CONTEXT:Data on cognition in patients with primary aldosteronism (PA) are scarce. Mild autonomous cortisol secretion (MACS), defined based on post-dexamethasone cortisol >1.8 mcg/dL, is diagnosed in up to 30% of patients with PA. OBJECTIVES:(1) Assess cognition in patients with PA vs referent subjects with hypertension and (2) determine differences in cognition between patients with PA and those with MACS. METHODS:A prospective, cross-sectional study, 2019-2023. Cognition was assessed by National Institute of Health Toolbox Cognition Battery and reported as T-scores corrected for age, sex, race, and education. Only subjects with hypertension were included. RESULTS:Cognitive assessment was performed in 52 patients with PA (including 11 patients with both PA and MACS, median age of 51.0 years, 30 (57.7%) women), 47 patients with MACS (median age of 57.0 years, 31 (66.0%) women), and 52 referent subjects (median age of 66.1 years, 30 (57.7%) women). When compared to referents, and after adjusting for age, smoking, systolic blood pressure, and alcohol use, patients with PA had lower total cognition (β = -5.7, P = .023), notably fluid cognition (β = -6.8, P = .017), including attention and executive function (β = -5.6, P = .012) and cognitive flexibility and executive function (β = -8.2, P = .006). When compared to patients with MACS, patients with PA had a higher processing speed (β = 9.0, P = .003). No differences in cognition were found between patients with PA with and without MACS. CONCLUSION:Patients with PA demonstrated lower cognition compared with referents and processing speed compared with MACS. Future studies should characterize the impact of MACS on the cognition of patients with PA.

CONTEXT:Patients with mild autonomous cortisol secretion (MACS) have higher rates of vertebral fractures compared to patients with non-functioning adrenal nodules, yet bone density is not always reduced. OBJECTIVE:To characterize the effect of MACS on bone density, metabolism, and microstructure as measured by high-resolution peripheral quantitative computed tomography (HR-pQCT). DESIGN:Cross-sectional study, 2019-2022. SETTING:Tertiary referral center. PARTICIPANTS:75 patients with MACS and 75 age-, sex-, and gonadal status matched referent subjects. MEASUREMENTS:Bone turnover markers, dual-energy x-ray absorptiometry (DXA) scan, and HR-pQCT. OUTCOMES:Areal and volumetric bone mineral density (aBMD, vBMD), trabecular bone score (TBS), microstructural parameters including trabecular bone volume to total volume (BV/TV) ratio. RESULTS:While no differences in aBMD were observed at any skeletal site, patients with MACS had decreased TBS (1.389 vs 1.475, P < 0.001) and lower osteocalcin concentration (17.1 vs 19.5 ng/mL, P = 0.030) than referent subjects. On HR-pQCT at the tibia, patients with MACS had reduced trabecular BV/TV (0.220 vs 0.233, P = 0.015) compared to referent subjects. On multivariable analysis, MACS was associated with lower TBS (OR per SD decrease 2.87 [1.65-5.00]), lower trabecular BV/TV at the radius (OR per SD decrease 2.58 [1.33-5.00]), and lower trabecular BV/TV at the tibia (OR per SD decrease 4.06 [2.10-7.86]). CONCLUSION:Patients with MACS have microstructural deterioration that may not be evident on routine DXA aBMD testing.

