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Cited by 107Adrenal Hormones and DisordersAdrenal and Paraganglionic TumorsHormonal Regulation and Hypertension

Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects

Morelli, V., Masserini, B., Salcuni, A. S., Eller‐Vainicher, C., Savoca, C., Viti, R., Coletti, F., Guglielmi, G. +7 more·2010·Clinical Endocrinology
DOI 10.1111/j.1365-2265.2010.03794.x
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Abstract

OBJECTIVE: Subclinical hypercortisolism (SH) has been associated with increased prevalence of hypertension, type 2 diabetes mellitus, dyslipidaemia, central obesity, osteoporosis and vertebral fractures. We aimed to investigate the accuracy of different SH diagnostic criteria in predicting the presence of complications. DESIGN: This was a retrospective study. PATIENTS: We evaluated data from 231 patients (120 women and 111 men) affected with adrenal incidentalomas (AI). MEASUREMENTS: We studied the accuracy of different SH diagnostic criteria (cortisol after 1 mg overnight dexamethasone suppression test - 1mg-DST - at different cut-off such as 49.7, 82.8, 137.9 nmol/l, elevated urinary free cortisol, reduced adrenal corticotroph hormone (ACTH) levels alone or various combination of these parameters) in predicting the concomitant presence of the following three complications: hypertension, type 2 diabetes and vertebral fractures. RESULTS: The criterion characterized by the presence of two of 1mg-DST >82.8 nmol/l, elevated UFC and reduced ACTH struck the best balance between sensitivity and specificity, reaching a good accuracy in predicting the cluster of complications (61.9%; 77.1% and 75.8%, respectively). The presence of this cluster was associated with this criterion (OR 4.75, 95%CI 1.8-12.7, P = 0.002) regardless of gonadal status, body mass index (BMI) and age. CONCLUSIONS: The SH criterion characterized by the presence of two of 1mg-DST >82.8 nmol/l, elevated UFC and reduced ACTH seems the best in predicting the presence of chronic manifestations of subtle cortisol excess.

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  • Overall, diabetes or impaired glucose tolerance was identified in 20% to 25% of patients with adrenal incidentaloma and subclinical Cushing syndrome and was related to age, adenoma size, midnight cortisol level, and plasma cortisol after dexamethasone suppression.

    “Overall, DM or IGT was identified in % to % of patients with AI and SCS and was related to patients' age (), the size of their adenomas, their midnight cortisol level, and their plasma cortisol level after suppression with dexamethasone ().”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [211]

  • The prevalence of impaired glucose tolerance or diabetes has been higher in patients with subclinical Cushing syndrome than in nonfunctioning adenoma or controls, but other studies did not confirm this.

    “Focusing on glucose metabolism, the prevalence of IGT or DM has been higher in patients with SCS than in cases of nonfunctioning adenoma or controls (, , , , , , ), but these data were not confirmed by other studies that found much the same prevalence of these comorbidities in SCS as in the overall series of AI and in the general population (, -).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [211]

  • Chronic mild cortisol secretion abnormality may be associated with classic metabolic and cardiovascular complications of hypercortisolism.

    “A chronic mild cortisol secretion abnormality may be associated with classic metabolic and cardiovascular complications of hypercortisolism (, -).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [211]

  • The Morelli study confirmed the low sensitivity and specificity of 1-mg dexamethasone suppression testing at high or low cutoffs and the low accuracy of reduced ACTH and increased urinary free cortisol as single criteria.

    “This study confirmed the low sensitivity and specificity of 1-mg DST when the high or low cutoff, respectively, is used and the low accuracy of the reduced ACTH and increased UFC level, when used as single criterion (59).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [59]

  • The DST-UFC-ACTH combination criterion seems the best compromise for diagnosing subclinical hypercortisolism because it has been validated on a clinical basis.

    “However, to date, the DST-UFC-ACTH combination criterion seems the best compromise to diagnose SH because it has been validated on a clinical basis (32,59,60).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [59]

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Authors
Morelli, V., Masserini, B., Salcuni, A. S., Eller‐Vainicher, C., Savoca, C., Viti, R., Coletti, F., Guglielmi, G., Battista, C., Iorio, L., Beck‐Peccoz, P., Ambrosi, B., Arosio, M., Scillitani, A., & Chiodini, I.
Affiliations
  • University of Milan (IT)
  • Casa Sollievo della Sofferenza (IT)
Corresponding author
Chiodini, I.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2010-07-21
Volume
73
Issue
2
Pages
161-166
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/j.1365-2265.2010.03794.x
OpenAlex
W2083751700
Cited by
107
References
31
Citations by year
2025: 1 · 2024: 3 · 2023: 6 · 2022: 2 · 2021: 10 · 2020: 3 · 2019: 3 · 2018: 12 · 2017: 6 · 2016: 9 · 2015: 12 · 2014: 5 · 2013: 4 · 2012: 14
FWCI
8.45
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
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, urinary free cortisol, ACTH, hypertension, type 2 diabetes, vertebral fractures, diagnostic criteria
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Aged, Cushing Syndrome, Dexamethasone, Female, Humans, Hydrocortisone, Male, Middle Aged, Pituitary-Adrenal Function Tests, Predictive Value of Tests, Retrospective Studies, Incidental Findings

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