High prevalence of smoking in patients with adrenal incidentalomas: causality or case selection?

in European Journal of Endocrinology

Correspondence should be addressed to H Olsen; Email: henrik.olsen@med.lu.se
Restricted access

Objective:

Autonomous cortisol secretion and possible autonomous cortisol secretion (ACS/pACS) are associated to an increase of cardiovascular risk factors such as hypertension, diabetes mellitus and dyslipidaemia. To our knowledge, the prevalence of smoking, another well-established risk factor for cardiovascular disease, has not been studied in detail in people with ACS/pACS or adrenal incidentalomas.

Methods:

Patients with adrenal incidentalomas were examined with the 1-mg overnight dexamethasone suppression test (cortisolONDST). Information about current smoking was collected from the patient’s records.

Results:

We studied 1044 patients, of whom 370 (35%) were current smokers. Of these, 22% had bilateral AI compared to 12% of the non-smokers (P < 0.001). Among patients with unilateral adrenal incidentalomas, smokers had larger adrenal incidentalomas than non-smokers (22 mm vs 19 mm, P < 0.001). Smokers also more often had cortisolONDST ≥50 nmol/L than non-smokers, 54% vs 40% (P < 0.001), a finding independent of the size of the adrenal incidentaloma in patients with unilateral adrenal incidentalomas.

Conclusions:

In the present study of patients with adrenal incidentalomas, the prevalence of current smoking was higher than in the general population. Furthermore, smokers had larger unilateral adrenal incidentalomas, more often bilateral adrenal incidentalomas, and more frequently ACS/pACS. Whether smoking is a risk factor for adrenal incidentalomas and ACS/pACS or our findings are due to case selection needs to be further studied.

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 193 193 193
Full Text Views 28 28 28
PDF Downloads 22 22 22
  • 1

    FassnachtMArltWBancosIDralleHNewell-PriceJSahdevATabarinATerzoloMTsagarakisSDekkersOM. Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. European Journal of Endocrinology 2016 175 G1G34. (https://doi.org/10.1530/EJE-16-0467)

    • Search Google Scholar
    • Export Citation
  • 2

    DebonoMBradburnMBullMHarrisonBRossRJNewell-PriceJ. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. Journal of Clinical Endocrinology & Metabolism 2014 99 44624470. (https://doi.org/10.1210/jc.2014-3007)

    • Search Google Scholar
    • Export Citation
  • 3

    Di DalmaziGVicennatiVGarelliSCasadioERinaldiEGiampalmaEMosconiCGolfieriRPaccapeloAPagottoU Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet: Diabetes & Endocrinology 2014 2 396405. (https://doi.org/10.1016/S2213-8587(13)70211-0)

    • Search Google Scholar
    • Export Citation
  • 4

    MorelliVReimondoGGiordanoRDella CasaSPolicolaCPalmieriSSalcuniASDolciAMendolaMArosioM Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. Journal of Clinical Endocrinology & Metabolism 2014 99 827834. (https://doi.org/10.1210/jc.2013-3527)

    • Search Google Scholar
    • Export Citation
  • 5

    PatrovaJKjellmanMWahrenbergHFalhammarH. Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center. Endocrine 2017 58 267275. (https://doi.org/10.1007/s12020-017-1400-8)

    • Search Google Scholar
    • Export Citation
  • 6

    NtaliGAsimakopoulouASiamatrasTKomninosJVassiliadiDTzanelaMTsagarakisSGrossmanABWassJAKaravitakiN. Mortality in Cushing’s syndrome: systematic analysis of a large series with prolonged follow-up. European Journal of Endocrinology 2013 169 715723. (https://doi.org/10.1530/EJE-13-0569)

    • Search Google Scholar
    • Export Citation
  • 7

    AliSMChaixBMerloJRosvallMWamalaSLindströmM. Gender differences in daily smoking prevalence in different age strata: a population-based study in southern Sweden. Scandinavian Journal of Public Health 2009 37 146152. (https://doi.org/10.1177/1403494808100274)

    • Search Google Scholar
    • Export Citation
  • 8

    NorbergMLundqvistGNilssonMGilljamHWeinehallL. Changing patterns of tobacco use in a middle-aged population: the role of snus, gender, age, and education. Global Health Action 2011 4 5613. (https://doi.org/10.3402/gha.v4i0.5613)

    • Search Google Scholar
    • Export Citation
  • 9

    HaoMLopezDLuque-FernandezMACoteKNewfieldJConnorsMVaidyaA. The lateralizing asymmetry of adrenal adenomas. Journal of the Endocrine Society 2018 2 374385. (https://doi.org/10.1210/js.2018-00034)

