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The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test

Journal of Human Hypertension volume 32, pages 3–11 (2018)Cite this article

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Abstract

There are limited data regarding the frequency of hypertension in nonfunctioning adrenal incidentaloma (NFAI). Our objectives were to investigate rates of hypertension and resistant hypertension in NFAI patients, and compare them to a control group without adrenal adenoma. We also aimed to evaluate the relationship between cortisol levels after 1 mg-dexamethasone suppression test (DST) and hypertension in NFAI patients. We selected 40 patients with NFAI and 40 control patients over the age of 18 without adrenal lesions on abdominal imaging. Data regarding hypertension, resistant hypertension, number, and type of antihypertensive drugs were collected from each subject. Blood samples for C-reactive protein (CRP), plasma adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEA-S) were also collected from the patients. Age, gender, race, smoking status, menopause status and BMI were comparable between patient and control groups. Patients with NFAI had a higher frequency of hypertension (72.5 vs. 47.5%; p = 0.04), resistant hypertension (37.9 vs. 11.1%; p = 0.04) and took three or more antihypertensive drugs (33.3 vs. 5.2%; p = 0.002) when compared to the controls, respectively. NFAI patients with hypertension had higher mean cortisol levels after 1 mg-DST when compared to NFAI patients without hypertension (1.3 ± 0.3 vs. 1.0 ± 0.4; p = 0.03, respectively). We found a negative correlation between cortisol levels after 1 mg-DST DHEA-S levels (r = −0.61; p < 0.001) and a positive correlation with CRP levels (r = 0.44; p = 0.02). In conclusion, NFAI patients presented a higher frequency of hypertension, resistant hypertension and used more antihypertensive medications when compared to the control group. We found an association between hypertension in NFAI patients and cortisol levels after 1 mg-DST.

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Acknowledgements

This study was made possible thanks to grants from the Research Support Foundation of the State of Rio de Janeiro, (FAPERJ) and the Brazilian National Council for Scientific and Technological Development (CNPq) to LVN.

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Authors and Affiliations

  1. Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil

    Mariana Arruda, Emanuela Mello Ribeiro Cavalari, Marcela Pessoa de Paula, Felipe Fernandes Cordeiro de Morais, Guilherme Furtado Bilro, Maria Caroline Alves Coelho, Nathalie Anne de Oliveira e Silva de Morais, Diana Choeri, Aline Moraes & Leonardo Vieira Neto

  2. Endocrinology Unit – State University of Rio de Janeiro, Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil

    Maria Caroline Alves Coelho

  3. Diabetes and Endocrinology Institution for the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Maria Caroline Alves Coelho & Nathalie Anne de Oliveira e Silva de Morais

  4. Endocrinology Unit, Lagoa Federal Hospital, Rio de Janeiro, RJ, Brazil

    Leonardo Vieira Neto

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Correspondence to Leonardo Vieira Neto.

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Arruda, M., Mello Ribeiro Cavalari, E., Pessoa de Paula, M. et al. The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test. J Hum Hypertens 32, 3–11 (2018). https://doi.org/10.1038/s41371-017-0011-4

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