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Autonomous cortisol secretion ups risk of atrial fibrillation

08 Jul 2020

Patients with adrenal incidentalomas and autonomous cortisol secretion (ACS) appear to have a higher risk of atrial fibrillation (AF), a study has shown.

“Electrocardiogram monitoring may be recommended during follow-up,” the authors said.

A total of 632 patients evaluated between 1990 and 2018 for adrenal incidentalomas, without pheochromocytoma, primary aldosteronism, Cushing syndrome, congenital adrenal hyperplasia, and adrenal malignancy, at a university hospital were included in this retrospective study.

Nonsecreting tumours (NST; n=420) and ACS (n=212) were defined as cortisol after 1-mg dexamethasone suppression test <50 or >50 nmol/L, respectively. The authors assessed AF at baseline (n=632) and during a median follow-up of 7.7 years retrospectively (NST, n=249; ACS, n=108), and compared this with the general population.

AF prevalence was higher in patients with ACS (8.5 percent) than those with NST (3.1 percent; p=0.003) and the general population (1.7 percent; p<0.001 vs ACS; p=0.034 vs NST). The age-adjusted rate ratio to the general population was 1.0 and 2.6 for NST and ACS, respectively.

AF correlated with ACS (odds ratio, 2.40, 95 percent confidence interval [CI], 1.07–5.39; p=0.035). A higher proportion of patients with AF at last evaluation was observed with ACS compared with NST (20.0 percent vs 11.9 percent; p=0.026).

Furthermore, the risk of incident AF was higher in ACS than NST (hazard ratio [HR], 2.95, 95 percent CI, 1.27–6.86; p=0.012), which correlated with postdexamethasone cortisol (HR, 1.15, 95 percent CI, 1.07–1.24; p<0.001), independently of known contributing factors.

“Chronic glucocorticoids excess leads to morphological and functional cardiac alterations, a substrate for arrhythmias,” the authors said. “ACS in adrenal incidentalomas is a model of chronic endogenous hypercortisolism.”

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Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.