Abstract Prognostic indices such as the CLL International Prognostic Index (CLL-IPI) and the International Prognostic Score for Early-stage CLL (IPS-E) can predict time to first treatment (TTFT) in patients with early-stage CLL. Their ability to predict risk of infection - a leading contributor to morbidity and mortality in CLL - remains uncertain. The CLL-TIM is a machine-learning model developed in Europe that integrates clinical, laboratory, and infection-related data to predict TTFT or infection risk within 2-years of diagnosis, Receiver Operating Characteristic - Area Under the Curve (ROC-AUC) 0.74; Agius et al., Nat Comm 11, 363 2020. We conducted the first validation of CLL-TIM in a US cohort of newly diagnosed CLL patients and compared its performance with the CLL-IPI and IPS-E indices. Adults with newly diagnosed CLL (2000-2020) were identified through the Rochester Epidemiology Project using International Classification of Disease (ICD) codes; all diagnoses were confirmed. We replicated the variable selection from the original CLL-TIM model and applied it to our cohort. The primary endpoint was a 2-year composite of either TTFT or incident infection (defined as having blood cultures drawn). Model performance was evaluated using ROC-AUC consistent with the original CLL-TIM methods. CLL-IPI and IPS-E performance was assessed using time-dependent ROC-AUC; pairwise differences in discrimination were tested using DeLong. We identified 454 CLL patients with a median age of 72 years [range, 30-97], 166 (37%) were female, Rai Stage was 0-II in 399 (92%) patients. IGHV genes were unmutated in 130/305 (42%) patients and TP53 disruption (either del17p by FISH or TP53 mutation) was present in 24/329 (8%) patients. At 2-years, 55 (12%) patients received CLL therapy, and 56 (12%) patients had an infection. The 2-year composite endpoint was observed in 94 (21%) patients. The ROC-AUC was 0.74 (95% CI 0.68-0.80) for CLL-TIM, 0.69 for CLL-IPI (95% CI 0.63-0.75, p=0.11 compared to CLL-TIM) , and 0.68 for IPS-E (95% CI 0.62-0.74, p=0.02 compared to CLL-TIM). We also evaluated the ROC-AUC using all the prognostic models for each individual endpoints. The corresponding ROC-AUC for TTFT at 2 years were 0.79, 0.74, and 0.76 for CLL-TIM, CLL-IPI, and IPS-E, respectively; and for infection at 2 years were 0.68, 0.57, and 0.52, respectively. This is the first validation of the CLL-TIM in a US-based cohort of newly diagnosed CLL patients. Although the CLL-TIM model exceeded the minimally meaningful discrimination threshold (AUC >0.7) for individual patient-level risk prediction, there was no statistical difference in AUC between CLL-TIM and CLL-IPI, suggesting either model can predict the composite endpoint at 2 years. Most of the observed discrimination was driven by prediction of TTFT rather than infection, underscoring the need to develop more infection-specific risk models for newly diagnosed CLL. Citation Format: Raphael Mwangi, Tait D. Shanafelt, Soren Basnet, Emily L. West, Owen Keegan, Timothy G. Call, Yao Yuan, Bryan Alexis Vallejo, Paul J. Hampel, Lindsey E. Roeker, Yucai Wang, Saad J. Kenderian, Sara J. Achenbach, Aaron D. Norman, Kari G. Rabe, Neil E. Kay, James R. Cerhan, Curtis A. Hanson, Susan L. Slager, Sameer A. Parikh. Validation of the CLL treatment infection model (CLL-TIM) in patients with newly diagnosed chronic lymphocytic leukemia (CLL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 4228.

CONTEXT:The clinical relevance of etiologic concordance and temporal presentation in bilateral adrenal masses remains poorly defined, creating uncertainty in diagnostic evaluation and management. OBJECTIVE:To characterize the etiologic spectrum of bilateral adrenal masses, evaluate patterns by concordance and synchronicity, and identify predictors of discordance and malignant or pheochromocytoma contralateral lesions. DESIGN:Retrospective cohort study (2010-2025). SETTING:Tertiary referral center. PARTICIPANTS:Adults with bilateral adrenal masses. MAIN OUTCOME MEASURES:Etiology, concordance, synchronicity, interval to contralateral lesion, and factors associated with discordance and malignant or pheochromocytoma contralateral lesions. RESULTS:Among 1,035 patients (median age 59.6 years; 51% women), 85% had concordant and 15% discordant etiologies. Concordant cases were predominantly bilateral benign cortical lesions (76%), whereas discordant cases were heterogeneous (benign 35%, malignant 31%, indeterminate 34%). Presentation was synchronous in 84% and asynchronous in 16%, with a median interval of 45 months (IQR 15-87). Asynchronous disease was associated with higher discordance (23% vs 13%, P=0.001) and greater prevalence of malignant lesions (bilateral malignant: 17% vs 7%; discordant malignant: 8% vs 4%; overall P<0.001). Among asynchronous cases, shorter interval to contralateral lesion (<2 vs ≥5 years) was independently associated with malignant or pheochromocytoma etiology (adjusted OR 2.63, 95% CI 1.01-6.85), as was larger tumor size (adjusted OR 1.06 per mm, 95% CI 1.02-1.09). CONCLUSIONS:Most bilateral adrenal masses are benign and concordant; however, discordant or asynchronous disease identifies a higher-risk subgroup enriched for malignancy. Early contralateral lesion development and larger tumor size are key risk factors.

