Mortality Not Increased in Patients With Nonfunctional Adrenal Adenomas

Albin Kjellbom, Ola Lindgren, Malin Danielsson, Henrik Olsen, Magnus Löndahl
The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 8, August 2023, Pages e536–e541
https://doi.org/10.1210/clinem/dgad074

Abstract

Context

Mild autonomous cortisol secretion (MACS) is associated with increased mortality in patients with adrenal incidentalomas, but little is known regarding the potential risk associated with nonfunctional adrenal adenomas (NFAA), which constitute the majority of adrenal incidentalomas.

Objective

Compare mortality risk in patients with NFAA, and different levels of MACS, to matched controls.

Method

This was a retrospective matched cohort study. All patients referred to 2 endocrine centers in southern Sweden because of an adrenal incidentaloma between 2005 and 2015 were enrolled. Controls (3:1) matched for sex, age, and residency were included. Primary endpoint was all-cause mortality. Outcome data were obtained from the Cause of Death Register. Patients were grouped according to cortisol level post 1-mg dexamethasone suppression test (cortisol_DST) (<50 (NFAA), 50–82, 83–137, and ≥138 nmol/L).

Results

1154 patients and 3462 matched controls were included. During a median follow-up of 6.6 years, 210 patients and 505 controls died. There were no statistically significant differences in mortality between patients with NFAA and their controls (HR 1.13 [0.87–1.46]) whereas mortality was increased compared to controls in patients with cortisol_DST 83–137 (HR 1.99 [1.38–2.88]) and ≥138 nmol/L (HR 4.09 [2.41–6.93]). Likewise, the mortality risk was increased in patients younger than 65 years with cortisol_DST 50–82 nmol/L compared with controls (HR 2.33 [1.30–4.17]).

Conclusion

NFAA does not seem to pose a clinically relevant risk for increased mortality in patients with adrenal incidentalomas while patients with MACS, and especially younger patients and those with cortisol_DST ≥83 nmol/L, have significantly increased mortality risk compared with matched controls.

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