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Cited by 133Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Subclinical hormone secretion by incidentally discovered adrenal masses

Caplan, Robert H.·1994·Archives of Surgery
DOI 10.1001/archsurg.1994.01420270067016
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Abstract

OBJECTIVE: To determine the frequency of subclinical hormone secretion in incidentally discovered adrenal masses. DESIGN: We reviewed the radiologic reports of 1779 consecutive computed tomographic scans of the chest, abdomen, and pelvis. SETTING: Regional referral medical center. PATIENTS: Eighty-nine patients with abnormalities of one or both adrenal glands were identified. Patients with nonadrenal gland malignant neoplasms, primary aldosteronism, adrenal hemorrhage, and death or severe illness were not investigated. The final study group consisted of 26 patients with incidentally discovered adrenal masses. MAIN OUTCOME MEASURES: Aldosterone secretion was assessed by measuring plasma renin activity and the plasma aldosterone concentration in patients with unexplained hypokalemia. We evaluated cortisol secretion by performing a 1-mg overnight dexamethasone suppression test and by measuring the corticotropin concentration at 8 AM by a sensitive method. In patients with low corticotropin values, we also measured the 24-hour urinary excretion of free cortisol and 17-ketosteroids and assessed diurnal variation by measuring plasma cortisol concentrations at 8 AM and 4 PM. Adrenal medullary function was studied by measuring urinary free catecholamines. RESULTS: One patient had unrecognized primary aldosteronism, two patients had elevated free catecholamine excretion, and three patients (12%) had subclinical Cushing's syndrome. CONCLUSION: Based on our observations and a review of the literature, we conclude that subclinical hormone secretion, especially cortisol secretion, is more common in patients with incidentally discovered adrenal masses than previously appreciated. Surgeons and anesthesiologists must be alert to the possibility that adrenal insufficiency or a hypertensive crisis may develop in the perioperative period in patients with incidentally discovered adrenal masses.

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  • Over the last 2 decades, there has been a dramatic increase in the detection of AIs; series with contemporary high-resolution CT techniques report a prevalence close to that observed at autopsy.

    “Over the last 2 decades, there has been a dramatic increase in the detection of AIs; series with contemporary high-resolution CT techniques report a prevalence close to that observed at autopsy (Table 2 (36-44)).”

    From Adrenal incidentaloma (2020) · cites this paper as [40]

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Authors
Caplan, R. H.
Affiliations
Gundersen Lutheran Hospital (US)
Corresponding author
Caplan, Robert H.
Venue
Archives of Surgery
Publisher
American Medical Association (AMA)
Published
1994-03-01
Volume
129
Issue
3
Pages
291
ISSN
0004-0010 (ISSN-L)
DOI
10.1001/archsurg.1994.01420270067016
OpenAlex
W2059674695
Cited by
133
References
25
Citations by year
2025: 1 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 3 · 2014: 1 · 2013: 3 · 2012: 8
FWCI
2.61
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
adrenal incidentaloma, adrenal mass, cortisol secretion, Cushing's syndrome, primary aldosteronism, catecholamine excess, adrenal insufficiency, perioperative complications, plasma renin activity, plasma aldosterone, dexamethasone suppression test, urinary free cortisol, 17-ketosteroids
MeSH terms
Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Adult, Aged, Aged, 80 and over, Aldosterone, Catecholamines, Dexamethasone, Female, Humans, Hydrocortisone, Male, Middle Aged, Tomography, X-Ray Computed, 17-Ketosteroids

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