Objective The purpose of this study was to determine the cumulative incidence of diagnosis switching, drug-free remission, and initiation of a biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) in individuals with seronegative rheumatoid arthritis (RA).Methods Adult residents of Olmsted County, Minnesota, with incident seronegative (rheumatoid factor negative/anti-cyclic citrullinated peptide antibody negative) RA meeting the 1987 and/or 2010 American College of Rheumatology classification criteria were included. Data were collected from January 1, 2005, to December 31, 2023, through manual chart review. Drug-free remission was defined as a period of at least six months where the individual was no longer taking treatment for RA and did not have evidence of active inflammatory arthritis upon evaluation by a rheumatologist. We calculated the 10-year cumulative incidence of a change in diagnosis, adjusting for the competing risk of death, and of drug-free remission and initiation of a b/tsDMARD, adjusting for the competing risks of death or change in diagnosis.Results A total of 176 individuals with seronegative RA (68% women) were included. The 10-year cumulative incidence of a change in diagnosis was 12.8% (95% confidence interval [CI] 8.7%-18.9%). The most common change in diagnosis was to spondyloarthritis (4%). The 10-year cumulative incidence of drug-free remission and initiation of a b/tsDMARD was 26.6% (95% CI 20.7%-34.2%) and 19.9% (95% CI 14.7%-26.9%), respectively. Over a median follow-up of 11.8 years, 49 individuals entered drug-free remission.Conclusion After initial diagnosis of seronegative RA, about 13% of individuals had a change in diagnosis and a quarter experienced drug-free remission within 10 years.

Context:Bilateral adrenalectomy (BLA) and autoimmune adrenal insufficiency (AAI) are 2 major causes of primary adrenal insufficiency (PAI). Comparative data between etiologies are limited. Objective:To compare management, quality of life (QoL), and frequency of adrenal crises between participants post-BLA vs AAI. Methods:We conducted a dual-center, cross-sectional study of adults with AAI or BLA between 2018 and 2025. All participants completed questionnaires on management, adrenal crises, and the Addison Disease-specific QoL Questionnaire (AddiQoL). Results:Of 343 participants, 203 had AAI (median age 54 years, 72% women) and 139 had BLA (median age 57 years, 76% women). AddiQoL scores were similar between participants with AAI and BLA (median 84 vs 83, P = .947), but better in participants post-BLA for pheochromocytoma versus hypercortisolism (median 88 vs 81, P = .031). Participants with AAI reported a higher number of adrenal crises within the past year than those post-BLA (25% vs 13%, P = .022). In multivariable analyses of age, sex, glucocorticoid dose and type, PAI type, AddiQoL score, and autoimmune comorbidities, only PAI type was associated with higher number of reported adrenal crisis within the last year (AAI vs BLA: odds ratios of 2.1-2.2, P < .05 for all models). Conclusion:QoL was comparable between participants with AAI and BLA, though patients post-BLA for pheochromocytoma reported better QoL than patients post-BLA for hypercortisolism. Adrenal crises were more common in participants with AAI than those post-BLA, a finding that was not explained by patients' glucocorticoid management, underscoring the need for tailored crisis prevention strategies.

Objective The objective of this study was to investigate the association between dual seropositive, single seropositive, and seronegative rheumatoid arthritis (RA) with radiographic erosions, disease flares, and death. Methods We performed a retrospective, population‐based study of residents in Southern Minnesota with incident RA who fulfilled criteria for RA in 2003 to 2019. Radiographic erosions and flares were evaluated within one year of incident RA. All‐cause mortality was obtained from medical records and death certificates. Cox models adjusted for age, sex, smoking status, year of incident RA, and comorbidities were used. Results The study included 1,373 patients with RA. At RA incidence, 37% were dual seropositive, 13% seropositive for anti–cyclic citrullinated protein (anti‐CCP) only, 12% seropositive for rheumatoid factor (RF) only, and 38% seronegative. The highest proportion of radiographic erosions before or within one year of RA incidence was in the dual seropositive (31%) and lowest in those seropositive for anti‐CCP only (13%). Flares occurred in 69% of the dual seropositive and 51% of the seropositive for anti‐CCP only within the first year of RA incidence. Those seropositive for RF only had over a two‐fold increase in mortality rates compared with the seronegatives (adjusted hazard ratio [aHR] 2.18, 95% confidence interval [CI] 1.47–3.24). In contrast, the dual seropositives had only a >50% increase in mortality rates (aHR 1.66, 95% CI 1.21–2.28), and those seropositive only for anti‐CCP had a >30% increase in mortality rates (aHR 1.32, 95% CI 0.83–2.11). Conclusion Patients with RA seropositive for RF only have an increase in mortality rates compared with patients who are dual seronegative. RF positivity could be an indicator of inflammation that requires pharmacologic treatment to decrease mortality rates.

