The DOI matches its Crossref record; 111 of the 122 references it cites were found in a registry or an index; none of the 207 sources its claims cite is checked for support yet.
Diagnosis and Treatment of Subclinical Hypercortisolism
Open accessAbstract
Context: Subclinical hypercortisolism (SH) is a condition of biochemical cortisol excess without the classical signs or symptoms of overt hypercortisolism. It is thought to be present in the 5–30% of patients with incidentally discovered adrenal mass (adrenal incidentalomas), which in turn are found in 4–7% of the adult population. Therefore, SH has been suggested to be present in 0.2–2.0% of the adult population. Some studies suggested that this condition is present in 1–10% of patients with diabetes or established osteoporosis. The present manuscript reviews the literature on diagnostic procedures and the metabolic effect of the recovery from SH. Evidence Acquisition: A PubMed search was used to identify the available studies. The most relevant studies from 1992 to November 2010 have been included in the review. Evidence Synthesis: The available data suggest that SH may be associated with chronic complications, such as hypertension, diabetes mellitus, overweight/obesity, and osteoporosis. The available intervention studies suggest that the recovery from SH may lead to the improvement of hypertension and diabetes mellitus. A retrospective study suggests that this beneficial effect could be predicted before surgery. Conclusions: SH is suggested to be associated with some chronic complications of overt cortisol excess. Recovery from this condition seems to improve these complications. However, a large, prospective, randomized study is needed to confirm this hypothesis and to establish the best diagnostic approach to identify patients with adrenal incidentalomas who can benefit from surgery.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This review summarizes the diagnosis, prevalence, and management of subclinical hypercortisolism (SH), defined as biochemical cortisol excess without classical signs or symptoms of overt hypercortisolism. It concludes that no consensus or gold standard exists for diagnosis, that the DST-UFC-ACTH combination is the best available compromise, and that surgery may improve metabolic complications but evidence remains limited.
Key findings
- SH is estimated to be present in 5–30% of patients with adrenal incidentalomas (AI); because AI are found in 4–7% of adults, SH may be present in 0.2–2.0% of the adult population, and in 1–10% of patients with diabetes or established osteoporosis.
- No single HPA-axis parameter has adequate sensitivity and specificity. In one scintigraphy-validated study, the 1-mg DST cutoff of 3.0 μg/dl showed the best compromise (sensitivity 63%, specificity 75%); in 231 AI patients, the DST-UFC-ACTH combination criterion had sensitivity 61.9%, specificity 77.1%, and accuracy 75.8% for predicting a cluster of complications.
- Prevalence in at-risk groups varied: 10.8% in 294 type 2 diabetic inpatients; 4.8% in osteoporosis and 10.8% in osteoporosis with vertebral fractures. SH appears more commonly of adrenal than pituitary origin.
- In the only prospective randomized study cited (23 surgically treated, 22 conservatively treated), surgery improved hypertension, diabetes, obesity, and dyslipidemia in 66.7%, 62.5%, 50%, and 37.5% of cases, respectively; conservative management worsened hypertension, diabetes, and dyslipidemia in 80%, 33.3%, and 20%.
Methods
- Narrative clinical review of the literature on diagnostic procedures and the metabolic effects of recovery from SH.
- Synthesizes studies of patients with adrenal incidentalomas and at-risk populations (diabetes, osteoporosis), including diagnostic accuracy studies and surgical versus conservative treatment/follow-up studies; tables summarize HPA-axis alterations, diagnostic accuracy, prevalence, and outcomes.
- Main analysis is qualitative synthesis; no new primary data or meta-analysis are presented.
Limitations
- The paper states there is no consensus on clinical or biochemical criteria for SH, no clinical gold standard, and that cortisol secretion is a continuum and highly variable; ACTH and 24-h UFC reliability is low, comorbidities and medications affect the DST, and salivary cortisol methods are not standardized.
- The paper states that no large prospective randomized trial has compared surgical versus conservative treatment, available studies are small and often retrospective or nonrandomized, and data on hard endpoints and cost-effectiveness are lacking.
- Evident from the text: as a single-author narrative review, it draws on heterogeneous studies with differing cutoffs, assays, and outcome definitions, which limits comparability across findings.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
83 Not checked yet · 24 Own interpretation · 16 No basis given · 2 Own method
In the paper
“In patients with 1-mg DST between these values, the presence of MSeC greater than 4.0 mg/dl (110 nmol/liter) or ACTH less than 10.0 pg/ml (2.2 pmol/ liter) combined with the presence of at least two metabolic complications before surgery had a 76% accuracy in predicting improvement.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
plaincorrelationaln = 55- Asserted: passes — The authors put it forward as true.
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In the paper
“Looking to the above-mentioned retrospective data on 55 surgically treated patients with AI (60), 1-mg DST greater than 5 g/dl (138 nmol/liter) and less than 2 g/dl (55 nmol/liter) had the best specificity and sensitivity (96.9 and 91.3%, respectively) for identifying patients that may improve after surgery.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
plaincorrelationaln = 55- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Using the protocol illustrated in the study, in more than 80% of cases the improvement after surgery was correctly predicted before surgery (60).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
plaincorrelationaln = 55- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“the progression toward overt clinical hypercortisolism is very rare (11)(12)(13).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Abstract
What the sources say
- Not checked yetcites (11)(12)(13)
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“the glucocorticoid sensitivity may be different among the different individuals and among the different tissues in the same individual, due also to polymorphisms of both glucocorticoid receptor (25)(26)(27)(28) and 11-hydroxysteroid-dehydrogenase type 1 genes (29,30).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
What the sources say
- Not checked yetcites (25)(26)(27)(28)
- Not checked yetcites [29] Tomlinson, 2004, 11β-Hydroxysteroid dehydrogenase type 1: a tissue specific regulator of glucocorticoid response., Endocr Rev source
- Not checked yetcites [30] Hwang, 2009, HSD11B1 polymorphisms predicted bone mineral density and fracture risk in postmenopausal women without clinically apparent hypercortisolemia., Bone source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, diagnosing SH by arbitrary cutoffs of indexes of cortisol secretion leads to unavoidable mistakes in classifying some patients.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“Because AI are thought to be present in up to 4 -7% of adults (6 -11)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Abstract
What the sources say
- Not checked yetcites [6] Griffing, 1994, Editorial A-I-D-S: the new endocrine epidemic., J Clin Endocrinol Metab
- Not checked yetcites [7] Glazer, 1982, Nonfunctioning adrenal masses: incidental discovery on computed tomography., AJR Am J Roentgenol source
- Not checked yetcites [8] Bovio, 2006, Prevalence of adrenal incidentaloma in a contemporary computerized tomography series., J Endocrinol Invest source
- Not checked yetcites [9] Mantero, 2000, A survey on adrenal incidentaloma in Italy., J Clin Endocrinol Metab
- Not checked yetcites [10] Chidiac, 1997, Incidentaloma. A disease of modern technology., Endocrinol Metab Clin North Am source
- Not checked yetcites [11] Young, 2000, Management approaches to adrenal incidentalomas: a view from Rochester, Minnesota., Endocrinol Metab Clin North Am source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“the prevalence of SH in this population may be estimated to be between 0.2 and 2.0% (2).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Abstract
What the sources say
- Not checked yetcites [2] Reincke, 2000, Subclinical Cushing's syndrome., Endocrinol Metab Clin North Am source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [19] Chiodini, 2004, Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effect of subclinical hypercortisolism and gonadal status., J Clin Endocrinol Metab source
