33 Takanami K, Kaneta T, Morimoto R, Satoh F, Nakamura Y, Takase K, Takahashi S. Characterization of lipid-rich adrenal tumors by FDG PET/CT: Are they hormone-secreting or not?. Ann Nucl Med 2014; 28: 145-153