Background: adrenal incidentaloma (IS) is defined as an adrenal mass found incidentally in the context of other investigations or treatments performed for other causes. Estimates made on the general population place its prevalence between 0.1 and 0.43%. A percentage varying from 5 to 30% of patients with IS also presents subclinical hypercortisolism, defined as a state of altered cortisol secretion with loss of feedback from the hypothalamic-pituitary-adrenal (HPA) axis, in the absence of the classic signs or symptoms of hypercortisolism, but still associated with a greater incidence of cardiovascular events. The 2023 ESE/European Network for Study of Adrenal Tumors (ENSAT) guidelines introduce the concept of MACS, or "mild autonomous cortisol secretion", to describe the biochemical evidence of abnormal cortisol secretion, typically associated with the finding of incidentaloma of the adrenal gland. It is also known that clinical hypercortisolism is associated with sex-specific and subtype-specific alterations of the blood count with leukocyte formula. Materials and methods: we conducted a retrospective observational study on a population consisting of 157 patients attending the endocrinology clinics of the Padua Hospital between 2001 and 2024. Objective: the primary objective is to investigate whether the same alterations can also be found in patients with adrenal incidentaloma and subclinical hypercortisolism. As a secondary objective, we looked for a possible correlation between MACS and major cardiovascular events. Results: our results showed that not only the mild autonomous secretion of cortisol is associated with sex-specific differences in blood count values with leukocyte count, sometimes similar to those documented in the literature in patients with Cushing's syndrome, but also with new differences dependent from age. Conclusions: we have therefore highlighted that even mild autonomous secretion of cortisol can be associated with alterations in erythropoiesis, immune function and the inflammatory state of patients diagnosed with adrenal incidentaloma and MACS.
Presupposti dello studio: l’incidentaloma del surrene (IS) è definito come una massa surrenalica riscontrata incidentalmente nel contesto di altre indagini o trattamenti effettuati per altre cause. Stime effettuate sulla popolazione generale pongono la sua prevalenza fra lo 0.1 e lo 0.43 %. Un percentuale variabile dal 5 al 30% di pazienti con IS presenta inoltre ipercortisolismo subclinico, definito come uno stato di alterata secrezione di cortisolo con perdita del feedback dell’asse ipotalamo-ipofisi-surrene (HPA), in assenza dei classici segni o sintomi dell’ipercortisolismo, ma associato comunque ad una maggior incidenza di eventi cardiovascolari. Le linee guida ESE/European Network for Study of Adrenal Tumors (ENSAT) del 2023 introducono il concetto di MACS, ovvero “mild autonomous cortisol secretion”, per descrivere l'evidenza biochimica di una secrezione anomala di cortisolo, tipicamente associata al riscontro di incidentaloma del surrene. È inoltre noto come l’ipercortisolismo clinico si associ ad alterazioni sesso – specifiche e sottotipo – specifiche dell’emocromo con formula leucocitaria. Materiali e metodi: abbiamo realizzato uno studio osservazionale retrospettivo su una popolazione costituita da 157 pazienti, afferenti agli ambulatori dell’endocrinologia dell’Azienda Ospedaliera di Padova tra il 2001 ed il 2024. Scopo dello studio: l’obiettivo primario è investigare se le medesime alterazioni possano essere riscontrate anche nei pazienti con incidentaloma del surrene ed ipercortisolismo subclinico. Come obiettivo secondario, abbiamo cercato un’eventuale correlazione fra il MACS ed eventi cardiovascolari maggiori. Discussione: i nostri risultati hanno mostrato che non solo la secrezione autonoma lieve di cortisolo si associ a differenze sesso – specifiche dei valori dell’emocromo con conta leucocitaria, talvolta analoghi a quelli documentati in letteratura nei pazienti con sindrome di Cushing, ma anche a nuove differenze dipendenti dall’età. Conclusioni: abbiamo dunque evidenziato che anche la secrezione autonoma lieve di cortisolo può associarsi ad alterazioni dell’eritropoiesi, della funzione immunitaria e dello stato infiammatorio dei pazienti con diagnosi di incidentaloma del surrene e MACS.
Valori dell'emocromo nei pazienti con incidentaloma del surrene.
PORSENNA, AURELIO
2023/2024
Abstract
Background: adrenal incidentaloma (IS) is defined as an adrenal mass found incidentally in the context of other investigations or treatments performed for other causes. Estimates made on the general population place its prevalence between 0.1 and 0.43%. A percentage varying from 5 to 30% of patients with IS also presents subclinical hypercortisolism, defined as a state of altered cortisol secretion with loss of feedback from the hypothalamic-pituitary-adrenal (HPA) axis, in the absence of the classic signs or symptoms of hypercortisolism, but still associated with a greater incidence of cardiovascular events. The 2023 ESE/European Network for Study of Adrenal Tumors (ENSAT) guidelines introduce the concept of MACS, or "mild autonomous cortisol secretion", to describe the biochemical evidence of abnormal cortisol secretion, typically associated with the finding of incidentaloma of the adrenal gland. It is also known that clinical hypercortisolism is associated with sex-specific and subtype-specific alterations of the blood count with leukocyte formula. Materials and methods: we conducted a retrospective observational study on a population consisting of 157 patients attending the endocrinology clinics of the Padua Hospital between 2001 and 2024. Objective: the primary objective is to investigate whether the same alterations can also be found in patients with adrenal incidentaloma and subclinical hypercortisolism. As a secondary objective, we looked for a possible correlation between MACS and major cardiovascular events. Results: our results showed that not only the mild autonomous secretion of cortisol is associated with sex-specific differences in blood count values with leukocyte count, sometimes similar to those documented in the literature in patients with Cushing's syndrome, but also with new differences dependent from age. Conclusions: we have therefore highlighted that even mild autonomous secretion of cortisol can be associated with alterations in erythropoiesis, immune function and the inflammatory state of patients diagnosed with adrenal incidentaloma and MACS.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/65724