The DOI matches its Crossref record; 48 of the 53 references it cites were found in a registry or an index; none of the 44 sources its claims cite is checked for support yet.
Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas
Open accessAbstract
CONTEXT: Incidental benign adrenocortical adenomas, adrenal incidentalomas are found in 4.5% of abdominal computed tomography scans, with the incidence increasing to 10% in patients older than 70 years of age. These incidentalomas frequently show evidence of excess cortisol secretion but without overt Cushing's syndrome. The mortality rate is increased in Cushing's syndrome. OBJECTIVE: This study sought to investigate whether patients with adrenal incidentalomas have an increased mortality. DESIGN: This was a retrospective, longitudinal cohort study. SETTING: The study was carried out in an Endocrine Investigation Unit in a University Teaching Hospital. PATIENTS: Two hundred seventy-two consecutive patients with an incidental adrenal mass underwent a dedicated diagnostic protocol, which included dexamethasone testing for hypercortisolism between 2005 and 2013. Overall survival was assessed in 206 patients with a benign, adrenocortical adenoma. MAIN OUTCOME MEASURES: Survival analysis was carried out by using Kaplan-Meier curves and the effect of dexamethasone cortisol estimated by Cox-regression analysis. Cause-specific mortality was ascertained from death certificates and compared with local and national data. RESULTS: Eighteen of 206 patients died and the mean time (SD) from diagnosis to death was 3.2 (1.7) years. Seventeen of 18 patients who died had a post dexamethasone cortisol >1.8 μg/dL and there was a significant decrease in survival rate with increasing dexamethasone cortisol levels (P = .001). Compared with the <1.8 μg/dL group, the hazard ratio (95% confidence interval) for the 1.8-5 μg/dL group was 12.0 (1.6-92.6) whereas that of the >5 μg/dL group was 22.0 (2.6-188.3). Fifty percent and 33% of deaths were secondary to circulatory or respiratory/infective causes, respectively. CONCLUSIONS: PATIENTS with adrenal incidentalomas and a post-dexamethasone serum cortisol >1.8 μg/dL have increased mortality, mainly related to cardiovascular disease and infection.
Overview
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Written from the paper’s full text.
TL;DR
In a retrospective cohort of 206 patients with benign adrenocortical incidentalomas, higher post-dexamethasone serum cortisol was associated with increased mortality. Patients with cortisol >1.8 g/dL had markedly worse survival, mainly from circulatory and respiratory/infective causes.
Key findings
- Eighteen of 206 patients died; mean (SD) time from diagnosis to death was 3.2 (1.7) years.
- Seventeen of 18 patients who died had a post-dexamethasone cortisol >1.8 g/dL, and survival decreased with increasing cortisol levels (log-rank trend test, P = .001).
- Compared with the <1.8 g/dL group, hazard ratios (95% CI) were 12.0 (1.6–92.6) for the 1.8–5 g/dL group and 22.0 (2.6–188.3) for the >5 g/dL group.
- Causes of death were 50% circulatory and 33% respiratory/infective; malignancy accounted for 6%, lower than the local/national incidence of 29%.
Methods
- Retrospective, longitudinal cohort study of 272 consecutive patients with incidental adrenal masses referred to an Endocrine Investigation Unit between January 2005 and July 2013; final survival analysis included 206 patients with benign adrenocortical adenoma.
- Patients underwent a dedicated diagnostic protocol including a 1-mg overnight dexamethasone suppression test; cortisol groups were <1.8 g/dL, 1.8–5 g/dL, and >5 g/dL.
- Survival was assessed with Kaplan-Meier curves and log-rank trend tests; hazard ratios were estimated by Cox regression. Cause-specific mortality came from death certificates and was compared with local Sheffield and UK national data; a subanalysis excluded patients with extra-adrenal malignancy (n = 190).
Limitations
- Stated: small number of deaths and retrospective design preclude causative extrapolation; only an initial dexamethasone suppression test was available; dexamethasone levels were not measured; vaccination records were unavailable; hypercortisolism could be secondary to conditions such as alcoholism, depression, or psychotic disease, though no deaths from suicide or alcohol-related issues occurred.
- Stated: multivariable modeling was limited by the small number of events, yielding unstable models and imprecise coefficients.
- Evident from the text: single-center design, no prospective randomized intervention, and inability to determine whether patients died because of or with hypercortisolism.
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Claims the paper makes
28 Not checked yet · 28 Own result · 16 Own method · 6 Own interpretation
A result the paper reports from its own data — 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 neutrophil to lymphocyte ratio was significantly higher in patients with a serum cortisol Ͼ1.8 g/dL post dexamethasone (P ϭ .014).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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 result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients with bilateral disease also had a higher post-dexamethasone serum cortisol level, although this relationship was less pronounced (median, 2.25 g/dL [62 nmol/L] bilateral vs 1.8 g/dL [51 nmol/L] unilateral; P ϭ .019).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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 result the paper reports from its own data — 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 hazard ratio (95% confidence interval) for the 1.8 -5g/dL group was 12.0 (1.6 -92.6)”
- Also stated in: § Results · plain
“The hazard ratio (95% confidence interval) for the 1.8 -5-g/dL group was 12.0 (1.6 -92.6) whereas that of the Ͼ5 g/dL group was 22.0 (2.6 -188.3) using the Ͻ1.8-g/dL group as reference.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
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.