- Not checked yetcites [34] Reincke, 1992, Preclinical Cushing's syndrome in adrenal incidentalomas: comparison with adrenal Cushing's syndrome., J Clin Endocrinol Metab
- Not checked yetcites [41] Tsagarakis, 1998, Elevated post-dexamethasone suppression cortisol concentrations correlate with hormonal alterations of the hypothalamo-pituitary adrenal axis in patients with adrenal incidentalomas., Clin Endocrinol (Oxf) source
- Not checked yetcites [44] Tanabe, 2001, Autonomy of cortisol secretion in clinically silent adrenal incidentaloma., Horm Metab Res source
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
- Not checked yetcites [48] Valli, 2001, Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [53] Chiodini, 2002, Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [55] Hadjidakis, 2003, Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas?, Clin Endocrinol (Oxf) source
- Not checked yetcites [56] Katabami, 2005, Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing's syndrome., Endocr J source
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“there is no consensus yet on the clinical and/or biochemical criteria to diagnose this condition.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“SH is estimated to be present in 5-30% of patients with adrenal masses serendipitously found by imaging for unrelated diseases [adrenal incidentalomas (AI)] (1,5).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Abstract
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [34] Reincke, 1992, Preclinical Cushing's syndrome in adrenal incidentalomas: comparison with adrenal Cushing's syndrome., J Clin Endocrinol Metab
- Not checked yetcites [35] Osella, 1994, Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)., J Clin Endocrinol Metab source
- Not checked yetcites [36] Flecchia, 1995, Reduced serum levels of dehydroepiandrosterone sulphate in adrenal incidentalomas: a marker of adrenocortical tumour., Clin Endocrinol (Oxf) source
- Not checked yetcites [38] Bardet, 1996, 131I-6-b-Iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas., Clin Endocrinol (Oxf) source
- Not checked yetcites [44] Tanabe, 2001, Autonomy of cortisol secretion in clinically silent adrenal incidentaloma., Horm Metab Res source
- Not checked yetcites [45] Favia, 2000, Management of incidentally discovered adrenal masses and risk of malignancy., Surgery source
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
- Not checked yetcites [9] Mantero, 2000, A survey on adrenal incidentaloma in Italy., J Clin Endocrinol Metab
- Not checked yetcites [18] Rossi, 2000, Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features., J Clin Endocrinol Metab
- Not checked yetcites [21] Chiodini, 2009, Bone mineral density, prevalence of vertebral fractures and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian Multicenter Study., J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The frequency of altered 1-mg or 3-mg DST in AI patients varies among the different studies, ranging from 3.0 to 100% on the basis of the cutoff, dexamethasone doses, and modality of execution (Table 1).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“the reliability of almost all markers of HPA axis activity, particularly ACTH and 24-h urinary free cortisol (UFC), is low (3,14,23)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
What the sources say
- Not checked yetcites [3] Grumbach, 2003, Management of the clinically inapparent adrenal masses (“incidentaloma”)., Ann Intern Med source
- Not checked yetcites [14] Nieman, 2008, The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline., J Clin Endocrinol Metab source
- Not checked yetcites [23] Tsagarakis, 2006, Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications., J Endocrinol Invest source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“some evidence suggests that this condition may lead to long-term consequences of cortisol excess (i.e.diabetes, hypertension, obesity, and osteoporosis) (15)(16)(17)(18)(19)(20)(21).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Abstract
What the sources say
- Not checked yetcites (15)(16)(17)(18)(19)(20)(21)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“because SH by definition is not characterized by a specific clinical picture, a clinical “gold standard” for diagnosing SH is lacking.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“in our and other authors' experience (1), the presence of signs and/or symptoms of cortisol excess is extremely rare in patients referred for the presence of an AI.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
What the sources say
- Not checked yetcites [1] Terzolo, 2005, Subclinical Cushing's syndrome in adrenal incidentalomas., Endocrinol Metab Clin North Am source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“several comorbidities (i.e.type 2 diabetes and obesity) and concomitant medications may affect the result of the dexamethasone suppression test (DST) (24).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
What the sources say
- Not checked yetcites [24] Valassi, 2009, Concomitant medication use can confound interpretation of the combined dexamethasone-corticotropin releasing hormone test in Cushing's syndrome., J Clin Endocrinol Metab source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“This may be because UFC cannot reliably reveal a slight cortisol excess (69,70)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [69] Kidambi, 2007, Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome., Eur J Endocrinol source
- Not checked yetcites [70] Duclos, 1999, Abdominal obesity increases overnight cortisol excretion., J Endocrinol Invest source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Low serum ACTH levels are frequently found in AI patients (19,21,32,36,40,43,44,48,49,56,60,61).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [19] Chiodini, 2004, Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effect of subclinical hypercortisolism and gonadal status., J Clin Endocrinol Metab source
- Not checked yetcites [21] Chiodini, 2009, Bone mineral density, prevalence of vertebral fractures and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian Multicenter Study., J Clin Endocrinol Metab source
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [36] Flecchia, 1995, Reduced serum levels of dehydroepiandrosterone sulphate in adrenal incidentalomas: a marker of adrenocortical tumour., Clin Endocrinol (Oxf) source
- Not checked yetcites [40] Kasperlik-Zeluska, 1997, Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients., Clin Endocrinol (Oxf) source
- Not checked yetcites [43] Torlontano, 1999, Altered bone mass and turnover in female patients with adrenal incidentalomas: the effect of subclinical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [44] Tanabe, 2001, Autonomy of cortisol secretion in clinically silent adrenal incidentaloma., Horm Metab Res source
- Not checked yetcites [48] Valli, 2001, Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [49] Chiodini, 2001, Bone loss rate in adrenal incidentalomas: a longitudinal study., J Clin Endocrinol Metab source
- Not checked yetcites [56] Katabami, 2005, Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing's syndrome., Endocr J source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, ACTH alone does not seem sensitive enough for diagnosing SH.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [40] Kasperlik-Zeluska, 1997, Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients., Clin Endocrinol (Oxf) source
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
- Not checked yetcites [54] Emral, 2003, Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentalomas: clinical, biochemical and surgical outcomes., Endocr J source
- Not checked yetcites [56] Katabami, 2005, Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing's syndrome., Endocr J source
- Not checked yetcites [14] Nieman, 2008, The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline., J Clin Endocrinol Metab source
- Not checked yetcites [23] Tsagarakis, 2006, Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications., J Endocrinol Invest source
- Not checked yetcites [66] Arnaldi, 2003, Diagnosis and complications of Cushing's syndrome: a consensus statement., J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“Few studies reported a high frequency (i.e. higher than 25%) of elevated UFC levels in patients with AI (21,43,48,49,53,60).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [21] Chiodini, 2009, Bone mineral density, prevalence of vertebral fractures and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian Multicenter Study., J Clin Endocrinol Metab source
- Not checked yetcites [43] Torlontano, 1999, Altered bone mass and turnover in female patients with adrenal incidentalomas: the effect of subclinical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [48] Valli, 2001, Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [49] Chiodini, 2001, Bone loss rate in adrenal incidentalomas: a longitudinal study., J Clin Endocrinol Metab source