CONTEXT:The impact of active hypercortisolism on sleep is incompletely characterized. Studies report impaired sleep in patients with Cushing syndrome (CS). Patients with mild autonomous cortisol secretion (MACS) demonstrate mild nocturnal hypercortisolism that could impact sleep. OBJECTIVES:To characterize sleep abnormalities in patients with CS and MACS using the Pittsburgh Sleep Quality Index (PSQI), identify factors associated with poor sleep, and compare sleep abnormalities in patients with MACS vs referent subjects. METHODS:We conducted a single-center cross-sectional study of adults with active CS and MACS. Clinical and biochemical severity scores for hypercortisolism were calculated. Parallelly, we enrolled referent subjects. Quality of life was assessed using (1) the Short Form-36 (SF-36) in all participants and (2) the CushingQoL in patients with active hypercortisolism. Sleep quality was assessed using PSQI. RESULTS:PSQI was assessed in 154 patients with CS (mean 12, SD ±4.5), 194 patients with MACS (mean 11, SD 4.6), and 89 referents (mean 5, SD ±3.4). Patients with MACS exhibited shorter sleep duration, longer sleep latency, more severe daytime dysfunction, lower sleep efficiency, and a higher sleep medication use compared to referent subjects (P = <.001 for all). Age-, sex, and body mass index-adjusted analysis demonstrated no differences in PSQI or its subcomponents between patients with CS and MACS (P > .05 for all). In a multivariable analysis of patients with MACS, younger age, female sex, and higher clinical hypercortisolism severity score were associated with impaired sleep. In patients with CS, only younger age was associated with poor sleep. CONCLUSION:Patients with MACS demonstrate sleep impairment that is similar to patients with CS. Younger women with higher clinical severity of MACS are more likely to have impaired sleep.

OBJECTIVE:Evidence on the duration of post-operative adrenal insufficiency (AI) in patients with endogenous hypercortisolism is scarce. We sought to determine the duration of post-operative AI and to identify factors associated with the duration of AI in patients undergoing surgery for endogenous hypercortisolism. METHODS:We conducted a single-center prospective cohort study, 2019-2025, of patients with endogenous hypercortisolism [Cushing syndrome (CS) or mild autonomous cortisol secretion (MACS)] treated with surgery. Associations of demographics, body mass index (BMI), clinical, and biochemical hypercortisolism severity, subtype of hypercortisolism, pre-surgical hypercortisolism duration, glucocorticoid type, and nadir cortisol in relation to duration of AI were investigated. RESULTS:The 242 patients [41% MACS, 46% pituitary CS, 12% adrenal CS, 1% ectopic CS, median age 50 years (IQR: 40-60), 85% women] who developed postsurgical AI were followed for a median duration of 13.7 months (IQR 7.2-26.3). The median time to recovery of AI was shorter in MACS vs. overt CS (3.9 months (95% CI: 3.3-6.2) vs. 13.5 months (95% CI 11.3-18.3), P value < .001). On multivariable analysis adjusting for age, sex, BMI, and glucocorticoid type, moderate to severe biochemical severity score (β = 11, P value < .001) and moderate to severe clinical severity score (β=8.7, P < .001), were associated with a longer duration of AI. CONCLUSIONS:Baseline clinical and biochemical hypercortisolism severity scores may inform individualized counseling on post-operative AI duration in patients treated for CS and MACS.