- Rests on an assumption: A single baseline overnight dexamethasone suppression test adequately classifies long-term cortisol exposure for mortality risk.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seventeen of 18 patients who died had a post dexamethasone cortisol Ͼ1.8 g/dL”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
plaincorrelationaln = 18- 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.
- Rests on an assumption: A single baseline overnight dexamethasone suppression test adequately classifies long-term cortisol exposure for mortality risk.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there was a significant decrease in survival rate with increasing dexamethasone cortisol levels (P ϭ .001).”
- Also stated in: § Results · boosted
“These show a significant decrease in survival rate that worsens with increasing post-dexamethasone cortisol cutoffs (log-rank trend test, P ϭ .001).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
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.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Patients lost to follow-up do not differ systematically in mortality risk from those included in the final analysis.
- Rests on an assumption: A single baseline overnight dexamethasone suppression test adequately classifies long-term cortisol exposure for mortality risk.
- Rests on an assumption: The cohort of patients referred to a single UK endocrine unit is representative of patients with adrenal incidentalomas generally.
- Also stated in: § Results · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eighteen of 206 patients died and the mean time (SD) from diagnosis to death was 3.2 (1.7) years.”
- Also stated in: § Results · plain
“between January 2005 and July 2013 there were 18 deaths.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
plainn = 206- 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.
- Rests on an assumption: Patients lost to follow-up do not differ systematically in mortality risk from those included in the final analysis.
- Also stated in: § Results · plain
A result the paper reports from its own data — 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 mean time (SD) from diagnosis to death was 3.2 (1.7) years.”
- Also stated in: § Results · plain
“the mean (SD) time from diagnosis to death was 3.2 (1.7) years.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
plainn = 18- 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.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“whereas that of the Ͼ5 g/dL group was 22.0 (2.6 -188.3)”
- Also stated in: § Results · plain
“The hazard ratio (95% confidence interval) for the 1.8 -5-g/dL group was 12.0 (1.6 -92.6) whereas that of the Ͼ5 g/dL group was 22.0 (2.6 -188.3) using the Ͻ1.8-g/dL group as reference.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
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.
- Rests on an assumption: A single baseline overnight dexamethasone suppression test adequately classifies long-term cortisol exposure for mortality risk.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients with adrenal incidentalomas and a post-dexamethasone serum cortisol Ͼ1.8 g/dL have increased mortality, mainly related to cardiovascular disease and infection.”
- Also stated in: § Results · plain
“There was 1/95 (1%) death in the group with post-dexamethasone serum cortisol Ͻ1.8 g/dL.”
- Also stated in: § Results · plain
“Twelve of 92 (13%) and 5/19 (26%) patients in the 1.8 -5 g/dL and Ͼ5 g/dL groups died, respectively.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
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.
- Rests on an assumption: Patients lost to follow-up do not differ systematically in mortality risk from those included in the final analysis.
- Rests on an assumption: A single baseline overnight dexamethasone suppression test adequately classifies long-term cortisol exposure for mortality risk.
- Rests on an assumption: The cohort of patients referred to a single UK endocrine unit is representative of patients with adrenal incidentalomas generally.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Post-dexamethasone serum cortisol was correlated with size of adenoma (Spearman's ϭ 0.35, P Ͻ .001) and age (Spearman's ϭ 0.32; P Ͻ .001).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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. 26
- Probably not a substantial claim. 26
- The quote only partly states this claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“which were higher than the 31% circulatory and the 14% respiratory/infective causes recorded locally in Sheffield, and nationally in the United Kingdom.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
- Rests on an assumption: Death certificates accurately identify the underlying cause of death.
- Rests on an assumption: Local and national mortality data are comparable to the study cohort.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifty percent and 33% of deaths were secondary to circulatory or respiratory/infective causes, respectively.”
- Also stated in: § Results · plain
“In our cohort there were 50% circulatory and 33% respiratory/ infective causes of death”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
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.
- Rests on an assumption: Death certificates accurately identify the underlying cause of death.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Conversely, 6% of our patients died directly resulting from malignancy, a percentage much lower than the local and national incidence of 29% (Figure 3).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
- Rests on an assumption: Death certificates accurately identify the underlying cause of death.
