Introduction: Diagnosed adrenal incidentalomas (AI) are increasing and dexamethasonesuppression test (DST) is gold standard for detection of excess cortisol production. Patients canbe categorized into three groups based on the DST level; non-functional adrenal adenomas(NFAA), possible autonomous cortisol secretion (PACS) and autonomous cortisol secretion(ACS), the latter two associated with increased risk of cardiovascular morbidity and mortality.

Aim: The aim of this study was to compare cardiovascular morbidity and mortality in patientswith adrenal incidentalomas with and without hypercortisolemia defined by the EuropeanSociety of Endocrinology (2016) guidelines.

Method: Retrospectively 160 consecutive patient charts between 2008 and 2015 were reviewedand 59 included. They were further categorized in NFAA (n = 37) or PACS (n = 22). Patientswith signs and symptoms of hormonal overproduction or AI found during malignancyinvestigations were excluded. Due to strict adherence to inclusion and exclusion criteria, onlyone case of ACS was found and excluded due to ethical reason.

Results: Increased prevalence of type 2 diabetes in PACS group at baseline. No difference incardiovascular disease or mortality between the groups could be seen after mean follow up of7 years. Three (8%) patients in the NFAA group deceased, all of malignancy. In the PACSgroup, five (23%) deceased. Cause of death was cerebral infarction (n = 2), malignancy (n =1)and other causes (n =2).

Conclusion: No significant difference of cardiovascular morbidity and mortality could be seenbetween NFAA and PACS during follow up. A prospective multicentre study is needed toidentify the long-term outcomes.