- Not checked yetcites [53] Chiodini, 2002, Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [1] Terzolo, 2005, Subclinical Cushing's syndrome in adrenal incidentalomas., Endocrinol Metab Clin North Am source
- Not checked yetcites [23] Tsagarakis, 2006, Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications., J Endocrinol Invest source
- Not checked yetcites [34] Reincke, 1992, Preclinical Cushing's syndrome in adrenal incidentalomas: comparison with adrenal Cushing's syndrome., J Clin Endocrinol Metab
- Not checked yetcites [35] Osella, 1994, Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)., J Clin Endocrinol Metab source
- Not checked yetcites [37] Ambrosi, 1995, Abnormalities of endocrine function in patients with clinically silent adrenal masses., Eur J Endocrinol source
- Not checked yetcites [38] Bardet, 1996, 131I-6-b-Iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas., Clin Endocrinol (Oxf) source
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The possible use of midnight salivary cortisol (MSaC), which is more feasible and less expensive, is still debated (73,74).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [73] Newell-Price, 1998, The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states., Endocr Rev
- Not checked yetcites [74] Mazzuco, 2009, Adrenal incidentalomas and subclinical Cushing's syndrome: diagnosis and treatment., Curr Opin Endocrinol Diabetes Obes source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
In the paper
“the various studies on the diagnostic accuracy of the different salivary cortisol assays are hardly comparable for differences in the patients' and controls' selection criteria and in the diagnostic performance and sample collection techniques of the various laboratory methods (75).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [75] Sereg, 2011, Diagnostic performance of salivary cortisol and serum osteocalcin measurements in patients with overt and subclinical Cushing's syndrome., Steroids source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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In the paper
“Low serum DHEAS levels are one of the most frequent HPA axis alterations in AI patients (35)(36)(37)(38)41).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites (35)(36)(37)(38)41)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Although it may reflect an autonomous ACTH-independent cortisol hypersecretion, available data do not demonstrate that low DHEAS concentration is a reliable index of SH (1,23,35), also considering that DHEAS levels decrease with age (77).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [1] Terzolo, 2005, Subclinical Cushing's syndrome in adrenal incidentalomas., Endocrinol Metab Clin North Am source
- Not checked yetcites [23] Tsagarakis, 2006, Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications., J Endocrinol Invest source
- Not checked yetcites [35] Osella, 1994, Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)., J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, all studies specifically designed for individuating the best criterion for diagnosing SH showed that no single parameter has, in fact, an adequate sensitivity and specificity.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Several studies suggest that SH is likely to be underreported.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The main pitfall of these studies is that the increased uptake of the radiotracer may simply reflect the presence of enlarged adrenal tissue rather than an increased cortisol secretion (1,35,78).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [1] Terzolo, 2005, Subclinical Cushing's syndrome in adrenal incidentalomas., Endocrinol Metab Clin North Am source
- Not checked yetcites [35] Osella, 1994, Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)., J Clin Endocrinol Metab source
- Not checked yetcites [78] Rizza, 1978, Visualization of nonfunctioning adrenal adenomas with iodocholesterol: possible relationship to subcellular distribution of tracer., J Nucl Med
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In these patients, an ACTH peak below 30 pg/ml (6.6 pmol/liter) after CRH excludes the presence of an ACTH-dependent SH (76).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [76] Raff, 2003, A physiologic approach to diagnosis of the Cushing syndrome., Ann Intern Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, measuring basal and CRH-stimulated ACTH levels in AI patients with established SH helps to avoid missing a possible ACTHdependent origin of the cortisol excess.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The 1-mg DST cutoff of 3.0 g/dl (83 nmol/liter) showed the best compromise between sensitivity (63%) and specificity (75%) (48).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [48] Valli, 2001, Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas., Eur J Endocrinol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“To simplify the diagnostic workout, other authors used the concomitant presence of at least two altered parameters of HPA axis activity for SH diagnosis (9, 18, 19, 21, 32, 37, 39, 40, 42, 47, 49, 52-54, 56, 60, 61).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [9] Mantero, 2000, A survey on adrenal incidentaloma in Italy., J Clin Endocrinol Metab
- Not checked yetcites [18] Rossi, 2000, Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features., J Clin Endocrinol Metab
- Not checked yetcites [19] Chiodini, 2004, Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effect of subclinical hypercortisolism and gonadal status., J Clin Endocrinol Metab source
- Not checked yetcites [21] Chiodini, 2009, Bone mineral density, prevalence of vertebral fractures and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian Multicenter Study., J Clin Endocrinol Metab source
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [37] Ambrosi, 1995, Abnormalities of endocrine function in patients with clinically silent adrenal masses., Eur J Endocrinol source
- Not checked yetcites [39] Bondanelli, 1997, Evaluation of hormonal function in a series of incidentally discovered adrenal masses., Metabolism source
- Not checked yetcites [40] Kasperlik-Zeluska, 1997, Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients., Clin Endocrinol (Oxf) source
- Not checked yetcites [42] Terzolo, 1998, Subclinical Cushing's syndrome in adrenal incidentaloma., Clin Endocrinol (Oxf) source
- Not checked yetcites [47] Grossrubatscher, 2001, The natural history of incidentally discovered adrenocortical adenomas: a retrospective evaluation., J Endocrinol Invest source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, these results have been biased by the fact that the biochemical gold-standard criteria used to define SH had not been previously validated.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it suggests that by combining clinical and biochemical parameters, it could be possible to identify which AI patient may benefit from surgery.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
hedgedcorrelationaln = 55- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“it has been shown that receptors for several ligands are abnormally expressed at the membrane of tumoral adrenocortical cells, such as those for glucose-dependent insulinotropic peptide, catecholamine, vasopressin, serotonin, angiotensin II, leptin, and LH/human chorionic gonadotropin (98 -100).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [98] Lacroix, 2001, Ectopic and abnormal hormone receptors in adrenal Cushing's syndrome., Endocr Rev
- Not checked yetcites [99] Reznik, 2004, Aberrant adrenal sensitivity to multiple ligands in unilateral incidentaloma with subclinical autonomous cortisol hypersecretion: a prospective clinical study., Clin Endocrinol (Oxf) source
- Not checked yetcites [100] Libé, 2010, Aberrant cortisol regulations in bilateral macronodular adrenal hyperplasia: a frequent finding in a prospective study of 32 patients with overt or subclinical Cushing's syndrome., Eur J Endocrinol source