- Rests on an assumption: Local and national mortality data are comparable to the study cohort.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no relationship between the presence of hypertension (P ϭ .8),dyslipidemia (P ϭ .5),nor diabetes (P ϭ .6)and mortality.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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 result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no significant difference in post-dexamethasone serum cortisol between sexes (median 1.88 g/dL [52 nmol/L] women vs 1.92 g/dL [53 nmol/L] men; P ϭ .72).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Post-dexamethasone serum cortisol was correlated with size of adenoma (Spearman's ϭ 0.35, P Ͻ .001) and age (Spearman's ϭ 0.32; P Ͻ .001).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
plaincorrelational- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fasting glucose levels were similar in patients who survived or died.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
A result the paper reports from its own data — 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 mean (95% confidence interval) survival for the post-dexamethasone groups were as follows: cortisol Ͻ1.8, 1.8 -5, and Ͼ5 g/dL was 8.4 (8.2-8.6), 7.3 (6.8 -7.8), and 6.9 (5.6 -8.3) years, respectively.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
A result the paper reports from its own data — 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 our study, however, the mean time to death was 3.2 years.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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 quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were 15 deaths in total: none with serum cortisol 1.8 g/dL; 10 with serum cortisol 1.8 -5 g/dL (10/85[12%]); and five with a serum cortisol Ͼ5 g/dL (5/16[31%]).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
- Rests on an assumption: Patients lost to follow-up do not differ systematically in mortality risk from those included in the final analysis.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similar results were observed in the cohort of patients excluding those with extra-adrenal malignancy in whom there were 53, 27, and 7% deaths from circulatory, respiratory/infection, and malignant causes, respectively.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
- Rests on an assumption: Death certificates accurately identify the underlying cause of death.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our data show an increased mortality both from cardiovascular disease and infections in patients with adrenal incidentaloma and low-grade excess cortisol.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
- Rests on an assumption: The association between post-dexamethasone cortisol category and mortality is not due to unmeasured confounding.
- Rests on an assumption: The recorded causes of death accurately reflect the underlying causes.
None of the sources cited for this claim have been checked yet.
In the paper
“Adrenal incidentalomas secreting excess cortisol are associated with multiple complications including diabetes, hypertension, visceral obesity, low bone mineral density, vertebral fractures, a predisposition to thrombosis (2,15,25,26), and cardiovascular disease (8,15).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [2]
- Not checked yetcites [15]
- Not checked yetcites [25]
- Not checked yetcites [26]
- Not checked yetcites [8]
plaincorrelational- 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.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Cross-sectional data show that increased total cortisol exposure, measured in salivary cortisol samples, a marker of free cortisol, is associated with the development of atherosclerosis in the elderly, independent of the presence of other cardiovascular risk factors (34).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [34]
plaincorrelational- 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.
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
“Locally, all patients diagnosed with adrenal incidentalomas, after radiological investigation, were referred for investigation to the endocrinology unit irrespective of underlying diagnosis and health status.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“An important effect of glucocorticoids is to reduce Th-1 responses needed to counter bacterial infection, and reduce the Th-1:Th-2 cell ratio (41), and lower cellular immunity (42).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [41]
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.
None of the sources cited for this claim have been checked yet.
In the paper
“Overt endogenous Cushing's syndrome and use of excess exogenous glucocorticoids are associated with increases in cardiovascular events and mortality from cardiovascular disease or infection (11)(12)(13)(14).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
What the sources say
- Not checked yetcites [11]
- Not checked yetcites [12]
- Not checked yetcites [13]
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.
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
“Changes in cortisol exposure may distort lymphocyte rhythms resulting in impaired immune function.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
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
“Our data, on a consecutive series of patients, extend these observations.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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
“In most highly selected surgical studies patients with adrenal incidentalomas secreting excess cortisol have experienced improvement in their cardiovascular risk pro-file when compared with patients treated conservatively (30,31), but this finding is not universal (32).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [30]
- Not checked yetcites [31]
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.
In the paper
“A post-dexamethasone cortisol Ͼ1.8 g/dL is in keeping with a diagnosis of cortisol excess as recommended by Endocrine Society guidelines (20).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Study procedures
What the sources say
- Not checked yetcites [20]
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
“Nevertheless, a number of studies have shown an increased risk of cardiovascular disease in patients with adrenal incidentalomas (8,9), and a recent study has suggested increased mortality from cardiovascular causes (10).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
What the sources say
- Not checked yetcites [8]
- Not checked yetcites [9]
- Not checked yetcites [10]
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.
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
“The small number of events hampers the extent of modeling, which can be undertaken and the precision of the estimates, but nonetheless the data strongly suggest that hypercortisolemia in the context of an adrenal incidentaloma is detrimental.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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. 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
“We did, however, carefully ascertain our subjects to define the benign adrenocortical adenoma and assess the significance of the presence of this and excess cortisol as evidenced by dexamethasone testing.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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. 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
“When excluding patients on drugs that induce CYP3A4 (n ϭ 5) and inhibit CYP3A4 (n ϭ 8) results were similar.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
In the paper
“Glucocorticoids also stimulate apoptosis of eosinophils (43) and impair neutrophil apoptosis (44).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [43]
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.
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
“In addition, 21 patients were lost to follow-up.The final survival analysis was carried out on 206 patients (primary analysis).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Setting and participants
plainn = 21- 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
“which were higher than the 31% circulatory and the 14% respiratory/infective causes recorded locally in Sheffield, and nationally in the United Kingdom.”
- Also stated in: § Results · plain
“a percentage much lower than the local and national incidence of 29% (Figure 3).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
What the sources say
- Not checked yetcites [18]
- Not checked yetcites [19]
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.
