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- Title
Prevalence and Incidence of Atrial Fibrillation in a Large Cohort of Adrenal Incidentalomas: A Long-Term Study.
- Authors
Di Dalmazi, Guido; Vicennati, Valentina; Pizzi, Carmine; Mosconi, Cristina; Tucci, Lorenzo; Balacchi, Caterina; Cosentino, Eugenio Roberto; Paolisso, Pasquale; Fanelli, Flaminia; Gambineri, Alessandra; Pelusi, Carla; Repaci, Andrea; Garelli, Silvia; Galiè, Nazzareno; Borghi, Claudio; Golfieri, Rita; Pagotto, Uberto
- Abstract
<bold>Context: </bold>Chronic glucocorticoids excess leads to morphological and functional cardiac alterations, a substrate for arrhythmias. Autonomous cortisol secretion (ACS) in adrenal incidentalomas is a model of chronic endogenous hypercortisolism.<bold>Objective: </bold>To investigate prevalence and incidence of atrial fibrillation (AF) in a large cohort of patients with ACS.<bold>Design: </bold>Retrospective study.<bold>Setting: </bold>University hospital.<bold>Patients: </bold>Patients evaluated between 1990 and 2018 for adrenal incidentalomas (n = 632), without pheochromocytoma, primary aldosteronism, Cushing syndrome, congenital adrenal hyperplasia, and adrenal malignancy. Cortisol after 1-mg dexamethasone suppression test < or > 50 nmol/L defined nonsecreting tumors (NST) (n = 420) and ACS (n = 212), respectively.<bold>Intervention: </bold>Assessment of AF at baseline (n = 632) and during a median follow-up of 7.7 years retrospectively (NST, n = 249; ACS, n = 108). Comparison with general population.<bold>Main Outcome Measure: </bold>Prevalence and incidence of AF.<bold>Results: </bold>AF prevalence was higher in patients with ACS (8.5%) than NST (3.1%, P = 0.003) and the general population (1.7%; P < 0.001 vs ACS, P = 0.034 vs NST). The age-adjusted rate ratio to the general population was 1.0 for NST and 2.6 for ACS. AF was associated with ACS (odds ratio, 2.40; 95% confidence interval [CI], 1.07-5.39; P = 0.035). The proportion of patients with AF at last evaluation was higher in ACS (20.0%) than NST (11.9%; P = 0.026). ACS showed a higher risk of incident AF than NST (hazard ratio, 2.95; 95% CI, 1.27-6.86; P = 0.012), which was associated with post-dexamethasone cortisol (hazard ratio, 1.15; 95% CI, 1.07-1.24; P < 0.001), independently of known contributing factors.<bold>Conclusions: </bold>Patients with adrenal incidentalomas and ACS are at risk of AF. Electrocardiogram monitoring may be recommended during follow-up.
- Subjects
ATRIAL fibrillation; ATRIAL arrhythmias; HYDROCORTISONE; MEDICAL personnel; CUSHING'S syndrome; ATRIAL fibrillation diagnosis; RETROSPECTIVE studies; DISEASE incidence; ELECTROCARDIOGRAPHY; DISEASE prevalence; ADRENAL tumors; LONGITUDINAL method; DISEASE complications
- Publication
Journal of Clinical Endocrinology & Metabolism, 2020, Vol 105, Issue 8, p1
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa270