Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study

Alessandro Prete; Anuradhaa Subramanian; ENSAT EURINE-ACT Investigators; Irina Bancos; Vasileios Chortis; Stylianos Tsagarakis; Katharina Lang; Magdalena Macech; Danae A. Delivanis; Ivana D. Pupovac; Giuseppe Reimondo; Ljiljana V. Marina; Timo Deutschbein; Maria Balomenaki; Michael W. O’Reilly; Lorna C. Gilligan; Carl Jenkinson; Tomasz Bednarczuk; Catherine D. Zhang; Tina Dusek; Aristidis Diamantopoulos; Miriam Asia; Agnieszka Kondracka; Dingfeng Li; Jimmy R. Masjkur; Marcus Quinkler; Grethe Ueland; M. Conall Dennedy; Felix Beuschlein; Antoine Tabarin; Martin Fassnacht; Miomira Ivović; Massimo Terzolo; Darko Kastelan; William F. Young; Konstantinos N. Manolopoulos; Urszula Ambroziak; Dimitra A. Vassiliadi; Angela E. Taylor; Alice J. Sitch; Krishnarajah Nirantharakumar; Wiebke Arlt

doi:10.7326/M21-1737

Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study

Alessandro Prete, Anuradhaa Subramanian, ENSAT EURINE-ACT Investigators, Irina Bancos, Vasileios Chortis, Stylianos Tsagarakis, Katharina Lang, Magdalena Macech, Danae A. Delivanis, Ivana D. Pupovac, Giuseppe Reimondo, Ljiljana V. Marina, Timo Deutschbein, Maria Balomenaki, Michael W. O’Reilly, Lorna C. Gilligan, Carl Jenkinson, Tomasz Bednarczuk, Catherine D. Zhang, Tina DusekAristidis Diamantopoulos, Miriam Asia, Agnieszka Kondracka, Dingfeng Li, Jimmy R. Masjkur, Marcus Quinkler, Grethe Ueland, M. Conall Dennedy, Felix Beuschlein, Antoine Tabarin, Martin Fassnacht, Miomira Ivović, Massimo Terzolo, Darko Kastelan, William F. Young, Konstantinos N. Manolopoulos, Urszula Ambroziak, Dimitra A. Vassiliadi, Angela E. Taylor, Alice J. Sitch, Krishnarajah Nirantharakumar, Wiebke Arlt^*

^*Corresponding author for this work

Internal Medicine

Research output: Contribution to journal › Article › Academic › peer-review

77 Citations (Scopus)

Abstract

Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. Design: Cross-sectional study. Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). Participants: 1305 prospectively recruited persons with benign adrenal tumors. Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. Results: Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. Limitations: Cross-sectional design; possible selection bias. Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes.

Original language	English
Pages (from-to)	325-334
Number of pages	10
Journal	Annals of Internal Medicine
Volume	175
Issue number	3
DOIs	https://doi.org/10.7326/M21-1737
Publication status	Published - Mar 2022

Bibliographical note

Funding Information:
Prete]), by the European Commission under the 7th Framework Programme (FP7/2007-2013, grant agreement 259735, ENSAT-CANCER [Drs. Arlt, Fassnacht, and Beuschlein]), and under the European Union's Horizon 2020 Research and Innovation Program under grant agreement no. 633983 (ENSAT–HT) (Drs. Arlt and Beuschlein). This work was also supported by the U.K. Medical Research Council (strategic biomarker grant G0801473 [Dr. Arlt]), the Claire Khan Trust Fund at University Hospitals Birmingham Charities (project grant [Dr. Arlt]), the Mayo Clinic Foundation for Medical Education and Research (Mayo scholarship [Dr. Bancos]), the Wellcome Trust (clinical research training fellowship WT101671 [Dr. Chortis] and investigator award WT209492/Z/17/Z [Dr. Arlt]), and the Academy of Medical Sciences (starter grant for clinical lecturers [Dr. Chortis]). This research was partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the U.S. National Institutes of Health under award K23DK121888 (Dr. Bancos). Drs. Arlt and Sitch receive support from the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (grant reference number BRC-1215-20009). Dr. Beuschlein receives funding from the Clinical Research Priority Program of the University of Zurich for CRPP HYRENE (Clinical Research Priority Program HYpertension REsearch NEtwork). Support for this study also came in part from the Deutsche Forschungsgemeinschaft (project number 314061271; CRC/ Transregio 205) (Drs. Fassnacht and Beuschlein).

Funding Information:
Grant Support: This work was supported by Diabetes UK (Sir George Alberti Research Training Fellowship 18/0005782 [Dr.

Funding Information:
Primary Funding Source: Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research.

Publisher Copyright:
© 2022 American College of Physicians. All rights reserved.