- Also stated in: § Results · plain
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
“Dexamethasone levels were not measured, but recent data suggest that measuring dexamethasone levels does not improve the diagnostic performance of the 1-mg overnight dexamethasone-suppression test (45).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
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
“A higher neutrophil/lymphocyte ratio in our patients who failed to suppress serum cortisol after dexamethasone might be an indicator of such a relationship.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
In the paper
“Under normal circumstances in the young there is a circadian change to the total number of lymphocytes and some lymphocyte subpopulations such as CD3 (total T cells), CD4 (T-helper), and CD20 (total B-cells) with higher levels at night when cortisol levels are lowest, whereas CD8 (T-suppressor and cytotoxic) and CD16 (natural killer) cells are higher at 1200 h (40).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [40]
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.
In the paper
“This effect may also be explained by the binding of glucocorticoids to glucocorticoid and mineralocorticoid receptors in cardiovascular tissues such as the heart and vascular walls, enhancing contractility of vascular smooth muscle by increasing sensitivity to noradrenaline and decreasing endothelium-dependent vasodilatation (37).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [37]
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.
It may state two separate claims as one.
In the paper
“Patients with overt Cushing's syndrome have increased mortality due mainly to cardiovascular disease and infection (27).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [27]
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.
In the paper
“Low-grade excess cortisol secretion in adrenal incidentalomas has also been associated with an increased prevalence of insulin resistance, hypertension, and visceral obesity (15)”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Abstract
What the sources say
- Not checked yetcites [15]
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.
In the paper
“For example, nonsuppression on dexamethasone testing and higher baseline serum cortisol levels has been associated with cardiovascular disease death in patients with mood disorders (33).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [33]
plaincorrelational- 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.
In the paper
“Hypercortisolism and increased sensitivity to glucocorticoids in patients with glucocorticoid receptor polymorphisms have also been associated with severe atherosclerosis and coronary artery disease (36).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
What the sources say
- Not checked yetcites [36]
plaincorrelational- 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.
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
“The model assumption (proportional hazards) was not contradicted by the assessment of residuals, although again the formal tests are limited by the low death rate.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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.
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
“Furthermore, multivariable modeling was limited by the small number of events (24), which would yield unstable models and imprecise coefficients.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
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
“The average overall life expectancy for the local and national population during this time period was approximately 78 years for men and 82 years for women (18).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Results
What the sources say
- Not checked yetcites [18]
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.
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
“The study was approved and registered as an institutional case-notes review at Sheffield Teaching Hospitals National Health Service Foundation Trust (Registration No. 5133).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Setting and participants
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.
In the paper
“The study is reported as recommended by the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines, that recommend parameters to be included in a complete and accurate report of an observational study (17).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Setting and participants
What the sources say
- Not checked yetcites [17]
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.
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
“It is important to note that our subjects only had an initial dexamethasone suppression test, and this is a limitation of the study.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
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
“In the United Kingdom it is recommended for all patients age 65 years and over to receive the flu and pneumococcal vaccines but we did not have any records of this and cannot comment on whether this may have influenced infection-related mortality.”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
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
“Hazard ratios could not be calculated because no patients from the Ͻ1.8-g/dL group died (subanalysis).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Discussion
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.
The paper relies on this without support.
Death certificates accurately identify the underlying cause of death.
“The primary cause of death was ascertained from death certificates obtained from the General Register Office in the United Kingdom so that all-cause and cause-specific mortality could be determined.”
“Death certificates were coded using the 10th revision of the International Classification of Disease (ICD-10).”
The paper relies on this without support.
Patients lost to follow-up do not differ systematically in mortality risk from those included in the final analysis.
“In addition, 21 patients were lost to follow-up.The final survival analysis was carried out on 206 patients (primary analysis).”
The paper relies on this without support.
Local and national mortality data are comparable to the study cohort.
“The cause-specific mortality in the adrenal incidentaloma patients was compared with local incidence figures in 2010 obtained from the Sheffield Director of Public Health Report, 2011 (18).”
The paper relies on this without support.
A single baseline overnight dexamethasone suppression test adequately classifies long-term cortisol exposure for mortality risk.
“Only a baseline overnight dexamethasone suppression test is carried out in our unit (although we do acknowledge that in some cases post-dexamethasone cortisol levels may worsen (10) or normalize (22) on followup).”
The paper relies on this without support.
The cohort of patients referred to a single UK endocrine unit is representative of patients with adrenal incidentalomas generally.
“A retrospective, longitudinal, cohort study was performed on a consecutive series of 272 patients diagnosed with adrenal incidentalomas between January 2005 and July 2013, and referred to the Endocrine Investigation Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foun-dation Trust, Sheffield, United Kingdom, a University Hospital.”
The paper relies on this without support.
The association between post-dexamethasone cortisol category and mortality is not due to unmeasured confounding.
“When adjusting for age the relationship between postdexamethasone cortisol category and mortality remained identical.”
The paper relies on this without support.
The life expectancy at birth of the general population is a valid comparator for the age at death of patients with adrenal incidentalomas.