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Because these aberrant receptors may be specific pharmacological targets for controlling cortisol secretion, their detection deserves particular interest and some protocols have been developed (99).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [99] Reznik, 2004, Aberrant adrenal sensitivity to multiple ligands in unilateral incidentaloma with subclinical autonomous cortisol hypersecretion: a prospective clinical study., Clin Endocrinol (Oxf) source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“On the contrary, in surgically untreated SH patients, blood pressure, glucose, and cholesterol levels worsened more frequently (50.0, 37.5, and 50.0%, respectively) than in surgically treated patients (0, 0, and 24%, respectively) (61).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, in this study, a direct comparison of the changes of the endpoints between the two groups was not done.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“At variance with all the above-mentioned studies, a recent retrospective study found no difference in hypertension, diabetes, and obesity between five and eight SH patients surgically and conservatively treated, respectively (97).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [97] Sereg, 2009, Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study., Eur J Endocrinol source
plainn = 5- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“This is of utmost importance because in several studies some of the surgically treated patients without SH experienced improvement of some metabolic endpoints (18,46,61,93).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [18] Rossi, 2000, Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features., J Clin Endocrinol Metab
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [93] Bernini, 2003, Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery., Eur J Endocrinol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In keeping with this, Taniguchi et al. (84) found a 2.6% prevalence of SH in a sample of 77 inpatients with type 2 diabetes.Diagnosis was done by measuring MSeC using a cutoff of 5 g/dl (138 nmol/liter).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [84] Taniguchi, 2008, Subclinical hypercortisolism in hospitalized patients with type 2 diabetes mellitus., Endocr J source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In a retrospective, nonrandomized study, we reported that in 25 surgically treated SH patients, body weight, blood pressure, and glucose levels improved (32, 56, and 48%, respectively) more frequently than in untreated SH subjects (12.5, 0.0, and 0.0%, respectively) (61).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
plaincorrelationaln = 25- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In assessing the HPA axis by 3-mg DST with a sensitive cutoff, a 3.8% prevalence of SH was found; all cases were of adrenal origin (90).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [90] Kann, 2001, Suppressed levels of serum cortisol after high-dose oral dexamethasone administration differ between healthy postmenopausal females and patients with established primary vertebral osteoporosis., Clin Rheumatol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Several small studies suggested the improvement of blood pressure (54, 93, 95), glucose metabolism (46,54,93,95), and body weight (54,95) in surgically treated SH patients.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [54] Emral, 2003, Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentalomas: clinical, biochemical and surgical outcomes., Endocr J source
- Not checked yetcites [93] Bernini, 2003, Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery., Eur J Endocrinol source
- Not checked yetcites [95] Mitchell, 2007, “Subclinical Cushing's syndrome” is not so subclinical: improvement after adrenalectomy in 9 patients., Surgery source
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“However, these figures were partially different in the study of Reimondo et al. (85), in which only one of 100 patients with newly diagnosed diabetes was found to have a pituitary-dependent SH.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [85] Reimondo, 2007, Screening of Cushing's syndrome in adult patients with newly diagnosed diabetes mellitus., Clin Endocrinol (Oxf) source
plainn = 100- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Unfortunately, to date, no large prospective randomized trial compared the effect of surgical vs. conservative treatment in patients with SH (Table 4).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Besides the different cutoffs or screening tests used, these discordances may be related to the different populations studied (i.e.outpatients or inpatients, patients with poorly or well-controlled diabetes).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“By using 1-mg DST as a screening test with a low cutoff in a sample of 178 diabetic patients, Newsome et al. (86) did not find any subject with SH.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [86] Newsome, 2008, Cushing's syndrome in a clinic population with diabetes., Intern Med J source
plainn = 178- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, from the available data regarding the screening of the population at risk for SH (diabetics and osteoporotics), it comes evident that, unlike the condition of overt cortisol excess, the condition of SH is more commonly of adrenal origin.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it is likely that the high number of patients who refused to participate in this study have introduced a crucial selection bias.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
hedgedconditionaln = 5- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, summarizing the available data, it is likely that in all patients with SH, and particularly in those with possible SH complications, surgical treatment may be advantageous.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The usefulness of the screening of SH in the populations at risk clearly depends on the possible SH-associated increased morbidity and mortality, which are still unknown.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
boostedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Few studies evaluated the accuracy of the SH diagnosis before surgery to predict the improvement after surgery and, therefore, to address the treatment of choice in the individual subject (18,46,61,93).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [18] Rossi, 2000, Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features., J Clin Endocrinol Metab
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [93] Bernini, 2003, Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery., Eur J Endocrinol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Nonetheless, as observed by the authors, these data suggest that surgical treatment is more beneficial than conservative treatment (57).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [57] Toniato, 2009, Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study., Ann Surg source
hedgeddirectn = 23- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, no data are available on the cost effectiveness of the screening of the populations at risk.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Similarly, by using MSaC, a poor test for screening SH, two studies did not detect SH in more than 150 overweight/obese diabetic patients (87,88).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [87] Mullan, 2010, Is there a value in routine screening for Cushing's syndrome in patients with diabetes?, J Clin Endocrinol Metab source
- Not checked yetcites [88] Liu, 2005, Elevated late-night salivary cortisol levels in elderly male type 2 diabetic veterans., Clin Endocrinol (Oxf) source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“However, no data are available regarding the prevalence of subclinical ACTH hypersecretion in patients with pituitary incidentalomas (92).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [92] Molitch, 2009, Pituitary incidentalomas., Best Pract Res Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“the available data suggest a possible deleterious role of SH, at least on glucose and bone metabolism and on hypertension, even in patients adequately followed up with antihypertensive and antidiabetic medical therapy (61).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
What the sources say
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This is due to the lack of a clinical or functional parameter to be used as the gold standard to test the diagnostic accuracy of the available biochemical parameters.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“On the other hand, definitive data about the risk of transformation of nonfunctioning nodules to functional tumors are lacking.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Follow-up of patients with SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Some improvements attributed to surgery could, in fact, have been related to nonspecific changes in medical treatment/lifestyle and not to the previous surgery.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Similarly, because in some patients with SH not operated on, bone mineral density, fasting glucose, blood pressure, and cholesterol levels have been shown to worsen during follow-up (49, 61)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Follow-up of patients with SH
What the sources say
