Metabolic phenotype in non-aldosterone producing adrenal adenomas with co-existent polycystic ovary syndrome: a joint Ens@t project

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PURPOSE: Non-aldosterone producing-adrenal-adenomas (NAPACAs) and polycystic ovary syndrome (PCOS) are associated with insulin-resistance (IR). Whether the co-existence of the two diseases leads to accentuated adverse metabolic profile remains unknown. Aim of this study is the assessment of cardiometabolic risk factors in women with NAPACAs with and without PCOS. METHODS: We conducted a retrospective multicenter study including adult premenopausal women categorized as NAPACA (n = 45), PCOS (=20) or NAPACA+PCOS (n = 24), excluding women with hormonally active adenomas, congenital-adrenal-hyperplasia, diabetes, systemic steroid medication or active malignancy. RESULTS: NAPACA patients were significantly older than the other two groups (P < 0.001). All groups did not differ in blood pressure, HbA1c, fasting plasma glucose (P > 0.05) or in body-mass-index (P = 0.06). NAPACA+PCOS patients displayed significantly increased insulin resistance (IR) (GIR:P < 0.05, HOMA: P < 0.05, QUICKI:P < 0.05, MATSUDA-index: P < 0.05). Cortisol levels upon 1-mg-dexamethasone-suppression-test (DST) did not differ among the groups; DHEA-S (P < 0.05) and testosterone (P < 0.01) were significantly higher in the two groups with PCOS patients. Free-androgen-index positively correlated with IR in NAPACA (GIR P < 0.01, HOMA P < 0.05, QUICKI P < 0.05) and PCOS (GIR P < 0.01, HOMA P < 0.01, QUICKI P < 0.01, MATSUDA P < 0.01), while 1mg-DST positively correlated with IR in NAPACA+PCOS (GIR P = 0.05, HOMA P < 0.05, QUICKI P < 0.05, MATSUDA P < 0.05). Younger age, higher IR and lower HDL levels predicted the PCOS presence in NAPACA patients whereas the multivariate analysis revealed age and HDL levels as the most important predictors of this association. CONCLUSION: These findings provide evidence for a distinct metabolic pattern in NAPACA+PCOS patients compared to NAPACA patients. Further prospective studies with larger patient cohorts will be necessary to elucidate this observation.

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