Comparison of Cardiometabolic Profiles in Patients with Nonfunctioning Adrenal Incidentalomas and Mild Autonomous Cortisol Secretion

Objective: To compare the cardiometabolic characteristics of patients with mild autonomous cortisol secretion (MACS) and nonfunctioning adrenal incidentalomas (NFAI), with particular emphasis on their biochemical and echocardiographic profiles. Methods: This retrospective study included 67 patients with adrenal incidentalomas, classified as NFAI (n = 32) or MACS (n = 35) according to the post-1-mg dexamethasone suppression test (DST) cortisol concentration. Clinical characteristics, hormonal profiles, metabolic parameters, conventional echocardiographic measurements, and global longitudinal strain (GLS) were compared between the groups. Associations between GLS and biochemical parameters were evaluated using correlation analyses, with Benjamini–Hochberg false discovery rate correction applied for multiple testing. Results: Compared with the NFAI group, patients with MACS had lower adrenocorticotropic hormone (ACTH) (13.0 ± 7.1 vs. 18.6 ± 9.7 pg/mL, p = 0.008) and dehydroepiandrosterone sulfate (DHEA-S) concentrations (46.4 ± 31.6 vs. 82.8 ± 48.0 µg/dL, p < 0.001), as well as higher post-1-mg DST cortisol concentrations (3.4 ± 1.3 vs. 1.2 ± 0.5 µg/dL, p < 0.001). Triglyceride concentrations were also higher in the MACS group (165.3 ± 70 vs. 129.4 ± 90.2 m g/dL, p = 0.004). Most conventional echocardiographic parameters were comparable between the groups. GLS did not differ significantly between NFAI and MACS patients (21.92 ± 2.2 vs. 21.94 ± 1.9, respectively; mean difference: 0.0, 95% CI: −1.0 to 1.0, p = 0.846). Nominal correlations between GLS and selected biochemical parameters did not remain statistically significant after false discovery rate correction. Conclusions: MACS was associated with distinct endocrine and metabolic characteristics compared with NFAI; however, no significant between-group difference in GLS was observed. These cross-sectional findings do not establish myocardial dysfunction or a temporal relationship between cortisol autonomy and cardiovascular alterations. Larger prospective longitudinal studies are required to clarify the cardiovascular implications of MACS.