ArticleBMC endocrine disorders2026
Cardiometabolic and inflammatory profiles associated with intermediate post-DST cortisol levels (1.0-1.8 µg/dL) in patients with adrenal incidentalomas.
Article in BMC endocrine disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe clinical relevance of post-dexamethasone cortisol levels below the conventional 1.8 µg/dL threshold remains uncertain in patients with adrenal incidentalomas. We aimed to evaluate whether cortisol levels within the 1.0-1.8 µg/dL range are associated with adverse cardiometabolic and inflammatory profiles.
methodsIn this retrospective, single-center cohort study, 199 patients with adrenal incidentalomas evaluated between 2023 and 2025 were included. Participants were stratified according to 1 mg overnight dexamethasone suppression test (DST) results into two groups: <1.0 µg/dL (n = 112) and 1.0-1.8 µg/dL (n = 87). Baseline hormonal (ACTH, DHEAS), metabolic (fasting glucose, HbA1c), and hematological parameters were obtained prior to DST to minimize the acute effects of dexamethasone. Systemic inflammation was assessed using the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). Group comparisons were performed using appropriate parametric or non-parametric tests. Multivariable logistic regression analysis was conducted to identify independent predictors of hypertension and diabetes mellitus.
resultsThe prevalences of hypertension (71.3% vs. 42.9%, p < 0.001) and diabetes mellitus (37.9% vs. 18.8%, p = 0.003) were significantly higher in the 1.0-1.8 µg/dL group. These patients exhibited lower basal ACTH (p = 0.012) and DHEAS (p = 0.001) levels, along with higher fasting plasma glucose (p < 0.001) and HbA1c (p = 0.003). Inflammatory markers, including NLR (p = 0.024) and SII (p = 0.040), were also significantly elevated. After adjustment for age, sex, tumor size, and LDL cholesterol, cortisol levels within the 1.0-1.8 µg/dL range remained independently associated with both hypertension (OR = 2.74, 95% CI: 1.35-5.54, p = 0.005) and diabetes mellitus (OR = 2.39, 95% CI: 1.15-4.97, p = 0.020).
conclusionCortisol levels between 1.0 and 1.8 µg/dL were associated with increased systemic inflammation and an unfavorable cardiometabolic profile in patients with adrenal incidentalomas. These findings support the concept that cardiometabolic risk may exist along a continuum of post-DST cortisol values, even below the conventional 1.8 µg/dL threshold. Patients within this intermediate cortisol range may benefit from closer clinical follow-up and cardiometabolic risk assessment, although prospective studies are needed to clarify its long-term clinical significance. CLINICAL TRIAL NUMBER: Not applicable.
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