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Rodrigues MO, Moraes AB, de Paula MP, Pereira VA, Leão ATT, Vieira Neto L. Adrenal incidentaloma as a novel independent predictive factor for periodontitis. J Endocrinol Invest 2021; 44:2455-2463. [PMID: 33788166 DOI: 10.1007/s40618-021-01557-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/22/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE There are no data regarding periodontal derangements in patients with adrenal incidentalomas (AI). We assessed the frequency and severity of periodontitis in patients with AI [non-functioning adrenal incidentaloma (NFAI) and possible autonomous cortisol secretion (ACS)] and compared with individuals with normal adrenal. METHODS A cross-sectional study evaluated thirty-five individuals with AI and 26 controls. NFAI and possible ACS diagnosis was based on the current guidelines: NFAI [cortisol levels after 1 mg dexamethasone suppression test (1 mg-DST) ≤ 1.8 µg/dL (≤ 50 nmol/L)]; possible ACS [cortisol levels after 1 mg-DST 1.9-5.0 µg/dL (51-138 nmol/L)]. Sociodemographic data were collected, and a full-mouth periodontal evaluation was performed. RESULTS There was no significant difference between groups regarding age, sex, income, ethnicity, education level, smoking, body mass index, dysglycemia, and arterial hypertension. Patients with AI exhibited worse periodontal conditions than controls for the following periodontal clinical parameters: mean percentage of probing pocket depth (PPD) and clinical attachment level (CAL) ≥ 5 mm (p < 0.001 and p = 0.006, respectively). Patients with NFAI and possible ACS showed higher gingival bleeding index (p = 0.014), bleeding on probing (p < 0.001), and CAL (p < 0.001) means compared to controls. The frequencies of periodontitis were 72.7% in patients with NFAI, 84.6% in possible ACS, and 30.8% in controls (p = 0.001). Periodontitis was more severe in patients with possible ACS than NFAI and controls. Patients with NFAI and possible ACS exhibited odds ratio for periodontitis of 4.9 (p = 0.016) and 8.6 (p = 0.02), respectively. CONCLUSION Patients with AI have higher frequency and severity of periodontitis than controls. The presence of AI was an independent predictive factor for periodontitis.
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Affiliation(s)
- M O Rodrigues
- Department of Dental Clinic, Division of Periodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A B Moraes
- Department of Internal Medicine and Endocrine Unit, School of Medicine, Federal University of Rio de Janeiro, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255. 9th floor-Endocrinology Unit Rio de Janeiro, Rio de Janeiro, RJ, 21941-913, Brazil
| | - M P de Paula
- Department of Internal Medicine and Endocrine Unit, School of Medicine, Federal University of Rio de Janeiro, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255. 9th floor-Endocrinology Unit Rio de Janeiro, Rio de Janeiro, RJ, 21941-913, Brazil
| | - V A Pereira
- Department of Dental Clinic, Division of Periodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A T T Leão
- Department of Dental Clinic, Division of Periodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L Vieira Neto
- Department of Internal Medicine and Endocrine Unit, School of Medicine, Federal University of Rio de Janeiro, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255. 9th floor-Endocrinology Unit Rio de Janeiro, Rio de Janeiro, RJ, 21941-913, Brazil.
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de Paula MP, Moraes AB, de Souza MDGC, Cavalari EMR, Campbell RC, Fernandes GDS, Farias MLF, Mendonça LMC, Madeira M, Bouskela E, Kraemer-Aguiar LG, Vieira Neto L. Cortisol level after dexamethasone suppression test in patients with non-functioning adrenal incidentaloma is positively associated with the duration of reactive hyperemia response on microvascular bed. J Endocrinol Invest 2021; 44:609-619. [PMID: 32686043 DOI: 10.1007/s40618-020-01360-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Data on endothelial derangements in patients with non-functioning adrenal incidentaloma (NFAI) are scarce. METHODS We investigated if NFAI patients present clinical, biochemical and endothelial alterations compared to individuals without an adrenal lesion and also the associations among these variables. Forty-two NFAI and 40 controls were evaluated. NFAI diagnosis and controls were defined according to the current guidelines and based on a normal adrenal imaging exam, respectively. Body composition was evaluated by dual emission X-ray absorptiometry. Endothelial reactivity was assessed by two methods: tonometry (Endo-PAT®) and laser speckle contrast imaging (LSCI). RESULTS There were no differences between groups regarding age, gender, ethnicity, smoking status, and statin use. The frequency of metabolic syndrome according to the International Diabetes Federation criteria was 69% and 57.9%, respectively in NFAI and controls (p = 0.36), whereas the atherosclerotic cardiovascular disease (ASCVD) risk was 63.4% and 66.7% (p = 0.81). The clinical, laboratory, and anthropometric characteristics, as well as body composition, were similar between the groups. Additionally, any differences between groups were observed on endothelial reactivity tests. Nevertheless, we noted an association between cortisol levels after 1 mg-dexamethosone suppression test (1 mg-DST) and the duration of post-occlusive reactive hyperemia tested on microcirculation (r = 0.30; p = 0.03). NFAI patients require more antihypertensive drugs to achieve blood pressure control (p = 0.04). The number of antihypertensive drugs used to control blood pressure correlated with cortisol levels after 1 mg-DST (r = 0.29; p = 0.03). CONCLUSIONS Since both groups herein investigated had a high frequency of metabolic syndrome and ASCVD risk, it might explain similarities observed on endothelial reactivity. Nevertheless, prolonged reactive hyperemia response on microcirculation was correlated with cortisol levels under suppression.