    • Search Google Scholar
    • Export Citation
  • 10

    MorelliVPalmieriSLaniaATresoldiACorbettaSCairoliEEller-VainicherCArosioMCopettiMGrossiE Cardiovascular events in patients with mild autonomous cortisol secretion: analysis with artificial neural networks. European Journal of Endocrinology 2017 177 7383. (https://doi.org/10.1530/EJE-17-0047)

    • Search Google Scholar
    • Export Citation
  • 11

    Di DalmaziGVicennatiVRinaldiEMorselli-LabateAMGiampalmaEMosconiCPagottoUPasqualiR. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. European Journal of Endocrinology 2012 166 669677. (https://doi.org/10.1530/EJE-11-1039)

    • Search Google Scholar
    • Export Citation
  • 12

    AndroulakisIIKaltsasGAKolliasGEMarkouACGouliAKThomasDAAlexandrakiKIPapamichaelCMHadjidakisDJPiaditisGP. Patients with apparently nonfunctioning adrenal incidentalomas may be at increased cardiovascular risk due to excessive cortisol secretion. Journal of Clinical Endocrinology & Metabolism 2014 99 27542762. (https://doi.org/10.1210/jc.2013-4064)

    • Search Google Scholar
    • Export Citation
  • 13

    TerzoloMBovioSPiaAContonPAReimondoGDall’AstaCBemporadDAngeliAOpocherGMannelliM Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma. European Journal of Endocrinology 2005 153 307315. (https://doi.org/10.1530/eje.1.01959)

    • Search Google Scholar
    • Export Citation
  • 14

    Di DalmaziGFanelliFZavattaGRicci BittiSMezzulloMRepaciAPelusiCGambineriAAltieriPMosconiC The steroid profile of adrenal incidentalomas: subtyping subjects With high cardiovascular risk. Journal of Clinical Endocrinology & Metabolism 2019 104 55195528. (https://doi.org/10.1210/jc.2019-00365)

    • Search Google Scholar
    • Export Citation
  • 15

    UelandMethliePKellmannRBjørgaasMÅsvoldBOThorstensenKKelpOThordarsonHBMellgrenGLøvåsK Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test. European Journal of Endocrinology 2017 176 705713. (https://doi.org/10.1530/EJE-17-0078)

    • Search Google Scholar
    • Export Citation
  • 16

    BovioSCataldiAReimondoGSperonePNovelloSBerrutiABorasioPFavaCDogliottiLScagliottiGV Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. Journal of Endocrinological Investigation 2006 29 298302. (https://doi.org/10.1007/BF03344099)

    • Search Google Scholar
    • Export Citation
  • 17

    BailieLLoughreyMBColemanHG. Lifestyle risk factors for serrated colorectal polyps: a systematic review and meta-analysis. Gastroenterology 2017 152 92104. (https://doi.org/10.1053/j.gastro.2016.09.003)

    • Search Google Scholar
    • Export Citation
  • 18

    KimSYMinCOhDJChoiHG. Tobacco smoking and alcohol consumption are related to benign parotid tumor: A nested case-control study using a national health screening cohort. Clinical & Experimental Otorhinolaryngology 2019 12 412419. (https://doi.org/10.21053/ceo.2018.01774)

    • Search Google Scholar
    • Export Citation
  • 19

    HoltVLCushing-HaugenKLDalingJR. Risk of functional ovarian cyst: effects of smoking and marijuana use according to body mass index. American Journal of Epidemiology 2005 161 520525. (https://doi.org/10.1093/aje/kwi080)

    • Search Google Scholar
    • Export Citation
  • 20

    GalantiMRGranathFCnattingiusSEkbom-SchnellAEkbomA. Cigarette smoking and the risk of goitre and thyroid nodules amongst parous women. Journal of Internal Medicine 2005 258 257264. (https://doi.org/10.1111/j.1365-2796.2005.01523.x)

    • Search Google Scholar
    • Export Citation
  • 21

    DouglasSHariharanG. The hazard of starting smoking: estimates from a split population duration model. Journal of Health Economics 1994 13 213230. (https://doi.org/10.1016/0167-6296(94)90024-8)

    • Search Google Scholar
    • Export Citation
  • 22

    CeccatoFArtusiCBarbotMLizzulLPinelliSCostantiniGNieroSAntonelliGPlebaniMScaroniC. Dexamethasone measurement during low-dose suppression test for suspected hypercortisolism: threshold development with and validation. Journal of Endocrinological Investigation 2020 [Online ahead of print]. (https://doi.org/10.1007/s40618-020-01197-6)

    • Search Google Scholar
    • Export Citation
  • 23

    ConroyRMPyöräläKFitzgeraldAPSansSMenottiADe BackerGDe BacquerDDucimetièrePJousilahtiPKeilU Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. European Heart Journal 2003 24 9871003. (doi:10.1016/s0195-668x(03)00114-3)

    • Search Google Scholar
    • Export Citation