- Not checked yetcites [49] Chiodini, 2001, Bone loss rate in adrenal incidentalomas: a longitudinal study., J Clin Endocrinol Metab source
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, no widely accepted guidelines are available regarding the most adequate follow-up in patients with possible or ascertained SH who did not undergo surgery.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Follow-up of patients with SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“two studies suggested that in patients with an adrenal mass more than 2 cm in size, the estimated cumulative risk of developing SH may vary between 7 and 47% after 5 yr (50,52).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Follow-up of patients with SH
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this regard, however, the major issue is that if SH is present, at least, in 0.2% of the population, many more adrenal operations will be neces-sary than those currently performed.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Indeed, in patients with SH the optimization with strict criteria of the medical treatment of osteoporosis, hypertension, diabetes, and dyslipidemia may avoid the development of the clinical consequences of these complications (i.e.fractures, cardiovascular diseases, etc.).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If a clear diagnosis of SH cannot be made, it is difficult to ascertain the effect of surgery.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Although this risk was reported to be low in patients with adrenal adenomas smaller than 3 cm (3)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Follow-up of patients with SH
What the sources say
- Not checked yetcites [3] Grumbach, 2003, Management of the clinically inapparent adrenal masses (“incidentaloma”)., Ann Intern Med source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although no studies have investigated the association of SH with “hard” endpoints, such as cardiovascular morbidity and mortality”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on the data reported above, it becomes clear that no agreement exists regarding how to biochemically diagnose SH.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, because patients with SH seem to worsen if not surgically treated”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Moreover, to date, methodological problems exist in reliably measuring cortisol secretion.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 43
- Probably not a substantial claim. 11
In the paper
“Moreover, after excluding MSeC, all combinations of the remaining parameters did not show enough reliability for predicting hypocortisolism after surgery, and conversely, the normality of all parameters of HPA axis activity before surgery could not rule out with 100% probability the appearance of postsurgical adrenal insufficiency.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [58] Eller-Vainicher, 2010, Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?, Eur J Endocrinol source
plainn = 60- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Also in this study, lowering the cutoff of 1-mg DST was demonstrated to lead to a reduction in specificity (from 85.7 to 23.8%) and an increase in sensitivity (from 33.3 to 79.5%).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [58] Eller-Vainicher, 2010, Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?, Eur J Endocrinol source
boosteddirectn = 60- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“We found that the simultaneous presence of elevated UFC and MSeC levels [Ͼ5.4 g/dl (149 nmol/liter)] before surgery had a 100% specificity for predicting postsurgical hypocortisolism, but at the expense of a 30.8% sensitivity.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [58] Eller-Vainicher, 2010, Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?, Eur J Endocrinol source
plaincorrelationaln = 60- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The DST-UFC-ACTH combination criterion was confirmed to be useful because it showed the best accuracy in predicting improvement (sensitivity, 65.2%; specificity, 68.8%) in surgically treated patients and worsening of the endpoints (sensitivity, 55.6%; specificity, 82.9%), in the conservatively treated subjects.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Some studies suggested that this condition is present in 1-10% of patients with diabetes or established osteoporosis.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Abstract
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“particularly in AI patients, cortisol secretion is a continuum from completely normal to clearly increased levels, and it is highly variable in the same individual (3,22).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Pitfalls in the diagnosis of SH
What the sources say
- Not checked yetcites [3] Grumbach, 2003, Management of the clinically inapparent adrenal masses (“incidentaloma”)., Ann Intern Med source
- Not checked yetcites [22] Terzolo, 2005, Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma., Eur J Endocrinol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The National Institutes of Health State-of-the-Science Conference (64) and the American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of AI (65) recommend the cutoff of 5 g/dl (138 nmol/liter) as the normal level of cortisol suppression in patients with suspected SH.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [64] 2002, NIH State-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”)., 2002 NIH Consensus and State-of-the-Science Statements
- Not checked yetcites [65] Zeiger, 2009, American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas., Endocr Pract source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Even if midnight serum cortisol (MSeC) has been shown to be a promising tool for diagnosing SH (22), its use is limited by the need of the hospital admission for the cumbersome procedure, and it could be used as a confirmative test in selected patients (60).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [22] Terzolo, 2005, Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma., Eur J Endocrinol source
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [19] Chiodini, 2004, Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effect of subclinical hypercortisolism and gonadal status., J Clin Endocrinol Metab source
- Not checked yetcites [21] Chiodini, 2009, Bone mineral density, prevalence of vertebral fractures and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian Multicenter Study., J Clin Endocrinol Metab source
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [34] Reincke, 1992, Preclinical Cushing's syndrome in adrenal incidentalomas: comparison with adrenal Cushing's syndrome., J Clin Endocrinol Metab
- Not checked yetcites [38] Bardet, 1996, 131I-6-b-Iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas., Clin Endocrinol (Oxf) source
- Not checked yetcites [39] Bondanelli, 1997, Evaluation of hormonal function in a series of incidentally discovered adrenal masses., Metabolism source
- Not checked yetcites [44] Tanabe, 2001, Autonomy of cortisol secretion in clinically silent adrenal incidentaloma., Horm Metab Res source
- Not checked yetcites [46] Midorikawa, 2001, The improvement of insulin resistance in patients with adrenal incidentalomas by surgical resection., Clin Endocrinol (Oxf) source
- Not checked yetcites [49] Chiodini, 2001, Bone loss rate in adrenal incidentalomas: a longitudinal study., J Clin Endocrinol Metab source
- Not checked yetcites [53] Chiodini, 2002, Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism., J Clin Endocrinol Metab source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Therefore, UFC should not be considered an adequate screening test for SH and should be used in combination with other tests or in specific populations (1,14).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Thus, reducing the cutoff of 1-mg DST leads to a decrease in specificity and, therefore, to more false diagnosis of SH (65).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [65] Zeiger, 2009, American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas., Endocr Pract source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The reason to screen for SH with a higher cutoff than that recommended for overt cortisol excess [1.8 g/dl (50 nmol/liter)] (66) is that in patients without signs or symptoms suggestive of hypercortisolism, the a priori possibility of having SH is estimated to be lower than that of a false-positive result (1).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [1] Terzolo, 2005, Subclinical Cushing's syndrome in adrenal incidentalomas., Endocrinol Metab Clin North Am source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, this test should not be used for diagnosing SH until further studies and a standardization of the laboratory methods are available.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Some authors found a low sensitivity of MSaC in identifying SH (31,32), whereas others showed that subjects with either consistent or frequent elevations of this parameter may actually have SH (69).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [31] Nunes, 2009, Late-night salivary cortisol for diagnosis of overt and subclinical Cushing's syndrome in hospitalized and ambulatory patients., J Clin Endocrinol Metab source