“In addition, the age of death for patients with adrenal incidentalomas was lower than the life expectancy at birth of the general population (men/women, 74/72 vs 78/82 y) (18).”
The paper relies on this without support.
The recorded causes of death accurately reflect the underlying causes.
“Graphs show a higher rate of mortality from circulatory and infective/respiratory (resp) causes in the adrenal incidentaloma group of patients between January 2005 and July 2013.”
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
“Levels between 1.9 and 5.0 μg/dL (50-140 nmol/L) may indicate “possible autonomous cortisol secretion,” and cortisol levels above 5.0 μg/dL (140 nmol/L) are suggested to confirm ACS (79,220).”
From Adrenal incidentaloma (2020) · cites this paper as [220]
In the citing paper
“A study with up to 15 years of follow-up in patients with ACS has documented increased cardiovascular morbidity (43% vs 8.8%, P < .005) and mortality (22.6% vs 2.5%, P < .02) in ACS patients compared with nonfunctioning AI.”
From Adrenal incidentaloma (2020) · cites this paper as [220]
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
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Study procedures
“A post-dexamethasone cortisol Ͼ1.8 g/dL is in keeping with a diagnosis of cortisol excess as recommended by Endocrine Society guidelines (20).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > References
“20. Bernini GP, Moretti A, Oriandini C, Bardini M, Taurino C, Salvetti A. Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas. Br J Cancer. 2005;92:1104 -1109.”
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
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > Study procedures
“The cause-specific mortality in the adrenal incidentaloma patients was compared with local incidence figures in 2010 obtained from the Sheffield Director of Public Health Report, 2011 (18).”
§ Cortisol as a Marker for Increased Mortality in Patients with Incidental Adrenocortical Adenomas > References
“18. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cush- ing's syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526 -1540.”
Citations
Cites
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.11.008 · Cited by 17,893
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010 · Cited by 17,796
Modeling Survival Data: Extending the Cox Model
Therneau, T. M., & Grambsch, P. M. (2000) · Statistics for Biology and Health · doi:10.1007/978-1-4757-3294-8 · Cited by 8,674
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
Self-citationThe Hypothalamic–Pituitary–Adrenal Axis and Immune-Mediated Inflammation
Chrousos, G. P. (1995) · New England Journal of Medicine · doi:10.1056/nejm199505183322008 · Cited by 2,579
Peduzzi, P., Concato, J., Feinstein, A. R., & Holford, T. R. (1995) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(95)00048-8 · Cited by 2,154
Lacroix, A., Feelders, R. A., Stratakis, C. A., & Nieman, L. K. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61375-1 · Cited by 1,777
Newell-Price, J. D. C., BERTAGNA, X. Y., Grossman, A. B., & Nieman, L. K. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68699-6 · Cited by 1,258
Self-citationA 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
Cited by
Sorted by citations
Items 201–268 of 268
Perini, A. M. E., Gigante, A., Puglisi, S., Saba, L., & Terzolo, M. (2024) · Updates in surgery/Updates in surgery series · doi:10.1007/978-3-031-62301-1_8 · Cited by 2
Meriç, C. (2024) · American Journal of Translational Research · doi:10.62347/jtqx7232 · Cited by 2
Urine-normetanephrine, a predictor of mortality risk in patients with adrenal adenomas
Kjellbom, A., Löndahl, M., Danielsson, M., Olsen, H., & Lindgren, O. (2025) · Scientific Reports · doi:10.1038/s41598-025-94951-w · Cited by 2
The landscape of bilateral adrenal incidentalomas associated with subclinical hypercortisolism
Dalmazi, G. D. (2016) · Endocrine · doi:10.1007/s12020-016-1004-8 · Cited by 2
Egan, R. J., & Scott-Coombes, D. M. (2018) · Springer eBooks · doi:10.1007/978-981-10-1124-5_25 · Cited by 2
Riester, A., & Beuschlein, F. (2021) · Der Internist · doi:10.1007/s00108-021-01188-6 · Cited by 2
Can non-functional adrenal incidentaloma be ranked among cardiovascular risk factors?
Yağız, B., Akalın, A., Yorulmaz, G., Macunluoğlu, A. C., & YAĞIZ, O. (2022) · The European Research Journal · doi:10.18621/eurj.872835 · Cited by 2
“obesity, hypertension (HT), glucose intolerance, diabetes mellitus (DM), hyperuricemia, and hyperlipidemia (HPL) is increased in patients with AI [2, 4-8].”
BackgroundCortisol-Producing Adrenocortical Carcinoma Presenting with Hypertensive Emergency
McGowan, M., & Kalinoski, T. (2023) · American Journal of Case Reports · doi:10.12659/ajcr.940228 · Cited by 2
“Adrenal gland tumors account for 18% of adrenocorticotropic-releasing hormone-independent cases and can be either benign or malignant [8].”
BackgroundCrawford, M., McDonald, B., Chen, W., Chowdhry, H., Contreras, R., Reyes, I., Dhakal, E., Villanueva, T., Barzilay, J. I., Vaughn, C. F., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11123167 · Cited by 2
“The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/biomedicines11123167/s1, Table S1: Autonomous diagnosis codes and electronic medical record problem list text used to identify adrenal incidentalomas”
MethodInfluentialWas soll ich tun bzw. lassen bei einem zufällig entdeckten Nebennierenknoten?