CONTEXT:Limited data are available on quality of life (QoL) and adrenal crises in patients with immune checkpoint inhibitor-induced secondary adrenal insufficiency (ICI-SAI). OBJECTIVE:To 1) characterize the presentation, management, and outcomes of patients with ICI-SAI; 2) compare outcomes of ICI-SAI with other etiologies of secondary adrenal insufficiency (oSAI);  and 3) identify variables associated with QoL and adrenal crisis. METHODS:In this single-center cross-sectional study, adults with ICI-SAI or oSAI (2018-2025) completed questionnaires assessing symptoms, management, adrenal crises, and the Addison disease-specific QoL survey (AddiQoL).Outcomes AddiQoL score and adrenal crisis events. RESULTS:Patients with ICI-SAI (n=109) were older (median age 66 vs 60 years), more often women (59% vs 43%), and more frequently diagnosed within one year of symptom onset (88% vs 42%, P<0.001), compared to patients with oSAI (n=139). Patients with ICI-SAI had higher AddiQoL scores (median 87 vs 85, P=0.020). In a multivariable analysis of age, sex, glucocorticoid dose and type, insurance support and duration of SAI, ICI-SAI remained independently associated with higher AddiQoL (estimate 5.4, P=0.010). The prevalence of reported adrenal crises within the prior year was similar between groups (15% vs 14%, P=0.782). In a multivariable analysis, higher AddiQoL scores were independently associated with lower odds of adrenal crisis (OR of 0.57, 95% CI 0.42-0.76). CONCLUSION:Patients with ICI-SAI report better QoL compared with patients with other causes of SAI, despite similar adrenal crisis rates. These differences may be related to earlier diagnosis and differing clinical contexts, underscoring the importance of timeline recognition and patient-centered management.

Context Patients with adrenal hormone excess demonstrate increased cardiovascular (CV) risk and mortality.Objective We aimed to determine the effect of adrenal disorders on the inflammation marker glycoprotein acetylation (GlycA), total branched-chain amino acids (BCAAs), ketone bodies, and the gut microbiome-derived metabolites trimethylamine N-oxide (TMAO) and betaine.Methods We conducted a single-center cross-sectional study of patients with nonfunctioning adenomas (NFAs), mild autonomous cortisol secretion (MACS), primary aldosteronism (PA), Cushing syndrome (CS), pheochromocytoma/paragangliomas (PPGLs), other benign or malignant adrenal masses, and adrenocortical carcinoma (ACC) between January 2015 and July 2022 (n = 802). Referent individuals included participants in the PREVEND (Prevention of Renal and Vascular End-Stage Disease) study (n = 5241). GlycA, BCAAs, ketone bodies, TMAO, and betaine were measured using nuclear magnetic resonance spectroscopy. Multivariable logistic analyses were adjusted for age, sex, body mass index, smoking, hypertension, diabetes mellitus, and statin therapy.Results In age- and sex-adjusted comparison to referent individuals, increased GlycA was noted in all patient categories, increased BCAAs in NFA, MACS, CS, PA, and ACC, increased TMAO in patients with other malignant adrenal masses, increased betaine in NFA and MACS, and increased ketone bodies in NFA, CS, and ACC. Essentially similar findings were observed in fully adjusted analysis and after exclusion of participants with diabetes and CV disease.Conclusion Patients with functioning and nonfunctioning adrenal masses demonstrated increased GlycA and BCAAs, biomarkers associated with adverse cardiometabolic disorders and mortality. Patients with NFA demonstrated an adverse metabolic profile similar to patients with MACS and CS.

BACKGROUND:The incidence, risk factors, and outcomes of venous thromboembolism (VTE) in patients with chronic lymphocytic leukemia (CLL) and monoclonal B-cell lymphocytosis (MBL) are not well described. OBJECTIVES:We aimed to determine the clinical characteristics, risk factors, and outcomes of incident VTE in patients with newly diagnosed MBL/CLL and compare the incidence to the age- and sex-matched general population. METHODS:Using the Mayo Clinic CLL Database, we identified 946 patients with newly diagnosed MBL/CLL between 1998 and 2021. Incidence of VTE was identified by querying the electronic health record for VTE-specific International Classification of Diseases-9 and -10 codes and reviewing results of radiographic studies. RESULTS:Eighty patients developed VTE. The incidence of VTE in patients with newly diagnosed MBL/CLL was ∼1% per year. In multivariable analyses, prior history of VTE (hazard ratio [HR]: 5.33; 95% CI: 1.93-14.68, P = .001) and high/very high-risk CLL-International Prognostic Index score (HR: 2.63; 95% CI: 1.31-5.26; P = .006) were associated with an increased risk of VTE; receipt of CLL treatment or occurrence of nonhematologic malignancy was not. Development of VTE was associated with shorter overall survival (HR: 1.82, 95% CI: 1.30-2.55) after adjusting for age, sex, prior history of VTE, and Rai stage. The age- and sex-adjusted VTE incidence rate for patients with MBL/CLL and no prior history of VTE (n = 904) was 1254 per 100 000 person-years compared with 204 per 100 000 person-years in the general population, reflecting a 5.9-fold increase. CONCLUSION:Our study demonstrates a 6-fold increased risk of VTE in patients with MBL/CLL compared with the age- and sex-matched general population.