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [69] Kidambi, 2007, Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome., Eur J Endocrinol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Similarly, LDDST has been used to diagnose SH (18,40,41,55) without advantages, with the exception of patients affected with alcoholism, psychiatric disorders, and diabetes in whom this test may be more accurate (1,14,66).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [18] Rossi, 2000, Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features., J Clin Endocrinol Metab
- Not checked yetcites [40] Kasperlik-Zeluska, 1997, Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients., Clin Endocrinol (Oxf) source
- Not checked yetcites [41] Tsagarakis, 1998, Elevated post-dexamethasone suppression cortisol concentrations correlate with hormonal alterations of the hypothalamo-pituitary adrenal axis in patients with adrenal incidentalomas., Clin Endocrinol (Oxf) source
- Not checked yetcites [55] Hadjidakis, 2003, Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas?, Clin Endocrinol (Oxf) source
- Not checked yetcites [1] Terzolo, 2005, Subclinical Cushing's syndrome in adrenal incidentalomas., Endocrinol Metab Clin North Am source
- Not checked yetcites [14] Nieman, 2008, The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline., J Clin Endocrinol Metab source
- Not checked yetcites [66] Arnaldi, 2003, Diagnosis and complications of Cushing's syndrome: a consensus statement., J Clin Endocrinol Metab source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Because the increase in sensitivity is accompanied by the decrease in specificity with the lowering of the 1-mg DST cutoff and vice versa, the combination of different parameters of HPA axis activity has been proposed to increase specificity without affecting sensitivity.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The main criticism to this approach for diagnosing SH is that postsurgical hypocortisolism reflects only the pituitary sensi- tivity to cortisol excess and not that at the peripheral tissues (25)(26)(27)(28)(29)(30).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites (25)(26)(27)(28)(29)(30)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“In particular, ACTH levels above 20 pg/ml (4.4 pmol/liter) or below 10 pg/ml (2.2 pmol/liter) suggest an ACTH-dependent or -independent cause of SH, respectively (66).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [66] Arnaldi, 2003, Diagnosis and complications of Cushing's syndrome: a consensus statement., J Clin Endocrinol Metab source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, if the lowest cutoffs were used [1.8 and 2.2 g/dl (50 and 60.6 nmol/liter), respectively], specificity decreased to 67-72%, whereas sensitivity increased to 75-100% (48 -62, 64 -67).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [48] Valli, 2001, Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [49] Chiodini, 2001, Bone loss rate in adrenal incidentalomas: a longitudinal study., J Clin Endocrinol Metab source
- Not checked yetcites [50] Barzon, 2002, Development of overt Cushing's syndrome in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [51] Bülow, 2002, Adrenal incidentaloma—experience of a standardized diagnostic programme in the Swedish prospective study., J Intern Med source
- Not checked yetcites [52] Libè, 2002, Long-term follow-up study of patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [53] Chiodini, 2002, Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism., J Clin Endocrinol Metab source
- Not checked yetcites [54] Emral, 2003, Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentalomas: clinical, biochemical and surgical outcomes., Endocr J source
- Not checked yetcites [55] Hadjidakis, 2003, Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas?, Clin Endocrinol (Oxf) source
- Not checked yetcites [56] Katabami, 2005, Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing's syndrome., Endocr J source
- Not checked yetcites [57] Toniato, 2009, Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study., Ann Surg source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, the use of the DST-UFC-ACTH combination criterion is limited to the diagnosis of SH of adrenal origin because ACTH levels are useless in patients with suspected ACTH-dependent SH.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The occurrence of hypocortisolism after the removal of an adrenal adenoma has been proposed as the gold standard for diagnosing SH (58).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [58] Eller-Vainicher, 2010, Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?, Eur J Endocrinol source
plaincorrelationaln = 60- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Using the highest cutoff [5 g/dl (138 nmol/liter)], 1-mg DST was confirmed to have good specificity (83-100%) but low sensitivity (44 -58%).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [48] Valli, 2001, Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [67] Barzon, 2001, Overnight dexamethasone suppression of cortisol is associated with radiocholesterol uptake patterns in adrenal incidentalomas., Eur J Endocrinol source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The limit of this approach is that these complications (i.e.osteoporosis, diabetes mellitus, and hypertension) are not specific for cortisol excess, being highly prevalent in the general population.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In a seminal paper, Terzolo et al. (42) proposed the use of different combinations of several different parameters (i.e.high UFC levels, cortisol levels after 1-mg DST, high average daily serum cortisol, altered circadian cortisol rhythm, low basal ACTH levels, or blunted ACTH response to CRH) to screen for SH and the terms “definitive SH,” “probable SH,” and “possible SH”.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Alterations of HPA axis activity parameters in patients with AI
What the sources say
- Not checked yetcites [42] Terzolo, 1998, Subclinical Cushing's syndrome in adrenal incidentaloma., Clin Endocrinol (Oxf) source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Overall, in these studies, the different parameters showed a good specificity (90 -98%, using 1-mg DST) but, generally, a poor sensitivity (41-86% using ACTH levels).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [9] Mantero, 2000, A survey on adrenal incidentaloma in Italy., J Clin Endocrinol Metab
- Not checked yetcites [31] Nunes, 2009, Late-night salivary cortisol for diagnosis of overt and subclinical Cushing's syndrome in hospitalized and ambulatory patients., J Clin Endocrinol Metab source
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [52] Libè, 2002, Long-term follow-up study of patients with adrenal incidentalomas., Eur J Endocrinol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A few studies (summarized in Table 2) evaluated the sensitivity and specificity of the different HPA axis parameters or combination of parameters for diagnosing SH.The difficulty in performing such studies is due to the lack of a clinical, biochemical, or functional parameter that can be used as the gold standard.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“It is known that diabetes mellitus and osteoporosis are frequently found in patients with cortisol excess.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The altered circadian rhythm, evaluated by either MSaC or MSeC, and UFC levels were not found to be sensitive enough for diagnosing SH (31,32).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [31] Nunes, 2009, Late-night salivary cortisol for diagnosis of overt and subclinical Cushing's syndrome in hospitalized and ambulatory patients., J Clin Endocrinol Metab source
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [59] Morelli, 2010, Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects., Clin Endocrinol (Oxf) source
plainn = 231- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Diagnostic accuracy of the different approaches for diagnosing SH
What the sources say
- Not checked yetcites [32] Masserini, 2009, The limited role of midnight salivary cortisol in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas., Eur J Endocrinol source
