Subclinical Cushing’s Syndrome in women with adrenal incidentalomas is associated with adipose tissue dysfunction

Introduction. The visceral adiposity index (VAI) is a mathematical formula based on simple anthropometric and biochemical parameters and reflects the distribution and function of the adipose tissue.

Aim: to investigate the possible association between the presence of subclinical Cushing’s syndrome (SCS) and VAI in patients with adrenal incidentalomas.

Patients and methods. We studied 258 patients with adrenal incidentalomas. The diagnosis of SCS was based on a post-LDDST cortisol level ≥1.8 mg/dl combined with an abnormal result of at least one other test of the HPA axis, in the absence of clinical signs. The VAI index was calculated as following: Women VAI= [WC/36.58+(1.89×BMI)] ×(TG/0.81)×(1.52/HDL), Men VAI= [WC/39.68+(1.88×BMI)] ×(TG/1.03)×(1.31/HDL).

Results. 122 patients were excluded from the analysis due to overt metabolic problems (8 with BMI>39, 82 with metabolic syndrome and 34 with type 2 diabetes). Among 136 patients who were included in the analysis (42M/94W, 56.9±9.7 y), SCS was diagnosed in 24 (17.6%). Patients with SCS presented with significantly higher levels of insulin (12.4±4.6 vs 9.9±3.2 μIU/ml, p=0.036) and triglycerides (114±36 vs 97±34 mg/dl, p=0.023), larger size of tumors (3.26±0.88 vs 2.28±1.06 cm, p<0.001) and higher calculated VAI (1.77±0.83 vs 1.39±0.69, p=0.045). Regression analysis revealed that the presence of SCS was positively associated with VAI [OR (95% CI) 1.888 (1.051–3.394), p=0.034] but when gender subgroup analysis followed, this was shown only in women [OR (95% CI) 2.284 (1.135–4.595), p=0.021]. Another important prognostic factor for the probability of SCS was the mass size [OR (95% CI) 2.237 (1.441–3.472), p<0.001].

Conclusion. SCS in women with adrenal incidentalomas is associated with adipose tissue dysfunction.