CONTEXT Many adrenal adenomas exhibit mild autonomous cortisol secretion (MACS). While MACS is associated with increased cardiovascular mortality, the underlying mechanisms are not fully defined. OBJECTIVE To investigate mechanisms that may link MACS and cardiovascular mortality in adults with adrenal adenoma. DESIGN Cross-sectional study. PATIENTS 20 adults with adrenal adenoma and MACS and 20 controls with non-functioning adrenal adenoma (NFAT). METHODS Reactive hyperemia index (RHI) was measured by peripheral artery tonometry and 24-hour ambulatory blood pressure (24h AMBP) monitoring was performed. Indices of insulin secretion and sensitivity were estimated by measuring glucose and insulin fasting and following a mixed meal. MAIN OUTCOME MEASURE The primary outcome was the difference in RHI between participants with MACS vs. NFAT. RESULTS The average cortisol after 1 mg dexamethasone and urinary free cortisol were higher in patients with MACS. There was no significant difference in fasting RHI (2.0 [IQR 1.6-2.4] vs. 2.0 [IQR 1.7-2.2, p = 0.72), but postprandial RHI was higher in patients with MACS (2.2 [1.8-2.7] vs. 1.8 [1.5-2.2], p = 0.04). 24h AMBP and Matsuda Index were not significantly different in the groups. Fasting glucose and glucose area under the curve after the mixed meal were higher and insulinogenic index was lower in participants with MACS. CONCLUSIONS Adults with adrenal adenoma and MACS do not have fasting endothelial dysfunction and postprandial endothelial function may be better. These patients have fasting and postprandial hyperglycemia with lower insulin secretion and this may underlie the association between MACS and increased cardiovascular mortality.

中文翻译：

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患有肾上腺偶发瘤和轻度自主皮质醇分泌的成人的心血管风险标志物。

背景许多肾上腺腺瘤表现出轻度自主皮质醇分泌（MACS）。虽然 MACS 与心血管死亡率增加有关，但其潜在机制尚未完全明确。目的 探讨 MACS 与成人肾上腺腺瘤心血管死亡率之间的联系机制。设计横断面研究。患者 20 名患有肾上腺腺瘤和 MACS 的成人以及 20 名患有无功能肾上腺腺瘤 (NFAT) 的对照患者。方法通过外周动脉张力测定法测量反应性充血指数（RHI）并进行24小时动态血压（24h AMBP）监测。通过测量空腹和混合餐后的葡萄糖和胰岛素来估计胰岛素分泌和敏感性的指数。主要结果指标 主要结果是 MACS 与 NFAT 参与者之间 RHI 的差异。结果 MACS 患者服用 1 mg 地塞米松后的平均皮质醇和尿游离皮质醇较高。空腹 RHI 没有显着差异（2.0 [IQR 1.6-2.4] vs. 2.0 [IQR 1.7-2.2，p = 0.72），但 MACS 患者的餐后 RHI 较高（2.2 [1.8-2.7] vs. 1.8 [IQR 1.7-2.2，p = 0.72）。 1.5-2.2]，p = 0.04）。24h AMBP 和松田指数在各组中没有显着差异。MACS 参与者的空腹血糖和混合餐后血糖曲线下面积较高，胰岛素生成指数较低。结论 患有肾上腺腺瘤和 MACS 的成人没有空腹内皮功能障碍，餐后内皮功能可能更好。这些患者存在空腹和餐后高血糖，且胰岛素分泌较低，这可能是 MACS 与心血管死亡率增加之间关联的基础。