- Not checked yetcites [59] Morelli, 2010, Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects., Clin Endocrinol (Oxf) source
- Not checked yetcites [60] Eller-Vainicher, 2010, Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma., Eur J Endocrinol source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Because in past years several studies have shown that SH may also be associated with a high risk of osteoporotic fractures and metabolic consequences (15)(16)(17)(18)(19)(20)(21)(22)”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites (15)(16)(17)(18)(19)(20)(21)(22)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Importantly, the criteria for defining an improvement of the possible complications of SH have been different among the different studies and were not always reported.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The only available prospective randomized study found in 23 surgically treated subjects improvement of hypertension, diabetes, obesity, and dyslipidemia in 66.7, 62.5, 50, and 37.5% of cases, respectively (57).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [57] Toniato, 2009, Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study., Ann Surg source
plaindirectn = 23- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Rossi et al. (18) found that blood pressure and diabetes improved in 100 and 60% of five surgically treated SH patients, respectively, whereas no changes were seen in seven conservatively treated SH subjects.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [18] Rossi, 2000, Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features., J Clin Endocrinol Metab
plaindirectn = 5- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In a larger study of a similar population using 1-mg DST as a screening test with a lower and, therefore, more sensitive cutoff, SH was ascertained in four (three of pituitary and one of adrenal origin) of 200 diabetic patients studied (2.0% prevalence) (82).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [82] Catargi, 2003, Occult Cushing's syndrome in type-2 diabetes., J Clin Endocrinol Metab source
plainn = 4- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“On the contrary, in 22 conservatively treated patients, hypertension, diabetes, and dyslipidemia worsened in 80, 33.3, and 20% of cases (57).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [57] Toniato, 2009, Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study., Ann Surg source
plaindirectn = 22- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A subsequent study from our group on more than 200 patients using the same screening test showed that SH was present in 4.8% of patients with osteoporosis and 10.8% of patients with osteoporosis and vertebral fractures.In this study, SH was of adrenal and pituitary origin in 4.1 and 0.7% of patients, respectively (91).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [91] Chiodini, 2007, Subclinical hypercortisolism among outpatients referred for “osteoporosis.”, Ann Intern Med source
plaincorrelationaln = 200- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These studies suggest that SH may be more frequent in patients with diabetes and osteoporosis, thus explaining the increased fracture risk.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A subsequent study of 10 subjects found after recovery from SH an improvement of blood pressure, metabolic control of diabetes, and dyslipidemia in 83, 22, and 67% of cases, respectively, whereas in 12 conservatively treated subjects, hypertension, diabetes, and obesity worsened in 17, 25, and 17% of cases, respectively (96).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [96] Tsuiki, 2008, Cardiovascular risks and their long-term clinical outcome in patients with subclinical Cushing's syndrome., Endocr J source
plaindirectn = 10- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“These data were confirmed in a similar controlled study on 294 diabetic inpatients in whom a 10.8% prevalence of SH was found, with pituitary, adrenal, and undefined/ectopic origin accounting for 1.4, 7.2, and 2.2%, respectively (83).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [83] Chiodini, 2005, Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients., Eur J Endocrinol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is possible to hypothesize that some patients classified as not having SH had, in fact, a mild degree of cortisol hypersecretion, suggesting that the diagnosis of SH had not been sensitive enough.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study clearly suffers from the limits of the small sample and of its retrospective and nonrandomized design.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
boostedn = 55- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, in reducing the cutoff of the screening test and therefore increasing its sensitivity, the adrenal cause of SH became more frequent than the pituitary cause.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In a cross-sectional study on 90 obese diabetic patients with poor metabolic control, Leibowitz et al. (63) found a 3.3% prevalence of SH due to an adrenal adenoma in one patient and a pituitary adenoma in two patients using 1-mg DST above 5.1 g/dl (140 nmol/liter) as a screening test.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [63] Leibowitz, 1996, Pre-clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients., Clin Endocrinol (Oxf) source
plainn = 2- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Overall in this study, the prevalence of SH could be estimated to be almost 5.5%, with a pituitary and adrenal origin of 1.5 and 4.0%, respectively.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
What the sources say
- Not checked yetcites [82] Catargi, 2003, Occult Cushing's syndrome in type-2 diabetes., J Clin Endocrinol Metab source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Indeed, somatostatin analogs have been used to control food-dependent cortisol hypersecretion due to the presence of aberrant glucose-dependent insulinotropic peptide receptors (100, 101); propranolol has been proposed in patients with adrenal hypercortisolism (102) and leuprolide acetate in LH-dependent Cushing's syndrome (103).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
What the sources say
- Not checked yetcites [100] Libé, 2010, Aberrant cortisol regulations in bilateral macronodular adrenal hyperplasia: a frequent finding in a prospective study of 32 patients with overt or subclinical Cushing's syndrome., Eur J Endocrinol source
- Not checked yetcites [101] de Herder, 1996, Food-dependent Cushing's syndrome resulting from abundant expression of gastric inhibitory polypeptide receptors in adrenal adenoma cells., J Clin Endocrinol Metab
- Not checked yetcites [102] Lacroix, 1997, Propranolol therapy for ectopic β-adrenergic receptors in adrenal Cushing's syndrome., N Engl J Med source
- Not checked yetcites [103] Lacroix, 1999, Leuprolide acetate therapy in luteinizing hormone-dependent Cushing's syndrome., N Engl J Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, to date, the small sample size of the available studies and the lack of a large prospective randomized trial could not allow us to draw any firm conclusion about this point.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The difficulties in defining a protocol are related to the variability of cortisol secretion in these patients (3,22) because even a 2-yr follow-up may be too short to ascertain the presence of SH (79).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Follow-up of patients with SH
What the sources say
- Not checked yetcites [3] Grumbach, 2003, Management of the clinically inapparent adrenal masses (“incidentaloma”)., Ann Intern Med source
- Not checked yetcites [22] Terzolo, 2005, Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma., Eur J Endocrinol source
- Not checked yetcites [79] Donadio, 2009, Role of adrenal gland scintigraphy in patients with incidentally discovered adrenal mass and subclinical hypercortisolism., J Endocrinol Invest source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“These uncertainties, in turn, bring into question the real clinical importance of SH itself and the need of a surgical treatment in these patients instead of the optimization of medical therapy (61).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
What the sources say
- Not checked yetcites [61] Chiodini, 2010, Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism., J Clin Endocrinol Metab source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Moreover, it must be considered that the optimization of the medical therapy is not completely free of adverse events and that adrenal surgery is becoming increasingly safer by endoscopic procedures.”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
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?