Objective. We aimed to assess the occurrence of carpal tunnel syndrome (CTS) before and after rheumatoid arthritis (RA) incidence and by serologic status. Methods. This population-based study included residents of a geographically defined area meeting the 1987 American College of Rheumatology classification criteria for RA in 1980 to 2019 matched 1:1 with individuals without RA. At least two diagnosis codes >= 30 days apart were used to identify CTS. Cumulative incidence of CTS adjusting for competing risk of death was assessed. Logistic regression and Cox proportional hazard models were used, adjusting for age, sex, calendar year, smoking, obesity, diabetes mellitus, and hypothyroidism. Results. We included 1,335 patients with RA and 1,331 individuals without RA. The overall prevalence of CTS before or on RA incidence or index was 179 patients with RA (13%) and 85 individuals without RA (6%), respectively (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.69-2.94). Most previous incidences of CTS occurred >= 2 years before the index date (112 events in patients with RA and 75 events in individuals without RA, respectively). Following RA incidence or index, individuals with RA (vs those without RA) had similar to 80%-higher risk of CTS (hazard ratio [HR] 1.78; 95% CI 1.38-2.30). The risk estimates of CTS in patients with seronegative (vs seropositive) RA were OR 1.33 (95% CI 0.96-1.84) before RA incidence and HR 1.37 (95% CI 0.99-1.88) after RA incidence. In RA, obesity (HR 1.42, 95% CI 1.02-1.99) and seronegative cyclic citrullinated peptide antibody status (HR 1.79, 95% CI 1.07-2.99), but not other risk factors, were associated with increased CTS risk. Conclusion. We found a more than two-fold increase in risk of CTS in the years preceding RA and a 1.8-fold increased risk of incident CTS following RA onset.

Context:Patients with endogenous hypercortisolism experience glucocorticoid withdrawal syndrome (GWS) after surgery. Meditation may be an effective intervention to alleviate the severity of GWS. Objective:To determine the acceptability of a portable, wearable electroencephalography device for guided meditation (MUSE headband) and the impact of MUSE use on GWS and quality of life 12 weeks postsurgery. Methods:We conducted a single-center prospective cohort study of adults with endogenous hypercortisolism undergoing curative surgery from 2019 to 2024. Patients had baseline and postsurgical assessments over 12 weeks. The study comprised patients using MUSE for ≥ 6 weeks (MUSE cohort) and patients matched by age, sex, BMI, hypercortisolism type, and glucocorticoid type at 1:4 ratio. Quality of life and GWS symptoms were assessed with AddiQoL, CushingQoL, and 36-item Short Form Health Survey mental and physical component (SF-36 MCS and PCS) questionnaires. Results:MUSE was offered to 52 patients, and 22 (42%) used MUSE for ≥ 6 weeks within 12 weeks after surgery. At baseline, compared to 88 matched subjects, 22 MUSE participants demonstrated similar prevalence of comorbidities and clinical and biochemical hypercortisolism severity, but lower AddiQoL (mean 73 vs 66, P = .031) and SF-36 MCS (mean 39 vs 33, P = .022). At 12 weeks, these differences in quality of life were no longer present. After adjusting for age, sex, BMI, clinical severity score, and baseline quality of life, MUSE use was an independent predictor of improved SF-36 PCS at 12 weeks postsurgery (beta 4.2, 95% CI: 0.5-7.9, P = .026). Conclusion:Postsurgical meditation intervention may improve physical symptoms and accelerate recovery.

