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Cited by 38Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Increased 17 a‐hydroxyprogesterone response to ACTH in silent adrenal adenoma: cause or effect?

Del Monte, P., Bernasconi, D., Bertoiazzi, L., Meozzi, M., Badaracco, B., Torre, R., Marugo, M.·1995·Clinical Endocrinology
DOI 10.1111/j.1365-2265.1995.tb01875.x
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Abstract

OBJECTIVE: Recent studies suggest a possible connection between silent adrenal nodules and mild forms of 21-hydroxylase deficiency. It remains unclear whether the enzymatic deficiency is generalized or intrinsic to the adrenal mass. To help to clarify this, we have studied 17 alpha-OH-progesterone (17OH-P) response to ACTH stimulation in a group of patients with adrenal 'incidentaloma' in comparison with normal subjects. In patients who underwent surgical treatment, the test was repeated to evaluate possible modifications in 17OH-P behaviour after resection of the adrenal mass. SUBJECTS AND METHODS: Fifteen subjects with incidentally discovered asymptomatic adrenal masses were studied. Basal hormone evaluations were normal, with normal cortisol suppression after low-dose dexamethasone. Iodocholesterol scanning, performed in 12 patients, showed normal bilateral adrenal uptake in 2 subjects and an increased uptake on the side of the lesion in 10 subjects. In every patient, ACTH stimulation was performed to evaluate the secretory response of cortisol, 17OH-P, progesterone and dehydroepiandrosterone sulphate. An identical test was performed in 10 control subjects with normal adrenal glands, matched for age and sex. In six patients with an adrenal lesion > 3.5 cm, the ACTH stimulation test was repeated one month after surgery. RESULTS: The 17OH-P response to ACTH stimulation was significantly higher in subjects with adrenal 'incidentaloma' than in controls (P < 0.01). In particular, 10 subjects out of 15 (66%) evidenced a 17OH-P peak > 18 nmol/l at 60 minutes. No differences were seen in baseline 17OH-P or cortisol levels or in cortisol response to ACTH between the two groups. Dehydroepiandrosterone sulphate concentrations were significantly lower in patients with adrenal 'incidentaloma' than in normals. In six patients who had an increased 17OH-P response to ACTH on initial evaluation, the ACTH test was repeated one month after surgery. In five of these patients, 17OH-P response to ACTH was clearly reduced, suggesting that in these cases the enzymatic defect was restricted to the adenoma. In the other patient, however, stimulated 17OH-P levels remained unchanged. In this case, therefore, all of the adrenal tissue seems to be involved, suggesting a late-onset 21-hydroxylase deficiency. No significant modifications in cortisol response to ACTH were observed. CONCLUSION: It seems therefore that in some cases of incidentaloma the steroidogenic enzymatic defect may be secondary to the adenomatous proliferation, while in others such defects may induce the development of silent adrenal nodules.

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Crossref · 10.1111/j.1365-2265.1995.tb01875.x

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  • Increased 17-OHP may represent increased secretion of steroid precursors from lesion(s) especially in malignant tumors or BMAH.

    “In some cases, increased levels of 17-OHP may represent increased secretion of steroid precursors (327) from the lesion(s) especially in malignant tumors or in bilateral macronodular adrenal hyperplasia.”

    From Adrenal incidentaloma (2020) · cites this paper as [327]

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Authors
Del Monte, P., Bernasconi, D., Bertoiazzi, L., Meozzi, M., Badaracco, B., Torre, R., & Marugo, M.
Affiliations
Ente Ospedaliero Ospedali Galliera (IT)
Corresponding author
Marugo, M.
Venue
Clinical Endocrinology
Publisher
Wiley
Published
1995-03
Volume
42
Issue
3
Pages
273-277
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/j.1365-2265.1995.tb01875.x
OpenAlex
W2106657299
Cited by
38
References
16
Citations by year
2024: 2 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 1 · 2016: 2
FWCI
4.30
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 4868 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
17-hydroxyprogesterone, ACTH stimulation test, adrenal incidentaloma, adrenal adenoma, 21-hydroxylase deficiency, congenital adrenal hyperplasia, dehydroepiandrosterone sulfate, cortisol response, adrenal surgery
MeSH terms
Adenoma, Adrenal Cortex Function Tests, Adrenal Gland Neoplasms, Adrenal Hyperplasia, Congenital, Adrenocorticotropic Hormone, Adult, Aged, Dehydroepiandrosterone, Female, Humans, Hydrocortisone, Hydroxyprogesterones, Male, Middle Aged, Postoperative Period, Progesterone, Dehydroepiandrosterone Sulfate, 17-alpha-Hydroxyprogesterone

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