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Affiliation(s)
- M P de Paula
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - A B Moraes
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - M das Graças Coelho de Souza
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - E M R Cavalari
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - R C Campbell
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - G da Silva Fernandes
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - M L F Farias
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - L M C Mendonça
- Department of Internal Medicine and Rheumatology Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil
| | - M Madeira
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - E Bouskela
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - L G Kraemer-Aguiar
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - L Vieira Neto
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil.
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Moraes AB, Cavalari EMR, de Paula MP, Arruda M, Curi DSC, Leitão RA, de Mendonça LMC, Farias MLF, Madeira M, Vieira Neto L. Evaluation of body composition using dual-energy X-ray absorptiometry in patients with non-functioning adrenal incidentalomas and an intermediate phenotype: Is there an association with metabolic syndrome? J Endocrinol Invest 2019; 42:797-807. [PMID: 30465247 DOI: 10.1007/s40618-018-0985-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Metabolic syndrome (MS) and sarcopenia are associated with increased cardiovascular risk. No studies using dual-energy x-ray absorptiometry (DXA) have evaluated association between body composition (BC) changes and MS in adrenal incidentaloma (AI). Our aim was to analyse BC in non-functioning AI (NFAI) and intermediate phenotype (IP) relative to controls and to correlate with cortisol levels. METHODS Cross-sectional study with 44 NFAI (serum cortisol ≤ 50 nmol/L after the overnight 1 mg dexamethasone suppression test), 27 IP (cortisol 51-138 nmol/L), and 41 controls (normal adrenal on imaging examination) using DXA. Autonomic cortisol secretion (cortisol > 138 nmol/L) was excluded from the study. BC data were compared using criteria for MS (World Health Organization, National Cholesterol Education Program-Adult Treatment Panel-III, American Association of Clinical Endocrinologists (AACE), and International Diabetes Federation). RESULTS There was no significant difference in clinical data and body mass index (BMI) among the three groups. Waist circumference (WC) was larger in AI vs. controls (p < 0.01). Waist-to-hip ratio was higher in NFAI vs. controls and waist-to-height ratio was higher in IP vs. controls (p = 0.03 and p = 0.02, respectively). The frequency of MS was higher in AI vs. controls. BC was not different among the groups. Patients with AI there was a significant association of MS with both an increase in total fat and body fat index (all criteria), and a significant difference between MS and smaller BMI-adjusted lean mass (AACE, p = 0.036). No correlation of cortisol after 1 mg dexamethasone test with BC or MS. AI and WC were independently associated with MS. CONCLUSIONS AI presented high frequency of MS and was independently associated with MS. Possible deleterious effects of cortisol secretion seem to initially affect the muscular system.
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Affiliation(s)
- A B Moraes
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - E M R Cavalari
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - M P de Paula
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - M Arruda
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - D S C Curi
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - R A Leitão
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - L M C de Mendonça
- Department of Internal Medicine and Rheumatology Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio De Janeiro, RJ, Brazil
| | - M L F Farias
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
| | - M Madeira
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil
- Endocrinology Unit, Bonsucesso Federal Hospital, Rio de Janeiro, RJ, Brazil
| | - L Vieira Neto
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rua Professor Rodolpho Paulo Rocco, 255. 9 Floor - Endocrine Unit, Rio De Janeiro, RJ, 21941-913, Brazil.
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