Objective The objective of this study is to identify social/metabolic risk factors associated with subsequent diagnosis of adrenal adenomaDesign The design is a population-based historical case-control study.Methods Cases were adult patients diagnosed with an adrenal adenoma between 2005 and 2017 with no overt hormone excess. Controls were age- and sex-matched individuals with (1) no diagnosis of adrenal adenoma and (2) no diagnosis of adrenal adenoma with cross-sectional imaging of the chest/abdomen performed within 5 years prior to index date. The frequency of various social/metabolic risk factors present 5-10 years prior to index date and odds ratios (ORs) for adrenal adenoma diagnosis were reported.Results Six hundred seventy cases identified (median age 63 years old, 56% women). During the 5-10 years prior to index date, patients with adrenal adenomas had higher prevalence of obesity (56.7% vs 49.3%, P = .007), low socioeconomic status (36.7% vs 31.1%, P = .039), tobacco use (70.2% vs 61.4%, P = .001), and diabetes (17.5% vs 11.7%, P = .003) compared to controls with prior imaging. No difference in prevalence of hypertension, substance use, chronic kidney disease, or combined cardiovascular events was observed. Based on a multivariable analysis, increased body mass index (BMI) and tobacco use were associated with increased odds of adrenal adenoma diagnosis with ORs 1.18 (95% confidence interval [CI] 1.07-1.32) and 1.41 (95% CI 1.06-1.87), respectively.Conclusions Compared to controls with prior imaging, patients with adrenal adenoma had higher prevalence of obesity, low socioeconomic status, tobacco use, and diabetes 5-10 years prior to index date. In particular, increased BMI and tobacco use were independent risk factors associated with increased odds of adrenal adenoma diagnosis.

In individuals with high-count monoclonal B-cell lymphocytosis (MBL), we investigated if lymphadenopathy or splenomegaly found by imaging was associated with shorter time to first chronic lymphocytic leukaemia (CLL) therapy (TTFT) and overall survival (OS). Individuals with MBL seen at Mayo Clinic (2002-2019) were retrospectively divided into three cohorts based on imaging studies within 1 year of diagnosis: no imaging studies (Cohort A); imaging with no evidence of lymphadenopathy/splenomegaly (Cohort B); imaging with evidence of lymphadenopathy/splenomegaly (Cohort C). We compared baseline characteristics, TTFT and OS across the MBL cohorts to a cohort of individuals with small lymphocytic lymphoma (SLL). A total of 1078 patients were included: 640 with MBL and 438 with SLL. Compared to Cohort B, individuals in Cohort C were more likely to have unmutated immunoglobulin heavy chain variable region (IGHV) (43% vs. 25% p = 0.016), high-risk fluorescence in situ hybridization (FISH) (del17p and del11q in 15% vs. 4%, p = 0.038) and higher expression of CD38 (31% vs. 16%; p = 0.011). After adjusting for sex and CLL-International Prognostic Index (IPI), lymphadenopathy/splenomegaly was associated with a shorter TTFT (hazard ratio [HR] = 2.04, 95% confidence interval [CI]: 1.02-4.04, p = 0.042) but not OS (HR = 1.09, 95% CI: 0.62-1.92, p = 0.775). Lymphadenopathy/splenomegaly on imaging in individuals with high-count MBL is associated with a more unfavourable risk profile and shorter time to first CLL-directed therapy.

OBJECTIVES:Assess atrial fibrillation (AF) risk in patients with rheumatoid arthritis (RA) versus general population and identify predictors of AF in RA. METHODS:Retrospective medical records review was completed to form an inception cohort of all patients with RA (1990-2019), among residents of 8 southern MN counties, aged ≥18 years. Each patient with RA was matched on age, sex, year, and county to randomly selected non-RA comparator and followed until incident AF, death, migration, or 12/31/2023. AF was defined using an electronic algorithm. RESULTS:1899 patients with RA and 1899 non-RA comparators (mean age 55.9 years, 68.5% female) were included. Occurrence of AF was similar in RA vs. non-RA, adjusting for age, sex, year, smoking, and obesity: HR:1.10; 95%CI:0.92-1.33. The 10-year cumulative incidence of AF was 9.5% in RA versus 8.8% in non-RA. In RA, significant risk factors for incident AF included age (HR:2.29 per 10-year increase; 95%CI:2.05-2.56), male sex (HR:1.57; 95%CI:1.22-2.03), former smoking (HR:1.35; 95%CI:1.01-1.81), current smoking (HR:2.16; 95%CI:1.51-3.09), obesity (HR:1.83, 95%CI:1.42-2.37), diabetes (HR:1.54, 95%CI:1.09-2.17), hypertension (HR:1.60; 95%CI:1.20-2.13), rheumatoid nodules (HR:1.77; 95%CI:1.23-2.55), large joint swelling (HR:1.32; 95%CI:1.01-1.73), and severe extra-articular manifestations (HR:1.88; 95%CI:1.17-3.02). AF occurrence rate was higher among patients with severe RA (i.e., erosions/destructive changes, nodules, or severe extra-articular manifestations in the first year) compared to non-RA (HR:1.46; 95%CI:1.09-1.94). CONCLUSION:Adverse cardiovascular risk profile and RA disease severity significantly increased the risk of AF among patients with RA. Future studies will inform to what extent early recognition and management of these factors improves AF outcomes in RA.

