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Cited by 134Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection

Midorikawa, Sanae, Sanada, Hironobu, Hashimoto, Shigeatsu, Suzuki, Takayuki, Watanabe, Tsuyoshi·2001·Clinical Endocrinology
DOI 10.1046/j.1365-2265.2001.01274.x
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Abstract

OBJECTIVE: Several recent studies have indicated that patients with adrenal incidentaloma often have disturbed glucose tolerance or/and hypertension. It is unclear whether these metabolic conditions could be caused by adrenal incidentaloma. We investigated the prevalence of disturbed glucose tolerance, hypertension and insulin resistance in the patients with non-functioning adrenal incidentaloma and evaluated the changes of the parameters such as glucose tolerance, blood pressure and insulin sensitivity after adrenalectomy. PATIENTS AND METHODS: Among 15 patients with incidentally discovered adrenal tumours in our department from 1996 to 1999, 4 patients were diagnosed as having pre-clinical Cushing's syndrome and the other 11 as having non-functioning tumours based on detailed endocrinological examinations including dexamethasone suppression testing. Four tumours with pre-clinical Cushing's syndrome and 8 tumours out of 11 patients with non-functioning tumours were diagnosed histopathologically as adrenocortical adenomas and the other 3 as of non-adrenal origin including a myelolipoma, an adrenal vascular cyst and an endothelioma. The prevalence of disturbed glucose tolerance was determined with an oral glucose tolerance test, and insulin sensitivity was evaluated by the method of steady state of plasma glucose (SSPG). RESULTS: All 12 patients with adrenocortical adenoma exhibited insulin resistance based on the SSPG (6.9-13.2 mmol/l). Before surgical removal of the tumours, the SSPG titre was relatively higher in the patients with pre-clinical Cushing's syndrome than in those with non-functioning with adrenocortical adenoma (mean value 11.65 vs. 8.99 mmol/l), whereas 2 of the 3 patients with non-adrenocortical tumours did not have insulin resistance. Among the 12 patients with adrenocortical adenoma, 7 (58%) and 9 (75%) patients exhibited hypertension and disturbed glucose tolerance, respectively. After removal of the tumours, SSPG of the patients with adrenocortical adenoma, but not that of the other 3 patients with non-cortical tumours, was significantly decreased compared to pre-adrenalectomy values. There are no significant differences in the changes of SSPG titres between in pre-clinical Cushing's syndrome and in non-functioning adrenocortical adenoma. Systolic blood pressure, but not diastolic blood pressure, was also significantly decreased in the patients with adrenocortical adenoma. CONCLUSION: High prevalences of disturbed glucose tolerance, insulin resistance and hypertension were found among the patients with non-functioning adrenocortical tumours. Adrenocortical adenoma may be one of the risk factors for insulin resistance that is believed to induce disturbed glucose tolerance and/or hypertension. Therefore, it is useful to evaluate insulin resistance for the patients with adrenal incidentalomas since results are likely to be helpful in deciding whether to remove the tumour by surgery.

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Crossref · 10.1046/j.1365-2265.2001.01274.x

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  • In more than 25% of patients with adrenal incidentalomas, cortisol is not suppressed after 1-mg or 3-mg overnight dexamethasone suppression testing or 2-day low-dose dexamethasone suppression testing.

    “In more than 25% of AI subjects, the lack of cortisol suppression after 1-or 3-mg overnight DST or 2-d low-dose DST (LDDST) (19,34,41,44,46,48,53,55,56,60,61)”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [46]

  • Several studies and the French Society for Endocrinology have proposed a lower 1-mg dexamethasone suppression test cutoff to increase sensitivity.

    “Several studies (19,21,32,34,38,39,44,46,49,53,60,61,67) and recently the French Society for Endocrinology (68), however, have proposed a lower cutoff to increase sensitivity.”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [46]

  • 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 [46]

  • The 1-mg dexamethasone suppression test is the most used test for diagnosing subclinical hypercortisolism.

    “To date, the 1-mg DST is the most used test to diagnose SH, either alone (34 -36, 38, 44 -46) or in combination with other parameters (9, 18, 21, 32, 37, 39, 42, 49, 52-54, 56, 60, 61).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [46]

  • 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 [46]

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Authors
Midorikawa, S., Sanada, H., Hashimoto, S., Suzuki, T., & Watanabe, T.
Affiliations
Fukushima Medical University (JP)
Corresponding author
Midorikawa, Sanae
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2001-06
Volume
54
Issue
6
Pages
797-804
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1046/j.1365-2265.2001.01274.x
OpenAlex
W2039932949
Cited by
134
References
26
Citations by year
2025: 3 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 7 · 2018: 7 · 2017: 1 · 2016: 5 · 2015: 7 · 2014: 6 · 2013: 7 · 2012: 10
FWCI
3.97
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 225 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
insulin resistance, adrenal incidentaloma, adrenalectomy, adrenal adenoma, glucose tolerance, hypertension, insulin sensitivity, steady-state plasma glucose, myelolipoma, endothelioma, adrenal myelolipoma
MeSH terms
Adenoma, Adrenal Cortex Neoplasms, Adrenalectomy, Adult, Aged, Blood Glucose, Child, Preschool, Cushing Syndrome, Female, Glucose Tolerance Test, Humans, Hypertension, Insulin Resistance, Male, Middle Aged

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