In the citing paper
“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 [209]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Prevalence of SH and of Its Different Causes
“In assessing the HPA axis by 3-mg DST with a sensitive cutoff, a 3.8% prevalence of SH was found; all cases were of adrenal origin (90).A subsequent study from our group on more than 200 patients using the same screening test showed that SH was present in 4.8% of patients with osteoporosis”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Conclusions
“| Chiodini, 2007 (91) | Osteoporotics (147) | 1-mg DST | 1.8 g/dl | 4.8 | 85.4 | 14.6 | 0 |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
“Importantly, studies using similar criteria were able to show a clear positive effect of surgery on the metabolic consequences of SH (18,54,61,93,96,97).”
§ Diagnosis and Treatment of Subclinical Hypercortisolism > Therapy of SH
“At variance with all the above-mentioned studies, a recent retrospective study found no difference in hypertension, diabetes, and obesity between five and eight SH patients surgically and conservatively treated, respectively (97).”
Citations
Cites
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944
Expert Panel on Detection, E. (2001) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.285.19.2486 · Cited by 26,011
2013 ESH/ESC Guidelines for the management of arterial hypertension
Authors Task Force Members, Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., Christiaens, T., Cífková, R., Backer, G. D., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht151 · Cited by 13,739
2007 Guidelines for the Management of Arterial Hypertension
Mancia, G., Backer, G. D., Dominiczak, A. F., Cífková, R., Fagard, R. H., Germanò, G., Grassi, G. M., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., et al. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e3281fc975a · Cited by 5,870
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718 · cited 4×
“Second, the reliability of almost all markers of HPA axis activity, particularly ACTH and 24-h urinary free cortisol (UFC), is low (3, 14, 23), and several comorbidities (i.”
BackgroundInfluentialDiagnosis and complications of Cushing’s syndrome: a consensus statement
Arnaldi, G., Angeli, A., Atkinson, A. B., Bertagna, X., Cavagnini, F., Chrousos, G. P., Fava, G. A., Findling, J. W., Gaillard, R. C., Grossman, A. B., et al. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030871 · Cited by 1,362
11β-Hydroxysteroid dehydrogenase type 1: a tissue specific regulator of glucocorticoid response
Tomlinson, J. W., Walker, E. A., Bujalska, I. J., Draper, N., Lavery, G. G., Cooper, M. S., Hewison, M., & Stewart, P. M. (2004) · Endocrine Reviews · doi:10.1210/er.2003-0031 · Cited by 969
Management of the clinically inapparent adrenal mass ("incidentaloma")
Grumbach, M. M., Biller, B. M. K., Braunstein, G. D., Campbell, K. K., Carney, J. A., Godley, P. A., Harris, E. L., Lee, J. K. T., Oertel, Y. C., Posner, M. C., et al. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-5-200303040-00013 · Cited by 945 · cited 5×
“nomas smaller than 3 cm (3), two studies suggested that in”
BackgroundInfluentialA Survey on Adrenal Incidentaloma in Italy
Mantero, F. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.85.2.637 · Cited by 907
The Diagnosis and Differential Diagnosis of Cushing’s Syndrome and Pseudo-Cushing’s States
Newell-Price, J., Trainer, P., Besser, M., & Grossman, A. (1998) · Endocrine Reviews · doi:10.1210/edrv.19.5.0346 · Cited by 833
Cited by
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Measuring cortisol in serum, urine and saliva—Are our assays good enough?
El-Farhan, N., Rees, D. A., & Evans, C. (2017) · Annals of Clinical Biochemistry: International Journal of Laboratory Medicine · doi:10.1177/0004563216687335 · Cited by 395
Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas
Debono, M., Bradburn, M., Bull, M., Harrison, B., Ross, R. J., & Newell-Price, J. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3007 · Cited by 269
Elhassan, Y. S., Alahdab, F., Prete, A., Delivanis, D. A., Khanna, A., Prokop, L., Murad, M. H., O'Reilly, M. W., Arlt, W., & Bancos, I. (2019) · Annals of Internal Medicine · doi:10.7326/m18-3630 · Cited by 263
Recurrent activating mutation in PRKACA in cortisol-producing adrenal tumors
Goh, G., Scholl, U. I., Healy, J. M., Choi, M., Prasad, M. L., Nelson-Williams, C. J., Kunstman, J. W., Korah, R. M., Suttorp, A., Dietrich, D., et al. (2014) · Nature Genetics · doi:10.1038/ng.2956 · Cited by 263
Long-term follow-up in adrenal incidentalomas: an Italian multicenter study
Morelli, V., Reimondo, G., Giordano, R., Della Casa, S., Policola, C., Palmieri, S., Salcuni, A. S., Dolci, A., Mendola, M., Arosio, M., et al. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3527 · Cited by 223
“Even if SH has been associated with the risk of major cardiovascular events (CVEs) (32), large studies focused on “hard” end-points, such as major CVEs, are lacking (11).”
Influential
Metadata
- Authors
- Chiodini, I.
- Affiliations
- University of Milan (IT)
- Corresponding author
- Chiodini, Iacopo
- ORCID
- Chiodini, Iacopo
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2011-05-01
- Volume
- 96
- Issue
- 5
- Pages
- 1223-1236
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2068496880
- Semantic Scholar
- b3e38e55547be819a98f080fc5eb59dd9144701d
- Cited by
- 279
- References
- 122
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 5 · 2023: 11 · 2022: 10 · 2021: 23 · 2020: 22 · 2019: 21 · 2018: 27 · 2017: 21 · 2016: 19 · 2015: 28 · 2014: 19 · 2013: 24 · 2012: 27
- FWCI
- 4.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- 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
- subclinical hypercortisolism, adrenal incidentaloma, cortisol excess, hypertension, diabetes mellitus, osteoporosis, obesity, adrenal surgery, metabolic recovery
- MeSH terms
- Adrenal Gland Neoplasms, Adult, Child, Cushing Syndrome, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Treatment Outcome
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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.
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