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Meta-Analysis
. 2024 Dec;47(12):2929-2942.
doi: 10.1007/s40618-024-02440-0. Epub 2024 Sep 30.

Cardiometabolic comorbidities and cardiovascular events in "non-functioning" adrenal incidentalomas: a systematic review and meta-analysis

Vittoria Favero  1   2 , Chiara Parazzoli  2 , Davide Paolo Bernasconi  3   4 , Iacopo Chiodini  5   6
Affiliations
Meta-Analysis

Cardiometabolic comorbidities and cardiovascular events in "non-functioning" adrenal incidentalomas: a systematic review and meta-analysis

Vittoria Favero et al. J Endocrinol Invest. 2024 Dec.

Abstract

Objective: Recent studies investigated the prevalence of arterial hypertension (AH), diabetes mellitus (DM) and/or prediabetes, dyslipidemia (DL), metabolic syndrome (MS) and cardiovascular events (CVE) in patients with non-functioning adrenal incidentalomas (NFAI). We aimed to investigate the available literature to determine the prevalence of AH, DM, DM and/or prediabetes (Composite DM, C-DM), DL, MS and CVE in patients with NFAI as compared to patients without adrenal incidentalomas (AI).

Design: Systematic review and meta-analysis.

Methods: A meta-analysis was performed using studies that evaluated the prevalence of AH, DM, C-DM, DL, MS and CVE in patients with NFAI versus matched subjects without AI. A random-effects model (DerSimonian and Laird) was used to calculate the pooled odds ratio (OR) and 95% Confidence Interval (95%CI) for each outcome.

Results: Among the 36 available studies, 19 studies provided the necessary data (4716 subjects, mean age 57.6 ± 4.6). The association between AH, DM, C-DM, DL, MS and CVE was reported in 18 (4546 subjects), 7 (1743 subjects), 5 (4315 subjects), 11 (3820 subjects), 8 (1170 subjects) and 5 (2972 subjects), respectively. The presence of NFAI was associated with AH (OR 1.87, 95%CI 1.39-2.51), C-DM (OR 2.04, 95%CI 1.70-2.45) and MS (OR 2.89, 95%CI 1.93-4.32), but not with DM, DL and CVE.

Conclusions: Patients with NFAI have higher prevalence of AH, C-DM and MS than control subjects without NFAI.

Keywords: Adrenal incidentalomas; Diabetes; Dyslipidaemia; Hypertension; Metabolic syndrome cardiovascular events.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Study selection process. Footnotes: PubMed, Web of Science and Scopus were searched between January 1990 and March 2024 using the following key words: “adrenal incidentalomas, AI, adrenal adenomas, non-functioning adrenal incidentalomas, non-functioning adrenal adenomas, subclinical hypercortisolism, subclinical Cushing’s syndrome, hidden hypercortisolism, mild autonomous cortisol secretion, less severe hypercortisolism, mild hypercortisolism”. A further analysis of the reference lists of the eligible articles was performed to find out other additional publications The Mendeley Desktop application (version 2.112.0, Mendeley Ltd) was used to remove the duplicates and apply the inclusion criteria
Fig. 2
Fig. 2
Forest-plot illustrating the association between the prevalence of arterial hypertension and the presence non-functioning adrenal tumors. Footnotes: The DerSimonian and Laird method for calculating the summary association estimates and their 95% Confidence Intervals (95%CI) has been used
Fig. 3
Fig. 3
Forest-plots illustrating the association between the prevalence of diabetes mellitus (panel A) and composite diabetes mellitus (panel B) and the presence non-functioning adrenal tumors. Footnotes: The DerSimonian and Laird method for calculating the summary association estimates and their 95% Confidence Intervals (95%CI) has been used. Composite diabetes mellitus: diabetes mellitus and/or impaired fasting glucose and/or glucose intolerance
Fig. 4
Fig. 4
Forest-plot illustrating the association between the prevalence of dyslipidemia and the presence non-functioning adrenal tumors. Footnotes: The DerSimonian and Laird method for calculating the summary association estimates and their 95% Confidence Intervals (95%CI) has been used. The presence of dyslipidemia was based on the criteria released by Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults [42]
Fig. 5
Fig. 5
Forest-plot illustrating the association between the prevalence of metabolic syndrome and and the presence non-functioning adrenal tumors. Footnotes: The DerSimonian and Laird method for calculating the summary association estimates and their 95% Confidence Intervals (95%CI) has been used. The metabolic syndrome diagnosis was based on the criteria by the American Diabetes Association 2023 [41]
Fig. 6
Fig. 6
Forest-plot illustrating the association between the prevalence of cardiovascular events and and the presence non-functioning adrenal tumors. Footnotes: The DerSimonian and Laird method for calculating the summary association estimates and their 95% Confidence Intervals (95%CI) has been used. Cardiovascular events: myocardial infarction, stroke, transient ischemic attack, angina pectoris, pulmonary embolism, intracerebral hemorrhage, and peripheral artery disease
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