Faßnacht, M. (2017) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/s-0042-121731 · Cited by 2
“Diese Konstellationen sind deshalb klinisch von Bedeutung, da zwei aktuelle retrospektive Studien eine Assoziation zwischen dem Cortisol nach Dexamethason und der Mortalität gefunden haben [5, 6].”
BackgroundSbardella, E., Minnetti, M., D’Aluisio, D., Rizzà, L., Di, G. M. R., Pofi, R., Giannetta, E., Vestri, A., Venneri, M. A., Morelli, S., et al. (2018) · Endocrine Abstracts · doi:10.1530/endoabs.56.p59 · Cited by 2
Chabre, O., Young, J., Caron, P. J., & Tabarin, A. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgz105 · Cited by 2
Takiguchi, M. K., Morimoto, S., Watanabe, D., Abe, K., & Ichihara, A. (2022) · Hypertension Research · doi:10.1038/s41440-022-00939-8 · Cited by 1
Pişkin, F. C., Odabaş, F., Aksoydan, Ü. P., & Akkuş, G. (2023) · Çukurova medical journal (Online)/Çukurova medical journal · doi:10.17826/cumj.1319639 · Cited by 1
Management of adrenal incidentalomas: who, why and how?
Araujo-Castro, M., Iriarte-Durán, M. B., Ramírez, P. A. P., & Donato, S. (2025) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000917 · Cited by 1
Salam, S., Memon, N., Amini, M., & Sachmechi, I. (2025) · Open Journal of Endocrine and Metabolic Diseases · doi:10.4236/ojemd.2025.1511021 · Cited by 1
Deryol, H. Y., Tek, S., Akpinar, E., Erkan, B., Keskin, Ü., Tuna, M. M., Niyazoğlu, M., & Hatipoğlu, E. (2026) · HORMONES · doi:10.1007/s42000-025-00750-3 · Cited by 2
“Although all three tests are indicative of free cortisol levels, the finding in this study that HCC aligns with LNSC but not with UFC may be due to UFC’s lower sensitivity, reflecting hyper - cortisolemia [25, 26 ].”
The effect of adrenalectomy on the patients with Mild Autonomous Cortisol Secretion
Köstek, M., Roy, R., Gillis, A., Chen, H. Y., & Lindeman, B. M. (2026) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2026.116922 · Cited by 1
Screening of subclinical Cushing's syndrome in patients with arterial hypertension
Третяк, О. Е., & Черенько, С. М. (2018) · Clinical endocrinology and endocrine surgery · doi:10.24026/1818-1384.1(61).2018.126905 · Cited by 1
“Два ретроспективных исследования демонстрируют также более высокий уровень сердечно-сосудистых катастроф и смертности от всех причин среди пациентов с подтвержденной автономной гиперпродукцией кортизола [12].”
Bancos, I., Terzolo, M., & Arlt, W. (2022) · doi:10.1093/med/9780198870197.003.0095 · Cited by 1
Comprehensive evaluation of adrenal cortical cancer: Single-center 22-year experience
Achras, B. A., Zakhour, J., Chauhan, A., Bena, J., Yogi-Morren, D., Pantalone, K. M., & Rao, P. P. R. (2023) · Endocrine and Metabolic Science · doi:10.1016/j.endmts.2023.100133 · Cited by 1
Challenges and controversies in adrenal surgery: A practical approach
Beninato, T. M., Duh, Q., Long, K. L., Kiernan, C. M., Miller, B. S., Patel, S. G., Randle, R. W., Wachtel, H., Zanocco, K. A., Zern, N. K., et al. (2023) · Current Problems in Surgery · doi:10.1016/j.cpsurg.2023.101374 · Cited by 1
Silent risk of ascending artery dilatation in non-functional adrenal incidentaloma
Yamazaki, O., Chonan, A., Yakuwa, Y., & Shibata, S. (2025) · Hypertension Research · doi:10.1038/s41440-025-02274-0 · Cited by 1
Lirov, R., & Gauger, P. G. (2018) · Springer eBooks · doi:10.1007/978-981-10-1124-5_26 · Cited by 1
Cushing’s Syndrome and Cardiovascular Risk
Anagnostis, P. G., & Goulis, D. G. (2019) · Current Vascular Pharmacology · doi:10.2174/1570161117999190318142847 · Cited by 1
Ragnarsson, Ó. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96120-2.00006-6 · Cited by 1
Candemir, B., Haymana, C., & Candemir, M. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab031 · Cited by 1
(2000) · Time to knit · doi:10.1016/j.ysur.2015.03.119 · Cited by 1
L'incidentalome surrénalien, étude du statut métabolique et de la fibrinolyse
Thebert, J. (2015) · HAL
Long-Term Effects of Prior Cushing’s Syndrome
Aulinas, A., Valassi, E., Resmini, E., Vives, A. S., Crespo, I., Barahona, M. J., & Webb, S. M. (2016) · Springer eBooks · doi:10.1007/978-3-319-45950-9_11
Adrenal Cushing’s Syndrome: Updates on Overt and Mild Hypercortisolism
Escobar, J. S., Ravikumar, A., & Levine, A. C. (2017) · Contemporary Endocrinology · doi:10.1007/978-3-319-62470-9_10
Surgical Considerations in Subclinical Cushing’s Syndrome. When is it Time to Operate?