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10.7326/M21-1737

https://birmingham.elsevierpure.com/en/publications/110928de-45a1-4c7c-a40b-94ce12e2228d

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Prete, A., Subramanian, A., ENSAT EURINE-ACT Investigators, Bancos, I., Chortis, V., Tsagarakis, S., Lang, K., Macech, M., Delivanis, D. A., Pupovac, I. D., Reimondo, G., Marina, L. V., Deutschbein, T., Balomenaki, M., O’Reilly, M. W., Gilligan, L. C., Jenkinson, C., Bednarczuk, T., Zhang, C. D., ... Arlt, W. (2022). Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study. Annals of Internal Medicine, 175(3), 325-334. https://doi.org/10.7326/M21-1737

@article{d8c1fe8e00364040a425a31068adf913,

title = "Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study",

abstract = "Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. Design: Cross-sectional study. Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). Participants: 1305 prospectively recruited persons with benign adrenal tumors. Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. Results: Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. Limitations: Cross-sectional design; possible selection bias. Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes.",

author = "Alessandro Prete and Anuradhaa Subramanian and {ENSAT EURINE-ACT Investigators} and Irina Bancos and Vasileios Chortis and Stylianos Tsagarakis and Katharina Lang and Magdalena Macech and Delivanis, {Danae A.} and Pupovac, {Ivana D.} and Giuseppe Reimondo and Marina, {Ljiljana V.} and Timo Deutschbein and Maria Balomenaki and O{\textquoteright}Reilly, {Michael W.} and Gilligan, {Lorna C.} and Carl Jenkinson and Tomasz Bednarczuk and Zhang, {Catherine D.} and Tina Dusek and Aristidis Diamantopoulos and Miriam Asia and Agnieszka Kondracka and Dingfeng Li and Masjkur, {Jimmy R.} and Marcus Quinkler and Grethe Ueland and Dennedy, {M. Conall} and Felix Beuschlein and Antoine Tabarin and Martin Fassnacht and Miomira Ivovi{\'c} and Massimo Terzolo and Darko Kastelan and Young, {William F.} and Manolopoulos, {Konstantinos N.} and Urszula Ambroziak and Vassiliadi, {Dimitra A.} and Taylor, {Angela E.} and Sitch, {Alice J.} and Krishnarajah Nirantharakumar and Wiebke Arlt and Stephan Gl{\"o}ckner and Sinnott, {Richard O.} and Anthony Stell and Fragoso, {Maria Candida B.V.} and Bojana Simunov and Feelders, {Richard A.} and Johannes Hofland and Hofland, {Leo J.} and Papathomas, {Thomas G.}",

note = "Funding Information: Prete]), by the European Commission under the 7th Framework Programme (FP7/2007-2013, grant agreement 259735, ENSAT-CANCER [Drs. Arlt, Fassnacht, and Beuschlein]), and under the European Union's Horizon 2020 Research and Innovation Program under grant agreement no. 633983 (ENSAT–HT) (Drs. Arlt and Beuschlein). This work was also supported by the U.K. Medical Research Council (strategic biomarker grant G0801473 [Dr. Arlt]), the Claire Khan Trust Fund at University Hospitals Birmingham Charities (project grant [Dr. Arlt]), the Mayo Clinic Foundation for Medical Education and Research (Mayo scholarship [Dr. Bancos]), the Wellcome Trust (clinical research training fellowship WT101671 [Dr. Chortis] and investigator award WT209492/Z/17/Z [Dr. Arlt]), and the Academy of Medical Sciences (starter grant for clinical lecturers [Dr. Chortis]). This research was partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the U.S. National Institutes of Health under award K23DK121888 (Dr. Bancos). Drs. Arlt and Sitch receive support from the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (grant reference number BRC-1215-20009). Dr. Beuschlein receives funding from the Clinical Research Priority Program of the University of Zurich for CRPP HYRENE (Clinical Research Priority Program HYpertension REsearch NEtwork). Support for this study also came in part from the Deutsche Forschungsgemeinschaft (project number 314061271; CRC/ Transregio 205) (Drs. Fassnacht and Beuschlein). Funding Information: Grant Support: This work was supported by Diabetes UK (Sir George Alberti Research Training Fellowship 18/0005782 [Dr. Funding Information: Primary Funding Source: Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research. Publisher Copyright: {\textcopyright} 2022 American College of Physicians. All rights reserved.",

year = "2022",

month = mar,

doi = "10.7326/M21-1737",

language = "English",

volume = "175",

pages = "325--334",

journal = "Annals of Internal Medicine",

issn = "0003-4819",

publisher = "American College of Physicians",

number = "3",

}

Prete, A, Subramanian, A, ENSAT EURINE-ACT Investigators, Bancos, I, Chortis, V, Tsagarakis, S, Lang, K, Macech, M, Delivanis, DA, Pupovac, ID, Reimondo, G, Marina, LV, Deutschbein, T, Balomenaki, M, O’Reilly, MW, Gilligan, LC, Jenkinson, C, Bednarczuk, T, Zhang, CD, Dusek, T, Diamantopoulos, A, Asia, M, Kondracka, A, Li, D, Masjkur, JR, Quinkler, M, Ueland, G, Dennedy, MC, Beuschlein, F, Tabarin, A, Fassnacht, M, Ivović, M, Terzolo, M, Kastelan, D, Young, WF, Manolopoulos, KN, Ambroziak, U, Vassiliadi, DA, Taylor, AE, Sitch, AJ, Nirantharakumar, K & Arlt, W 2022, 'Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study', Annals of Internal Medicine, vol. 175, no. 3, pp. 325-334. https://doi.org/10.7326/M21-1737

