Autonomy of cortisol secretion in clinically silent adrenal incidentaloma.
Abstract
Recent progress in non-invasive imaging techniques have resulted in an increasing frequency of adrenal incidentaloma discovery. In addition, even clinically silent adrenal tumor has been suggested to possess a subtle production of adrenal hormones. The aim of the study was to ascertain the autonomy of cortisol production in clinically silent adrenocortical incidentaloma. We investigated the hypothalamic-pituitary-adrenal axis in 38 patients with adrenal incidentaloma. Basal plasma cortisol level was reproducibly within normal range in all the patients with adrenal incidentaloma, but was also normal in half of the Cushing's syndrome cases studied. Eighteen of 38 patients showed plasma cortisol above 3 microg/dl after 1 mg dexamethasone (Dex) and above 1 microg/dl after 8 mg Dex, respectively, and were defined as preclinical Cushing's syndrome. These patients were subjected to further evaluation of the autonomy of cortisol production. The incidence of positive findings indicating autonomy of cortisol secretion was as follows: suppressed basal plasma ACTH level in 44%, loss of normal diurnal rhythm in 79%, lack of ACTH response to CRF in 35%, decreased plasma DHEA-S level in 28%, significant laterality of 131I-adosterol uptake in 75%, atrophy of the contralateral side of the adrenal on CT scan in 6%, and histological atrophy of the adjacent adrenal cortex in 56%, respectively. The endocrine feature relevant to the hypothalamic-pituitary-adrenal axis varied from patient to patient, ranging from the non-functioning adrenal adenoma to Cushing's syndrome. In addition, the results of each test did not coincide with others in each patient. These results clearly demonstrated that the incidence of autonomy of cortisol production in the clinically silent adrenal incidentaloma is not infrequent, showing significant diversity. Systemic evaluation of the hypothalamic-pituitary-adrenal axis before adrenal surgery is warranted for an appropriate glucocorticoid replacement after adrenal surgery.
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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 [44]
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 [44]
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 [44]
Low serum ACTH levels are frequently found in patients with adrenal incidentalomas.
“Low serum ACTH levels are frequently found in AI patients (19,21,32,36,40,43,44,48,49,56,60,61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [44]
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- Authors
- Tanabe, A., Naruse, M., Nishikawa, T., Yoshimoto, T., Shimizu, T., Seki, T., Takagi, S., Imaki, T., & Takano, K.
- Affiliations
- Tokyo Women's Medical University (JP)
- Venue
- Hormone and Metabolic Research
- Publisher
- Georg Thieme Verlag KG
- Published
- 2001-07
- Volume
- 33
- Issue
- 7
- Pages
- 444-450
- ISSN
- 0018-5043 (ISSN-L)
- 1439-4286
- OpenAlex
- W2078961432
- Cited by
- 36
- References
- 0
- Citations by year
- 2025: 1 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 1 · 2016: 2 · 2015: 1 · 2014: 2 · 2012: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hormone and Metabolic Research (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 › Pituitary Gland Disorders and Treatments
- Keywords
- adrenal incidentaloma, hypothalamic-pituitary-adrenal axis, preclinical Cushing's syndrome, dexamethasone suppression test, ACTH, diurnal cortisol rhythm, dehydroepiandrosterone sulfate, adrenal atrophy, adrenal adenoma, glucocorticoid replacement therapy
- MeSH terms
- Adrenal Gland Neoplasms, Adrenal Glands, Adrenocorticotropic Hormone, Adult, Aged, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal System, Radionuclide Imaging, Tomography, X-Ray Computed, Dehydroepiandrosterone Sulfate
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