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Background: Autonomous cortisol secretion in patients with adrenal incidentalomas is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available., Objective: To measure the association between mortality and levels of autonomous cortisol secretion in patients with adrenal incidentalomas., Design: Retrospective cohort study. (ClinicalTrials.gov: NCT03919734)., Setting: Two hospitals in southern Sweden., Patients: Consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 and were followed for up to 14 years. Outcome data were collected from national registers., Measurements: Patients were grouped according to plasma cortisol level after a 1-mg dexamethasone suppression test (cortisol DST ; <50, 50 to 82, 83 to 137, or ≥138 nmol/L)., Results: During a median follow-up of 6.4 years, 170 of 1048 patients died. Compared with a cortisol DST less than 50 nmol/L, a cortisol DST of 50 to 82 nmol/L was not associated with increased mortality (hazard ratio [HR], 1.15 [95% CI, 0.78 to 1.70]). However, a cortisol DST of 83 to 137 nmol/L ( n  = 119) had an HR of 2.30 (CI, 1.52 to 3.49), and a cortisol DST of 138 nmol/L or higher ( n  = 82) had an HR of 3.04 (CI, 1.86 to 4.98). Analyses using restricted cubic splines indicated that the association between cortisol DST and mortality was linear up to a cortisol DST of 200 nmol/L., Limitation: The results are not based on verified autonomous cortisol secretion; thus, the association may be underestimated., Conclusion: The association between mortality and cortisol DST increased linearly until cortisol DST reached 200 nmol/L. A cortisol DST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisol DST of 138 nmol/L or higher was associated with a 3-fold increase in mortality. Additional studies should be done, and until those studies are completed some clinicians may consider these findings when deciding which patients to recommend for surgery., Primary Funding Source: Lisa and Johan Grönberg Foundation and Gyllenstiernska Krapperup Foundation.

Diabetes mellitus is associated with decreased haemodynamic stability and reduced tolerance to hypovolaemia. Compensatory haemodynamic responses during experimental hypovolaemia in type 1 diabetes patients with (DMR+) and without (DMR-) retinopathy as well as healthy controls (C) were studied. Lower body negative pressure created hypovolaemic circulatory stress. Volumetric techniques were used to assess the compensatory capacitance response (redistribution of peripheral venous blood to the central circulation) and to assess capillary fluid absorption from tissue to blood. The compensatory capacitance response was 1/3 lower in DMR+ compared with C (p = 0.002) and DMR- (p = 0.01). Net capillary fluid absorption was reduced by one-third in DMR- and DMR+ compared with C (each p < 0.05). Type 1 diabetes patients with retinopathy demonstrate reduced mobilisation of peripheral venous blood to the central circulation. Furthermore, type 1 diabetes patients present with impaired capillary fluid absorption, which in combination with potentially decreased sympathetic vasoconstriction impedes cardiovascular homeostasis during acute hypovolaemic stress.