Nixon, A. M., Aggeli, C., Tserkezis, C., & Zografos, G. (2018) · Hellenic Journal of Surgery · doi:10.1007/s13126-018-0431-9
“(DM) and osteoporosis, among other disorders [9-11].”
Adrenal incidentaloma: management of patients with functionally autonomous cortisol synthesis
Chzhen, T. R., Киселева, Т. П., & Торосян, М. Р. (2019) · Kazan medical journal · doi:10.17816/kmj2019-277
“[69] также представили аналогичные результаты в ретроспективном исследовании, опубликованном в конце 2014 г.”
Therapy of mild cortisol excess
Iqbal, A., & Newell-Price, J. D. C. (2019) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2019.08.019
Self-citationKirnap, N. G., Öztekin, S., & Tütüncü, N. B. (2020) · Dicle Medical Journal / Dicle Tip Dergisi · doi:10.5798/dicletip.706119
Nonfunctioning Adrenal Cortical Adenomas
Nosé, V. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-52480-3.50084-6
Dalmazi, G. D., & Pagotto, U. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab032
Sagara, R., Inoue, T., Sonoda, N., Yano, C., Motoya, M., Umakoshi, H., Sakamoto, R., & Ogawa, Y. (2021) · Research Square · doi:10.21203/rs.3.rs-415041/v1
Adrenal Incidentalomas and Autonomous Cortisol Secretion
Tsomos, E., & Levine, A. C. (2022) · Springer eBooks · doi:10.1007/978-3-030-84367-0_18
Adrenal Mass in a Patient With a History of Extraadrenal Malignancy: The Role of Imaging
Young, W. F., & Bancos, I. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-79285-1.00002-9
Yanase, T. (2019) · Nihon Naika Gakkai Zasshi · doi:10.2169/naika.108.2148
Мислення Як Фактор Самотворення Людини: Ситуація Антропоезису
Володимирівна, І. Н. (2016) · INFM-OAR (INFN Catania) · doi:10.5281/zenodo.208936
Antonić, T., Petrović-Mucok, A., & Stefanović, A. (2022) · Arhiv za farmaciju · doi:10.5937/arhfarm72-36043
Il rischio cardiovascolare nel paziente con lesione surrenalica
Tucci, L., & Dalmazi, G. D. (2022) · L Endocrinologo · doi:10.1007/s40619-022-01148-8
“Debono, 2014 [14] Retrospettivo 95 111 n.”
Roienko, Y. V. (2022) · Ukraïnsʹkij žurnal medicini bìologìï ta sportu · doi:10.26693/jmbs07.06.100
A rare case of Cushing’s syndrome presenting with dilated cardiomyopathyPreprint
Erdoğan, B. T., Helvacı, B. C., Housseın, M., Postacı, A., Kafes, H., Seyrek, F. N. Ç., Aydın, C., Ersoy, R., Topaloğlu, O., & Çakır, B. (2023) · Research Square · doi:10.21203/rs.3.rs-2849040/v1
Adrenocortical Carcinoma and Adrenal Metastasis
Owusu‐Brackett, N., & Miller, B. S. (2024) · Contemporary surgical clerkships · doi:10.1007/978-3-031-62091-1_22
Haissaguerre, M., & Tabarin, A. (2020) · EMC - Endocrinologie - Nutrition · doi:10.1016/s1155-1941(19)83573-4
Normetanefrina urinaria: un predittore del rischio di mortalità nei pazienti con adenomi surrenalici
Colle, R., & Lania, A. G. (2025) · L Endocrinologo · doi:10.1007/s40619-025-01669-y
Meucci, R., Stigliano, A., Campagna, G., Garaci, F. G., Pintus, T., Roberto, G., & Signore, A. (2025) · Cancers · doi:10.3390/cancers17172897
Telomere length in patients with non-functional adrenal incidentalomas
Kutbay, N. Ö., Özcan, S. S., Turkmen, A., Güney, S. C., Hekimsoy, Z., & Korkmaz, M. (2026) · Endocrine Journal · doi:10.1507/endocrj.ej26-0033 · Cited by 1
“Most adrenal tumors are considered non-functional and therefore not associated with major health risks [3].”
Lee, J., Fukuoka, H., Park, S. S., Hong, A. R., Kim, J. H., Chin, S. O., Baek, H.-S., Lim, D., Kageyama, K., Nishiyama, M., et al. (2026) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2707
“This threshold was established based on studies demonstrating that post-dexamethasone cortisol levels above 1.8 µg/dL are associated with increased morbidity and mortality, even in patients without overt CS [38].”
