Clinical manifestations of functionally autonomous cortisol secretion in patients with adrenal masse

Abstract

Introduction. The choice of tactics for patients with adrenal masses (AM) with functionally autonomous cortisol secretion (FASC) remains controversial.The aim of the study was to determine the most significant clinical manifestations of FASC in unoperated AM patients.Materials and methods Thirty unoperated AM patients aged 67.0 [59.25 to 71.0] years with a disease duration of 92.0 [46.75 to 112.0] months were included in the study.Results. We defined thresholds for morning blood cortisol levels to predict clinical manifestations of FASC: for obesity ≥ 300.7 nmol/L, (p = 0.02), DM2 ≥ 508.0 nmol/L, (p < 0.001), dyslipidemia ≥ 450.0 nmol/L, (p = 0.02). Increases in AM size were determined: at 36 months − by 0.146 cm, at 60 months − by 0.169 cm, its positive marked direct correlation with the initial AM size.Discussion. According to the literature, FASC is diagnosed in 30−50 % of patients with AM. Our data are comparable with scientific sources: AH was observed in 86.7% (n = 26) of patients, obesity − 73.3 % (n = 22), T2DM − 36.7 % (n = 11), dyslipidemia − 60 % (n = 17), osteoporosis − 43.3 % (n = 13).Conclusion In unoperated outpatients with AM, obesity, DM2, and dyslipidemia are the most significant clinical manifestations of FASC. In patients over 60 years of age with a benign CT-phenotype of adrenal masses and controlled clinical manifestations of FASC, the treatment tactic is observation.