ObjectiveTo investigate trends in depression and anxiety over 3 decades among individuals with rheumatoid arthritis (RA).MethodsPatients with incident RA (age ≥ 18 years, meeting 1987 American College of Rheumatology criteria between 1985 and 2014) were identified using the Rochester Epidemiology Project. Individuals with RA were matched 1:1 with non-RA comparators on age, sex, and calendar year of RA incidence. Patients were followed until death, migration, or December 31, 2020. Depression and anxiety were defined using established International Classification of Diseases, 9th and 10th revision code sets. Cox models were used to compare trends in the occurrence of depression and anxiety diagnoses and cooccurring anxiety and depression by decade and RA status, adjusted for potential confounders.ResultsThe study included 1012 individuals with RA and 1012 matched controls (mean age 55.9 years, 68.38% female). Hazard ratios (HRs) demonstrated a temporal increase in anxiety and cooccurring anxiety and depression from 2005-2014 compared to 1985-1994 for individuals both with and without RA. Persons with RA exhibited a rising occurrence of anxiety (HR 1.27, 95% CI 0.86-1.88) and concomitant anxiety and depression (HR 1.49, 95% CI 0.96-2.33) compared to controls. Trends were most pronounced in seropositive patients with RA (anxiety: HR 4.01, 95% CI 2.21-7.30).ConclusionAnxiety and concomitant anxiety and depression diagnoses are elevated in individuals with RA. The increasing occurrence of anxiety and cooccurring anxiety and depression suggests rising awareness and diagnosis of these disorders. Adding to stable but high rates of depression diagnoses, individuals with RA now have evidence of a widening gap in mental health diagnoses that clinicians should address.

Disclosure: A.J. Han: None. S.J. Achenbach: None. B.J. Atkinson: None. I. Bancos: None. Background: The prevalence of adrenal adenomas continues to rise with increased utilization of imaging. However, much remains unknown about what risk factors may predispose individuals to develop adrenal adenomas. In this study, we aimed to identify modifiable and non-modifiable risk factors associated with development of adrenal adenomas. Methods: Historical case-control population study was performed. Patients diagnosed with adrenal adenoma between 2005-2017 with no evidence of overt hormone excess were paired with age- and sex-matched individuals without a diagnosis of adrenal adenoma who had a CT/MRI scan performed within 5 years prior to index date. The prevalence of various social and metabolic risk factors present within 10 years prior to index date (date of adrenal adenoma diagnosis) was compared. Results: Total of 670 patients (median age 63, IQR 53-74 years, 56% women) with adrenal adenomas were identified. At 10 years prior to index date, patients with adrenal adenomas had a higher body mass index (BMI) (median 30.1 vs 28.2 kg/m2, p<0.001), lower socioeconomic status (SES) based on Area Deprivation Index (36.2% with national percentile score >50 vs 30.9%, p=0.037), and more tobacco use (70.2% vs 61.4%, p=0.001), compared to referent subjects. Patients also had a higher prevalence of diabetes (17.5% vs 11.7%, p=0.003) 5-10 years prior to index date, but no difference in prevalence of hypertension, myocardial infarction, chronic kidney disease, atrial fibrillation, stroke, or heart failure was observed between groups. Based on multivariable analysis, increased BMI and tobacco use 10 years prior to index date was associated with increased odds of adrenal adenoma diagnosis with odds ratio (OR) of 1.18 (95% Confidence Interval 1.06-1.32) and 1.41 (1.06-1.87), respectively. Conclusions: Compared to controls, patients with adrenal adenoma were more likely to be obese, have lower SES, endorse tobacco use, and demonstrate evidence of impaired glucose metabolism at least 5-10 years prior to diagnosis. In particular, increased BMI and prior tobacco use was associated with increased odds of adrenal adenoma diagnosis. Further exploration of these intricate relationships may help identify modifiable risk factors for development of adrenal adenomas. Presentation: Saturday, July 12, 2025