The primary aim of the study is to assess mortality and cardiovascular events potentially linked to cortisol excess in patients with adrenal incidentalomas stratified by cortisol values following the 1-mg overnight dexamethasone test.

The NAPACA Outcome Study is part of the ENSAT Registry (https://registry.ensat.org/)

Inclusion Criteria:

• age ≥18 years
• adrenal incidentaloma (≥ 1cm) detected by cross-sectional imaging between January 1, 1996 and December 31, 2015
• imaging characteristics suggestive for an adrenal adenoma or excluded malignancy by follow-up imaging
• availability of a 1 mg dexamethasone test result
• follow-up data on living status and occurrence of cardiovascular events
• follow-up duration of at least 36 months.

Exclusion Criteria:

• proven pheochromocytoma, primary hyperaldosteronism or adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome
• clinical features suggestive for overt Cushing's syndrome; urinary free cortisol (UFC) ≥ 2-fold higher than the upper limit of normal of the local assay
• any active malignancy (including adrenocortical cancer) at the time of primary diagnosis

patients with adrenal incidentaloma

not yet decided.

From the date of primary diagnosis of the adrenal incidentaloma until the date of death or last follow-up (data lock December 31, 2018). Median follow-up duration was 7.0 years.

Serious adverse events are defined major adverse cardiovascular events (MACE): myocardial infarction or coronary revascularisation (either bypass surgery or percutaneous intervention), stroke, or cardiovascular-related death.

Time frame for MACE was defined as the time between the initial diagnosis of the adrenal incidentaloma and first documentation of any MACE thereafter.