Studio cross-sectional sulle alterazioni vascolari e metaboliche nei pazienti con incidentaloma surrenalico non funzionante

Abstract Introduction and aim. An adrenal incidentaloma (AI) is an adrenal mass ≥1 cm discovered during imaging not performed for suspected adrenal disease. While traditionally considered benign, recent studies suggest that non-functioning adrenal incidentalomas (NFAIs) may be associated with increased cardiovascular and metabolic risks. This study investigates the potential impact of NFAI on cardiometabolic health, specifically focusing on its association with metabolic and vascular risk factors and complications. Methods. We conducted a cross-sectional study of consecutive patients undergoing vascular and metabolic assessment through pulse wave velocity (PWV), pulse wave analysis (PWA) and supra-aortic trunks ultrasonography. NFAI patients were compared with a control group presenting established metabolic risk factors. Multivariable regression models were applied to assess the association of NFAI with vascular parameters while adjusting for potential confounders. Results. Our analysis included 25 patients with NFAI and 165 controls. In the univariate analysis, NFAI group presented a significant increase in arterial stiffness (peripheral pulse pressure: p=0.038; pulse pressure: p=0.0.027; P1 height: p=0.031; forward pulse height: p=0.009). Considering the metabolic risk, NFAI group was associated with an increased intima-media thickness (cIMT) (, particularly significant on the right CCA (DIAMmax Dx: p=0.003; DIAMm Dx: p=0.034). In three different models of multivariable analysis with linear regression, NFAI resulted associated with augmentation index normalized at 75bpm (AIX@hr75: β-coefficient 0.0704102, 95% CI [0.0038,0.1369], p=0.039), aortic augmentation index AP/PP (AIx AP/PP: β-coefficient 0.125243, 95% CI [0.041,0.208], p=0.004) and augmentation index P2/P1 (AIx P2/P1: β-coefficient 0.0927236, 95% CI [0.015, 0.169], p=0.019) increase. Moreover, in another model of multivariable analysis with linear regression, NFAI group shown an association with PWV (β-coefficient 0.7626021, 95% CI [0.02,1.50], p=0.044). Lastly, using multivariable logistic regression, results show that NFAI was independently associated with cIMT≥0.9 mm (OR=3.311959, 95% CI [1.010,10.855], p=0.048), adjusting for age, sex, presence of diabetes mellitus, BMI, eGFR, brachial SBP and DBP. We challenged our findings with a sensitivity test, by repeating our analysis only with controls that had a negative abdominal imaging exam. The results remained significant, thus confirming the association demonstrated in this study. Conclusions. Our findings suggest that NFAI may not be an indolent condition, as it is associated with increased blood pressure, arterial stiffness and atherosclerosis. These results highlight the need for routine cardiovascular monitoring in patients with NFAI to identify individuals at higher risk for adverse cardiometabolic outcomes. Future studies should aim to confirm these findings and explore potential therapeutic interventions.