InfluentialMore liberal use of bilateral adrenalectomy for bilateral adrenal tumours with cortisol excess
Duh, Q., & Mulder, M. B. (2026) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(25)00354-7
Engin, İ., & Tuna, M. M. (2026) · Medicina · doi:10.3390/medicina62030553 · Cited by 1
“While MACS is characterized by cortisol excess without the overt clinical features of Cushing’s syndrome, accumulating evidence demonstrates its association with increased cardiometabolic morbidity, including hypertension, diabetes, dyslipidemia, and reduced bone mineral density [3,4].”
Bonnet-Serrano, F. (2021) · theses.fr (ABES) · doi:10.70675/022bf2ffz5b62z4303z9460z55629099aab6
Morelli, V., Strata, M., Palmieri, S., Aresta, C., Favero, V., Frigerio, S., Pugliese, F., Musolino, A., Dall'Antonia, A., Corbetta, S., et al. (2026) · Journal of Endocrinological Investigation · doi:10.1007/s40618-026-02872-w · Cited by 1
“…Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, the cardiovascular mortality in patients with mild hyper-cortisolism is not related just to presence of diabetes and arterial hypertension [23 – 25].”
InfluentialChasseloup, F. (2022) · theses.fr (ABES) · doi:10.70675/ddec5b6dzf376z4aadz9970zf0bf052c6f02
Risk factors for adrenal insufficiency after adrenalectomy for mild autonomous cortisol secretion
Aggarwal, A., Balkan, A. O., Sistla, D., Mastandrea, K., Dassanaike-Perera, M., Seethala, R. R., Leung, J. H., Yip, L., Ramonell, K. M., McCoy, K. L., et al. (2026) · Surgery · doi:10.1016/j.surg.2026.110307
Akkuş, G., Kolsuz, İ., Arslan, Y. K., Pişkin, F. C., Evran, M., Sert, M., Tetıker, T., İnce, Y. E., Örs, A., Yılmaz, N., et al. (2026) · Endocrine · doi:10.1007/s12020-026-04667-8
Çakır, İ., Misiroglu, F., Belten, Z. E., et al. (2026) · Hormone and Metabolic Research · doi:10.1055/a-2874-9528
Hypercortisolism: Causes, Consequences and Clinical Significance – A Review of Pathophysiology
Eldib, M., Fierro, F. E., Abad, M. O., & Correa, R. R. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71022 · Cited by 1
Eisa, N., & Khoury, M. (2026) · Journal of Hypertension · doi:10.1097/hjh.0000000000004367
Akıllı, R. E., Aksoydan, Ü. P., Tepe, Ö., Akkuş, G., Deveci, O. S., Akray, A., & Günay, İ. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15166378
“Interventricular septal thickness also differed between the groups (median, 10 [9–11] vs. 10 [9–10] mm; p = 0.040), whereas posterior wall thickness and the remaining structural parameters were comparable. https://doi.org/10.3390/jcm15166378 In unadjusted analyses of the entire cohort, nominal…”
InfluentialZiccardi, L., Romano, A., Moltoni, G., Carolis, A. D., Aloini, M. E., Cavallari, M., Roberto, G., Bozzao, A., Giubilei, F., & Stigliano, A. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1913085
“Although often clinically silent, MACS is associated with increased morbidity and mortality (4 – 7).”
Velasco-López, J. A., Martínez, J. J. A., Martínez, M. G., Jiménez-Martínez, C., Moya, A. J. M., & Lamas, C. (2026) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2026.501904
Korkmaz, E. S., Gökçe, B. Ö., & Kebapçı, M. N. (2026) · Endocrine · doi:10.1007/s12020-026-04794-2
“Debono et al. demonstrated an association between increasing post-DST cortisol levels and mortality, whereas Di Dalmazi et al. reported that mild cortisol excess was associated with a higher risk of cardio-vascular events and mortality [ 14, 15].”
Metadata
- Authors
- Debono, M., Bradburn, M., Bull, M., Harrison, B., Ross, R. J., & Newell-Price, J.
- Affiliations
- National Health Service (GB)
- University of Sheffield (GB)
- Corresponding author
- Newell-Price, John
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-12
- Volume
- 99
- Issue
- 12
- Pages
- 4462-4470
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC4255126
- OpenAlex
- W1968633315
- Semantic Scholar
- 137d1f8a2ad1b183c0a736363bfdd73ae4786040
- Cited by
- 269
- References
- 53
- Citations by year
- 2026: 21 · 2025: 15 · 2024: 18 · 2023: 23 · 2022: 30 · 2021: 35 · 2020: 26 · 2019: 22 · 2018: 24 · 2017: 22 · 2016: 18 · 2015: 15
- FWCI
- 18.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (CL-2013-04-001, BRF-2011-005)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenal incidentaloma, adrenal adenoma, cortisol, mortality, dexamethasone suppression test, hypercortisolism, Cushing's syndrome, survival, cardiovascular disease, infection
- MeSH terms
- Adrenal Cortex Neoplasms, Adrenal Gland Neoplasms, Aged, Aged, 80 and over, Dexamethasone, Female, Humans, Hydrocortisone, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Cohort Studies, Biomarkers, Survival Analysis
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