最近的一项横断面研究表明，肾上腺偶发瘤 (AI) 患者的合并症和死亡率都与性别有关。然而，很少有纵向研究评估 AI 患者动脉高血压、高血糖、血脂异常和骨损伤的发展情况。本研究的目的是分析长期随访期间性别对这些合并症发生的影响。我们回顾性评估了来自意大利和克罗地亚四个转诊中心的 189 名 AI 患者（120 名女性，69 名男性）。在基线和最后一次随访 (LFUV) 时评估 1 mg 地塞米松抑制试验 (1 mg DST) 后的临床特征、合并症和皮质醇。中位随访时间为 52 个月（四分位距 25-86）个月。女性中动脉高血压和高血糖的发生率随着时间的推移而增加（基线时为 65.8%，LFUV 时为 77.8%，p=0.002；基线时为 23.7%，而 LFUV 时为 39.6%） LFUV 时，p<0.001；分别）和男性（基线时分别为 58.0%，LFUV 时为 69.1%，p=0.035；基线时为 33.8%，LFUV 时为 54.0%，p<0.001）。患者被分为两组，使用 1.8 µg/dl 作为 1 mg DST 后皮质醇的临界值：无功能性肾上腺肿瘤 (NFAT) 和具有轻度自主皮质醇分泌的肿瘤 (MACS)。在 NFAT 组（99 名患者，女性 62.6%）中，基线时，我们没有观察到男性和女性之间临床特征和合并症有任何差异。在 LFUV 中，男性出现高血糖的频率高于女性（57.6% vs 33.9%，p=0.03）。在 MACS 组（89 名患者，女性 64.0%）中，基线时，性别之间高血压、高血糖和血脂异常的患病率相似，尽管女性年龄较小（60 岁，IQR 55-69 对比 67.5，IQR 61-73 岁； p=0.01）。此外，女性的骨损伤率高于男性（89.3% vs 54.5%，p=0.02）。在 LFUV 中，观察到了类似的性别相关模式。AI 患者经常出现动脉高血压和高血糖，无论性别如何，都应定期检查这些合并症。在 MACS 患者中，尽管女性较年轻，但心脏代谢合并症的发生率在性别上没有差异，而且女性骨损伤的发生率较高，表明皮质醇具有性别特异性效应。版权所有 © 2024 Puglisi, Barač Nekić,莫雷利、阿莱西、福西、帕尼、齐巴尔·托姆西奇、帕尔米耶里、费劳、皮亚、基奥迪尼、卡斯特兰、雷蒙多和泰尔佐洛。

A recent cross-sectional study showed that both comorbidities and mortality in patients with adrenal incidentaloma (AI) are tied to sex. However, few longitudinal studies evaluated the development of arterial hypertension, hyperglycemia, dyslipidemia and bone impairment in patients with AI. The aim of this study is to analyze the impact of sex in the development of these comorbidities during long-term follow-up.We retrospectively evaluated 189 patients (120 females, 69 males) with AI, from four referral centers in Italy and Croatia. Clinical characteristics, comorbidities and cortisol after 1-mg dexamethasone suppression test (1-mg DST) were assessed at baseline and at last follow-up visit (LFUV). Median follow-up was 52 (Interquartile Range 25-86) months.The rates of arterial hypertension and hyperglycemia increased over time both in females (65.8% at baseline versus 77.8% at LFUV, p=0.002; 23.7% at baseline versus 39.6% at LFUV, p<0.001; respectively) and males (58.0% at baseline versus 69.1% at LFUV, p=0.035; 33.8% at baseline versus 54.0% at LFUV, p<0.001; respectively). Patients were stratified in two groups using 1.8 µg/dl as cut-off of cortisol following 1-mg DST: non-functional adrenal tumors (NFAT) and tumors with mild autonomous cortisol secretion (MACS). In the NFAT group (99 patients, females 62.6%), at baseline, we did not observe any difference in clinical characteristics and comorbidities between males and females. At LFUV, males showed a higher frequency of hyperglycemia than females (57.6% versus 33.9%, p=0.03). In the MACS group (89 patients, females 64.0%), at baseline, the prevalence of hypertension, hyperglycemia and dyslipidemia was similar between sexes, despite females were younger (60, IQR 55-69 versus 67.5, IQR 61-73, years; p=0.01). Moreover, females presented higher rates of bone impairment (89.3% versus 54.5%, p=0.02) than males. At LFUV, a similar sex-related pattern was observed.Patients with AI frequently develop arterial hypertension and hyperglycemia and should be periodically checked for these comorbidities, regardless of sex. In patients with MACS, the lack of difference between sexes in the frequency of cardiometabolic comorbidities despite that females are younger, and the higher frequency of bone impairment in females, suggest a sex-specific effect of cortisol.Copyright © 2024 Puglisi, Barač Nekić, Morelli, Alessi, Fosci, Pani, Zibar Tomsic, Palmieri, Ferraù, Pia, Chiodini, Kastelan, Reimondo and Terzolo.