TY - JOUR

T1 - Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study

AU - Prete, Alessandro

AU - Subramanian, Anuradhaa

AU - ENSAT EURINE-ACT Investigators

AU - Bancos, Irina

AU - Chortis, Vasileios

AU - Tsagarakis, Stylianos

AU - Lang, Katharina

AU - Macech, Magdalena

AU - Delivanis, Danae A.

AU - Pupovac, Ivana D.

AU - Reimondo, Giuseppe

AU - Marina, Ljiljana V.

AU - Deutschbein, Timo

AU - Balomenaki, Maria

AU - O’Reilly, Michael W.

AU - Gilligan, Lorna C.

AU - Jenkinson, Carl

AU - Bednarczuk, Tomasz

AU - Zhang, Catherine D.

AU - Dusek, Tina

AU - Diamantopoulos, Aristidis

AU - Asia, Miriam

AU - Kondracka, Agnieszka

AU - Li, Dingfeng

AU - Masjkur, Jimmy R.

AU - Quinkler, Marcus

AU - Ueland, Grethe

AU - Dennedy, M. Conall

AU - Beuschlein, Felix

AU - Tabarin, Antoine

AU - Fassnacht, Martin

AU - Ivović, Miomira

AU - Terzolo, Massimo

AU - Kastelan, Darko

AU - Young, William F.

AU - Manolopoulos, Konstantinos N.

AU - Ambroziak, Urszula

AU - Vassiliadi, Dimitra A.

AU - Taylor, Angela E.

AU - Sitch, Alice J.

AU - Nirantharakumar, Krishnarajah

AU - Arlt, Wiebke

AU - Glöckner, Stephan

AU - Sinnott, Richard O.

AU - Stell, Anthony

AU - Fragoso, Maria Candida B.V.

AU - Simunov, Bojana

AU - Feelders, Richard A.

AU - Hofland, Johannes

AU - Hofland, Leo J.

AU - Papathomas, Thomas G.

N1 - Funding Information: Prete]), by the European Commission under the 7th Framework Programme (FP7/2007-2013, grant agreement 259735, ENSAT-CANCER [Drs. Arlt, Fassnacht, and Beuschlein]), and under the European Union's Horizon 2020 Research and Innovation Program under grant agreement no. 633983 (ENSAT–HT) (Drs. Arlt and Beuschlein). This work was also supported by the U.K. Medical Research Council (strategic biomarker grant G0801473 [Dr. Arlt]), the Claire Khan Trust Fund at University Hospitals Birmingham Charities (project grant [Dr. Arlt]), the Mayo Clinic Foundation for Medical Education and Research (Mayo scholarship [Dr. Bancos]), the Wellcome Trust (clinical research training fellowship WT101671 [Dr. Chortis] and investigator award WT209492/Z/17/Z [Dr. Arlt]), and the Academy of Medical Sciences (starter grant for clinical lecturers [Dr. Chortis]). This research was partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the U.S. National Institutes of Health under award K23DK121888 (Dr. Bancos). Drs. Arlt and Sitch receive support from the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (grant reference number BRC-1215-20009). Dr. Beuschlein receives funding from the Clinical Research Priority Program of the University of Zurich for CRPP HYRENE (Clinical Research Priority Program HYpertension REsearch NEtwork). Support for this study also came in part from the Deutsche Forschungsgemeinschaft (project number 314061271; CRC/ Transregio 205) (Drs. Fassnacht and Beuschlein). Funding Information: Grant Support: This work was supported by Diabetes UK (Sir George Alberti Research Training Fellowship 18/0005782 [Dr. Funding Information: Primary Funding Source: Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research. Publisher Copyright: © 2022 American College of Physicians. All rights reserved.

PY - 2022/3

Y1 - 2022/3

N2 - Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. Design: Cross-sectional study. Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). Participants: 1305 prospectively recruited persons with benign adrenal tumors. Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. Results: Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. Limitations: Cross-sectional design; possible selection bias. Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes.

AB - Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. Design: Cross-sectional study. Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). Participants: 1305 prospectively recruited persons with benign adrenal tumors. Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. Results: Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. Limitations: Cross-sectional design; possible selection bias. Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes.

UR - http://www.scopus.com/inward/record.url?scp=85126490824&partnerID=8YFLogxK

U2 - 10.7326/M21-1737

DO - 10.7326/M21-1737

M3 - Article

C2 - 34978855

AN - SCOPUS:85126490824

SN - 0003-4819

VL - 175

SP - 325

EP - 334

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

IS - 3

ER -

Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study

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