Determinants of cerebrospinal fluid leakage in a large cohort of macroprolactinomas

Background: Non-functional adrenal incidentaloma (NFAI) is associated with increased risk of adverse cardiometabolic outcome. Identifying predictors of atherosclerotic cardiovascular disease (ASCVD) may enable more appropriate management strategies in patients with NFAI. We aimed to investigate body composition parameters and ASCVD risk in patients with NFAI.

Methods: Eighty patients with NFAI and 80 controls matched for age, gender and body mass index (BMI) were included. Risk of ASCVD was assessed by Framingham Risk Score (FRS) and American Heart Association /American College of Cardiology (AHA/ACC) score. Body composition was evaluated using a segmental body composition analyzer.

Results: There were no significant differences between the two groups in terms of age, gender, blood pressure or body composition. Patients with NFAI had higher FRS and AHA/ACC scores than controls (p=0.017, p=0.024, respectively). In patients with NFAI, independent predictors for FRS were serum cortisol level after 1 mg dexamethasone suppression test (DST) and waist/hip ratio (WHR), and independent predictors for AHA/ACC score were serum cortisol level after 1 mg DST, WHR and fasting plasma glucose (FPG), in various multivariate linear regression models.

Conclusions: Our findings suggest that FRS and AHA/ACC scores may be useful in determining ASCVD risk in patients with NFAI, and that serum cortisol level after 1 mg DST is an independent predictor of ASCVD in these patients, even in the absence of hypercortisolism.