CoChat
Sign Up
Cited by 113Adrenal Hormones and DisordersAdrenal and Paraganglionic TumorsHormonal Regulation and Hypertension

Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications.

Tsagarakis, S., Vassiliadi, D., Thalassinos, N.·2006·Journal of Endocrinological Investigation
DOI 10.1007/bf03344133
Open this paper in CoChat — free account

Abstract

Subclinical hypercortisolism (SH) is a newly characterized hormonal disorder that is almost exclusively detected in the context of incidentally discovered adrenal masses. The diagnostic criteria used for the definition of this condition are at present controversial. Amongst the various tests used for the detection of this abnormality (dexamethasone suppression, urinary free cortisol, ACTH levels, midnight serum or salivary cortisol concentrations, ACTH responses to CRH stimulation), the dexamethasone suppression tests (DST) seem to better accomplish the task of unmasking subtle abnormalities of cortisol secretion. Several versions of DST have been used: the 1-mg overnight, the 3-mg overnight and the classical 2-day low-dose DST. This latter test has the theoretical advantage that, by more efficiently suppressing pituitary ACTH secretion, it may provide a measure of the residual (ie non- ACTH-dependent) cortisol secretion from the adrenal mass. In this way, post-dexamethasone cortisol concentrations may quantify the degree of autonomous cortisol hypersecretion. In fact, post-dexamethasone cortisol concentrations have a negative correlation with basal ACTH levels and a positive correlation with midnight cortisol concentrations as well as the size of the incidentally discovered adrenal mass. Most of the existing data indicate that SH detected in the context of adrenal incidentalomas may have some clinically significant implications. In fact, patients with higher post-dexamethasone cortisol concentrations demonstrate higher lipid levels and lower bone mass densities. It has also been suggested that SH may be responsible for biochemical and phenotypic changes reminiscent of the metabolic syndrome. In summary, SH does exist and is associated with a negative impact in patients' health; however, hormonal cut-off criteria for decision-making remain to be defined.

Integrity signals

Registry

Crossref · 10.1007/bf03344133

Cites

89 of 89 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The reliability of nearly all markers of hypothalamic-pituitary-adrenal axis activity, especially ACTH and 24-hour urinary free cortisol, is low.

    “the reliability of almost all markers of HPA axis activity, particularly ACTH and 24-h urinary free cortisol (UFC), is low (3,14,23)”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [23]

  • Higher dexamethasone doses of 3 or 8 mg did not show better performance for diagnosing subclinical hypercortisolism.

    “some authors have proposed higher (3 or 8 mg) dexamethasone doses (40,46,54,56), which however did not show a better performance (14,23,66).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [23]

  • Determining ACTH levels after CRH does not add any advantage to screening for subclinical hypercortisolism.

    “The determination of ACTH levels after CRH does not seem to add any advantage (1,23,34,35,37,38,46) to screening for SH.”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [23]

  • Available data do not demonstrate that low DHEAS concentration is a reliable index of subclinical hypercortisolism.

    “Although it may reflect an autonomous ACTH-independent cortisol hypersecretion, available data do not demonstrate that low DHEAS concentration is a reliable index of SH (1,23,35), also considering that DHEAS levels decrease with age (77).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [23]

Cites

Flagged first, then by citations

1 of the 90 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Tsagarakis, S., Vassiliadi, D., & Thalassinos, N.
Affiliations
  • Polyclinic General Hospital (GR)
  • Evangelismos Hospital (GR)
Corresponding author
Tsagarakis, S.
ORCID
Venue
Journal of Endocrinological Investigation
Publisher
Springer Science and Business Media LLC
Published
2006-05
Volume
29
Issue
5
Pages
471-482
ISSN
  • 0391-4097 (ISSN-L)
  • 1720-8386
DOI
10.1007/bf03344133
OpenAlex
W2016206126
Cited by
113
References
90
Citations by year
2026: 1 · 2024: 2 · 2023: 2 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 4 · 2015: 9 · 2014: 13 · 2013: 2 · 2012: 12
FWCI
1.28
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Endocrinological Investigation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
subclinical hypercortisolism, adrenal incidentaloma, dexamethasone suppression test, ACTH, salivary cortisol, CRH stimulation test, autonomous cortisol secretion, metabolic syndrome, bone mineral density, serum lipids, diagnostic criteria
MeSH terms
Adrenal Gland Neoplasms, Adrenalectomy, Circadian Rhythm, Corticotropin-Releasing Hormone, Cushing Syndrome, Dexamethasone, Humans, Hydrocortisone, Osteoporosis, Radionuclide Imaging, Prevalence, Incidental Findings

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review