Abstract
Objective
The aim of this study was to estimate insulin sensitivity (IS) in nondiabetic patients
with adrenal incidentalomas (AI): nonfunctional adrenal incidentalomas (NAI) and patients
with AI and subclinical Cushing's syndrome (SCS).
Methods
Based on the inclusion criteria (normal fasting glucose levels, no previous history
of impaired fasting glucose and/or diabetes, and no medications or concomitant relevant
diseases) and the exclusion criteria (pheochromocytoma, overt hypercortisolism, hyperaldosteronism,
adrenal carcinoma, metastasis of extra-adrenal tumors, extra-adrenal malignancies),
142 subjects were drawn from a series of patients with AI. The subjects were age-,
sex- and body mass index (BMI)-matched: 70 with NAI (50 women and 20 men), 37 with
AI and SCS (31 women and 6 men) and 35 healthy control (HC) subjects (30 women and
5 men).
The oral glucose tolerance test (OGTT) and several indices of insulin sensitivity
(IS) were used: homeostasis model assessment (HOMA), quantitative insulin sensitivity
check index (QUICKI), triglycerides and glucose index (TyG), index of whole-body insulin
sensitivity (ISI-composite) and glucose to insulin ratio (G/I).
Results
There was a significant difference in IS between subjects with NAI and HC (HOMA, p=0.049; QUICKI, p=0.036; TyG, p=0.002; ISI-composite, p=0.024) and subjects with SCS and HC (AUC insulin, p=0.01; HOMA, p=0.003; QUICKI, p=0.042; TyG, p=0.008; ISI-composite, p=0.002). There was no difference in the tested indices of IS between subjects with
NAI and SCS (p>0.05). However, subjects with SCS had a significantly higher prevalence of impaired
glucose tolerance and higher area under the curve for glucose than subjects with NAI
(p=0.0174). The linear regression analysis showed that 1 mg-DST cannot be used as a predictor of HOMA (R2=0.004, F=0.407, p=0.525). Significant relationship was found between 1 mg-DST and ISI-composite (R2=0.042, F=4.981, p=0.028) but this relationship was weak and standard error of estimate was high. The
linear regression model also showed that ACTH cannot be used as a predictor of HOMA
(R2=0.001, F=0.005, p=0.943) or ISI-composite (R2=0.015, F=1.819, p=0.187).
Conclusions
Insulin resistance is a major cardiovascular risk factor; therefore, the assessment
of IS in patients with AI, even nonfunctional, has a valuable place in the endocrine
workup of these patients.
Abbreviations:
AI (adrenal incidentalomas), SCS (subclinical Cushing's syndrome), NAI (nonfunctional adrenal incidentaloma), HC (healthy control), IS (insulin sensitivity), IR (insulin resistance), HOMA (homeostasis model assessment), QUICKI (quantitative insulin sensitivity check index), G/I (glucose to insulin ratio), TyG (the product of triglycerides and glucose), ISI-composite (whole-body insulin sensitivity), OGTT (oral glucose tolerance test), ACTH (adrenocorticotrophic hormone), IGT (impaired glucose tolerance), IFG (impaired fasting glucose), 1mg-DST (overnight low dose dexamethasone suppression test), MSC (midnight serum cortisol), AUC (area under the curve), BMI (body mass index), CV (coefficient of variance)Keywords
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Article info
Publication history
Published online: January 18, 2013
Accepted:
December 9,
2012
Received:
December 6,
2011
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
