CoChat
Sign Up
Cited by 109Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours

Fernández‐Real, J. M., Ricart Engel, W., Simó, R., Salinas, I., Webb, S. M., and the Study Group of Incidental Adrenal Adenoma·1998·Clinical Endocrinology
DOI 10.1046/j.1365-2265.1998.00437.x
Open this paper in CoChat — free account

Abstract

OBJECTIVE: Clinically silent cortisol hypersecretion has been frequently observed in recent series of adrenal 'incidentalomas'. A significant body of data indicates that a spectrum of cortisol excess exists. Up to 90% of patients with cortisol hypersecretion are glucose intolerant. The aim of this study was (1) to assess glucose tolerance in consecutive patients with 'nonfunctioning' adrenal adenomas, and (2) to study the influence of the status of the hypothalamo-pituitary-adrenal axis (HPAA) on carbohydrate tolerance. PATIENTS AND METHODS: Sixty-four consecutive patients with nonfunctioning adrenal adenomas (non-hypersecretory) diagnosed between September 1995 and July 1996 in five hospitals were included in the study. The prevalence of glucose intolerance or diabetes mellitus was determined with an oral glucose tolerance test (oGTT) according to the recommendations of the National Diabetes Data Group. Twenty-three consecutive unselected patients diagnosed with 'nonfunctioning' adrenal adenoma were enrolled in a study to determine the influence of HPAA status on carbohydrate tolerance. In these patients, in addition to basal and post-dexamethasone serum and urinary free cortisol concentrations, assessment of peripheral sensitivity to insulin (estimated during the oGTT according to a previously validated method) and adrenal sensitivity to ACTH (calculated from the CRH test) were performed. RESULTS: Twenty-five patients were considered to have normal glucose tolerance (95% confidence interval (95% CI) for the mean of 2 h glucose, 5.5-6.5 mmol/l); 17 showed glucose intolerance (95% CI 8.5-9.3 mmol/l); and 22 were classified as having diabetes mellitus (95% CI 12.1-14.6 mmol/l), including six patients with previously known diabetes mellitus. These three groups were comparable in age, sex, body mass index, waist-hip ratio and concomitant diseases. Thus, the prevalence of disturbed glucose tolerance was 39/64 (61%), well above the prevalence of NIDDM described in a population of similar age in our area. Among the 23 patients included in the study of HPAA status, the size of the tumour correlated with serum cortisol after dexamethasone (DXM) (r = 0.52, P < 0.01) and 24-h urinary free cortisol (UFC) after DXM (r = 0.55, P < 0.01), and negatively with DHEAs (r = -0.42, P = 0.04). The area under the curve for ACTH after hCRH (AUCacth) correlated negatively with both UFC (r = -0.40, P = 0.04) and serum cortisol after dexamethasone (r = -0.47, P = 0.02). The degree of peripheral sensitivity to insulin (SI) positively correlated with adrenal sensitivity (r = 0.56, P = 0.005). CONCLUSIONS: A high prevalence (61%) of disturbed glucose tolerance was found among consecutive patients harbouring incidental 'nonfunctional' adrenal adenomas. Therefore, patients with incidental adrenal tumours should be tested for glucose tolerance. The positive correlation between insulin sensitivity and adrenal sensitivity to ACTH suggests that, in these patients, insulin resistance hampers ACTH action at the level of the adrenal.

Integrity signals

Registry

Crossref · 10.1046/j.1365-2265.1998.00437.x

Cites

32 of 32 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?

  • Autonomous cortisol secretion in patients with adrenal incidentaloma has been associated with hypertension, insulin resistance, type 2 diabetes mellitus, obesity, metabolic syndrome, and increased mortality.

    “Despite the absence of florid signs and symptoms, ACS in patients AI has been associated with hypertension (215), insulin resistance (216), type 2 diabetes mellitus (217), obesity (218), metabolic syndrome (219), and increased mortality (75).”

    From Adrenal incidentaloma (2020) · cites this paper as [217]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Fernández‐Real, J. M., Ricart Engel, W., Simó, R., Salinas, I., Webb, S. M., & and the Study Group of Incidental Adrenal Adenoma
Affiliations
  • Vall d'Hebron Hospital Universitari (ES)
  • Hospital Universitari Germans Trias i Pujol (ES)
  • Hospital de Sant Pau (ES)
Corresponding author
Fernández‐Real, J. M.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
1998-07
Volume
49
Issue
1
Pages
53-61
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1046/j.1365-2265.1998.00437.x
OpenAlex
W2100916515
Cited by
109
References
32
Citations by year
2026: 2 · 2024: 2 · 2023: 7 · 2022: 3 · 2020: 3 · 2019: 5 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 7 · 2014: 1 · 2013: 4 · 2012: 3
FWCI
8.61
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1283 d)
Locations
  • Clinical Endocrinology (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
glucose tolerance, non-functioning adrenal adenoma, cortisol hypersecretion, hypothalamic-pituitary-adrenal axis, insulin sensitivity, ACTH sensitivity, diabetes mellitus, type 2 diabetes, dexamethasone suppression test, urinary free cortisol, tumor size, oral glucose tolerance test
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Aged, Analysis of Variance, Blood Glucose, Corticotropin-Releasing Hormone, Dexamethasone, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Female, Glucocorticoids, Glucose Tolerance Test, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Insulin, Male, Middle Aged, Pituitary-Adrenal System, Regression Analysis, Prevalence, Chi-Square Distribution, Glucose Intolerance

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