---
title: "Cardiometabolic risk across post-DST cortisol levels in adrenal incidentaloma patients"
id: "pubmed-42804108"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42804108"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42804108/"
doi: "10.1007/s12020-026-04794-2"
published_at: "2026-09-28T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Cardiometabolic risk across post-DST cortisol levels in adrenal incidentaloma patients
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42804108
- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42804108/)
- **DOI:** [10.1007/s12020-026-04794-2](https://doi.org/10.1007%2Fs12020-026-04794-2)
- **Published At:** 2026-09-28T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective cross-sectional study evaluated cardiometabolic risk across three categories of **post-DST cortisol** in 156 patients with **adrenal incidentaloma**: ≤0.9 µg/dL, 0.91–1.79 µg/dL, and ≥1.8 µg/dL. - Conventional metabolic measures (blood pressure, fasting glucose, HbA1c, lipid profile) and atherogenic indices (TyG index, PAI, Castelli I and II) were compared between groups. - Blood pressure and hypertension prevalence increased progressively with higher post-DST cortisol; Group 2 (0.91–1.79 µg/dL) already showed higher systolic and diastolic blood pressure and hypertension prevalence than Group 1 (≤0.9 µg/dL). - Diabetes prevalence was higher in Group 2 than Group 1. Fasting glucose and HbA1c differed across groups; HbA1c was significantly higher in Group 2 versus Group 1. - Atherogenic lipids (total cholesterol, LDL-C, non-HDL-C) differed across cortisol categories; LDL-C was higher in Group 2 than Group 1. - The **TyG index** and Castelli Risk Indices I and II varied across groups, with pairwise differences mainly between the lowest and highest cortisol categories. - Overall, Group 2 displayed an intermediate cardiometabolic phenotype between the low-suppression and higher cortisol groups rather than being uniformly similar to the lowest suppression group. - Post-DST cortisol levels correlated positively with blood pressure, glucose metabolism markers, atherogenic lipids, and several atherogenic indices. - The authors conclude that patients with post-DST cortisol below the current MACS threshold (0.91–1.79 µg/dL) may not be metabolically homogeneous or benign and recommend further prospective study of cardiometabolic risk across the continuum of suppression test results.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Endocrinology and Metabolism, Osmangazi University, Eskişehir, Turkey. esrykvk@gmail.com. * 2 Department of Endocrinology and Metabolism, Eskisehir City Hospital, Eskişehir, Turkey. * 3 Department of Endocrinology and Metabolism, Osmangazi University, Eskişehir, Turkey. * PMID: **42804108** * DOI: [ 10.1007/s12020-026-04794-2 ](https://doi.org/10.1007/s12020-026-04794-2) Item in Clipboard # The cardiometabolic significance of post-dexamethasone cortisol levels below the MACS threshold in adrenal incidentaloma Elif Seray Korkmaz et al. Endocrine. 2026. Show details Display options Display options Format Abstract PubMed PMID Endocrine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Endocrine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Endocrine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) . 2026 Sep 28;91(1):319. doi: 10.1007/s12020-026-04794-2. ### Authors [Elif Seray Korkmaz](https://pubmed.ncbi.nlm.nih.gov/?term=Korkmaz+ES&cauthor_id=42804108)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42804108/#short-view-affiliation-1 "Department of Endocrinology and Metabolism, Osmangazi University, Eskişehir, Turkey. esrykvk@gmail.com."), [Birsen Öztürk Gökçe](https://pubmed.ncbi.nlm.nih.gov/?term=%C3%96zt%C3%BCrk+G%C3%B6k%C3%A7e+B&cauthor_id=42804108)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42804108/#short-view-affiliation-2 "Department of Endocrinology and Metabolism, Eskisehir City Hospital, Eskişehir, Turkey."), [Medine Nur Kebapçı](https://pubmed.ncbi.nlm.nih.gov/?term=Kebap%C3%A7%C4%B1+MN&cauthor_id=42804108)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42804108/#short-view-affiliation-3 "Department of Endocrinology and Metabolism, Osmangazi University, Eskişehir, Turkey.") ### Affiliations * 1 Department of Endocrinology and Metabolism, Osmangazi University, Eskişehir, Turkey. esrykvk@gmail.com. * 2 Department of Endocrinology and Metabolism, Eskisehir City Hospital, Eskişehir, Turkey. * 3 Department of Endocrinology and Metabolism, Osmangazi University, Eskişehir, Turkey. * PMID: **42804108** * DOI: [ 10.1007/s12020-026-04794-2 ](https://doi.org/10.1007/s12020-026-04794-2) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Purpose:** Although post-dexamethasone suppression test (DST) cortisol levels ≤ 1.8 µg/dL are generally considered compatible with nonfunctioning adrenal tumors, accumulating evidence suggests that cardiometabolic risk may vary even below the threshold for mild autonomous cortisol secretion (MACS). This study aimed to evaluate cardiometabolic risk across different post-DST cortisol levels in patients with adrenal incidentaloma using conventional metabolic parameters and atherogenic indices. **Methods:** In this retrospective cross-sectional study, 156 patients with adrenal incidentaloma were classified into three groups according to post-DST cortisol levels: ≤0.9 µg/dL (Group 1, n = 48), 0.91-1.79 µg/dL (Group 2, n = 60), and ≥ 1.8 µg/dL (Group 3, n = 48). Demographic characteristics, blood pressure, glucose metabolism parameters, lipid profiles, and cardiometabolic risk indices, including the triglyceride-glucose (TyG) index, plasma atherogenic index (PAI), and Castelli Risk Indices I and II, were compared among groups. Correlations between post-DST cortisol levels and cardiometabolic parameters were evaluated using Spearman correlation analysis. **Results:** Blood pressure and the prevalence of hypertension increased significantly across post-DST cortisol categories. Notably, Group 2 already differed significantly from Group 1 in systolic and diastolic blood pressure and hypertension prevalence. Diabetes mellitus was also more prevalent in Group 2 than in Group 1. Fasting glucose, HbA1c, total cholesterol, LDL cholesterol, and non-HDL cholesterol differed significantly among the three groups, with Group 2 showing significantly higher HbA1c and LDL cholesterol than Group 1. The TyG index and Castelli Risk Indices I and II also differed significantly across cortisol categories, although pairwise differences for these indices were primarily observed between Groups 1 and 3. Overall, Group 2 exhibited an intermediate cardiometabolic pattern between Groups 1 and 3. Post-DST cortisol levels were positively correlated with blood pressure, glucose metabolism parameters, atherogenic lipid parameters, and several atherogenic indices. **Conclusion:** Post-DST cortisol levels were associated with a graded pattern of cardiometabolic risk among patients with adrenal incidentaloma. Patients with post-DST cortisol levels of 0.91-1.79 µg/dL exhibited an intermediate cardiometabolic phenotype, with significant abnormalities in several cardiometabolic parameters compared with patients with more complete cortisol suppression. These findings suggest that patients below the current MACS threshold may not represent a metabolically homogeneous or uniformly benign population and support further prospective investigation of cardiometabolic risk across the continuum of post-DST cortisol levels. **Keywords:** Adrenal incidentaloma; Atherogenic indices; Cardiometabolic risk; Dexamethasone suppression test; Mild autonomous cortisol secretion; Triglyceride–glucose index. © 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval: The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Eskişehir Osmangazi University Non-Interventional Clinical Research Ethics Committee (Approval No. 14, dated November 28, 2023). All patient data were analyzed in accordance with institutional confidentiality regulations. Competing interests: The authors declare no competing interests. ## References 1. 1. W.F. Jr. Young, Clinical practice. The incidentally discovered adrenal mass. N Engl. J. Med. 356, 601–610 (2007). - [DOI](https://doi.org/10.1056/nejmcp065470) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/17287480/) 2. 1. M. Fassnacht, W. Arlt, I. Bancos, H. Dralle, J. Newell-Price, A. Sahdev et al., Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur. J. Endocrinol. Eur. J. Endocrinol. 175, G1–G34 (2016). - [DOI](https://doi.org/10.1530/eje-16-0467) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/27390021/) 3. 1. I. Bancos, A. Prete, Approach to the Patient With Adrenal Incidentaloma. J. Clin. Endocrinol. Metab. 106(11), 3331–3353 (2021). - [DOI](https://doi.org/10.1210/clinem/dgab512) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/34260734/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/8530736/) 4. 1. M. Araujo-Castro, P. Parra-Ramírez, P. Martín-Rojas-Marcos, R. García-Centeno, P. Gracia-Gimeno, M. Tomé-Fernández-Ladreda et al., Nonfunctioning adrenal incidentalomas with cortisol post-dexamethasone suppression test > 0.9 µg/dL have a higher prevalence of cardiovascular disease than those with values ≤ 0.9 µg/dL. Endocrine. 79, 384–391 (2023). - [DOI](https://doi.org/10.1007/s12020-022-03228-z) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36261701/) 5. 1. V. Favero, C. Eller-Vainicher, V. Morelli, A. Scillitani, I. Chiodini, Lowering the dexamethasone suppression test cut-off: is it time yet? J. Endocrinol. Invest. 48, 2831–2843 (2025). - [DOI](https://doi.org/10.1007/s40618-025-02679-1) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40856981/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/12640348/) Show all 22 references ## MeSH terms * Adrenal Gland Neoplasms* / blood Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adrenal+Gland+Neoplasms%2Fblood%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adrenal+Gland+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Adrenal Gland Neoplasms* / metabolism Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adrenal+Gland+Neoplasms%2Fmetabolism%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adrenal+Gland+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Blood Pressure / physiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Blood+Pressure%2Fphysiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Blood+Pressure) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Cardiometabolic Risk Factors Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiometabolic+Risk+Factors%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cardiometabolic+Risk+Factors) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Cross-Sectional Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cross-Sectional+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cross-Sectional+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Dexamethasone* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Dexamethasone%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Dexamethasone) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Hydrocortisone* / blood Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hydrocortisone%2Fblood%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Hydrocortisone) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Hypertension / blood Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hypertension%2Fblood%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Hypertension) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Hypertension / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hypertension%2Fepidemiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Hypertension) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Male Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Male%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Male) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Middle Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Middle+Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Middle+Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) * Retrospective Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Retrospective+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Retrospective+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42804108/) ## Substances * Hydrocortisone Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hydrocortisone%22%5Bnm%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/
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