CoChat
Sign Up
Cited by 206Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)

Osella, G, Terzolo, M, Borretta, G, Magro, G, Alí, A, Piovesan, A, Paccotti, P, Angeli, A·1994·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jcem.79.6.7989452
Open this paper in CoChat — free account

Abstract

Since 1989, 45 patients [pts; 26 females and 19 males, aged 19-79 yr (median, 58)] bearing incidentally discovered adrenal masses were studied. The aim of the study was to verify the prevalence of hormone activity in clinically silent adrenal masses. Endocrine work-up included determination of urinary catecholamines and their metabolites, measurement of PRA and aldosterone levels in clino- and orthostatic posture, and basal and dynamic [dexamethasone (dex) suppression and ovine CRH stimulation] evaluation of hypothalamic-pituitary-adrenal axis. The most frequent finding was the reduction of dehydroepiandrosterone sulfate (DHEA-S) levels below the third percentile of controls in 19 (42%) pts. DHEA-S levels were significantly lower in pts than in controls [68 (range, 5-1000) vs. 208 (34-326) micrograms/dL; 1.8 (0.1-27.1) vs. 5.6 (0.9-8.8) mumol/L; P < 0.001]. Three pts (7%) had high 24-h mean serum cortisol levels, and 6 (14%) had blunted day-night amplitude of cortisol rhythm. Defective dex suppressibility was found in 15% of pts vs. 8% of controls (P < 0.05). ACTH and cortisol responses to ovine CRH did not significantly differ between pts and controls, although blunted ACTH responses were found in 22% of the cases. The above-mentioned endocrine alterations could be accounted for by autonomous cortisol secretion by the adrenal nodule at a rate not sufficient to give clinical expression, but able to inhibit to some extent the hypothalamic-pituitary-adrenal axis. These results indicate that silent cortisol hypersecretion is frequently observed in pts with adrenal incidentaloma even if progression to overt Cushing's syndrome seems unlikely. Indeed, the size of the mass and the hormone pattern remained substantially unchanged in 9 pts followed up for 12 months. From merely a cost/benefit ratio, the evaluation of DHEA-S levels and dex suppression has sufficient sensitivity to identify the occurrence of silent hypercortisolism.

Integrity signals

Registry

Crossref · 10.1210/jcem.79.6.7989452

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

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?

  • All studies consistently report a higher incidence of ACC if the adrenal mass is greater than 4 cm in size.

    “However, it should be noted that all studies consistently report a higher incidence of ACC if the adrenal mass is greater than 4 cm in size (39,49,63,66,71).”

    From Adrenal incidentaloma (2020) · cites this paper as [49]

  • The 1-mg dexamethasone suppression test is the most used test for diagnosing subclinical hypercortisolism.

    “To date, the 1-mg DST is the most used test to diagnose SH, either alone (34 -36, 38, 44 -46) or in combination with other parameters (9, 18, 21, 32, 37, 39, 42, 49, 52-54, 56, 60, 61).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [35]

  • Available data do not demonstrate that low DHEAS concentration is a reliable index of subclinical hypercortisolism.

    “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).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [35]

  • Increased radiotracer uptake may reflect enlarged adrenal tissue rather than increased cortisol secretion.

    “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).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [35]

  • Determining ACTH levels after CRH does not add any advantage to screening for subclinical hypercortisolism.

    “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.”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [35]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Osella, G., Terzolo, M., Borretta, G., Magro, G., Alí, A., Piovesan, A., Paccotti, P., & Angeli, A.
Affiliations
University of Turin (IT)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
1994-12
Volume
79
Issue
6
Pages
1532-1539
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jcem.79.6.7989452
OpenAlex
W2110140957
Cited by
206
References
41
Citations by year
2025: 1 · 2024: 2 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 4 · 2014: 4 · 2013: 1 · 2012: 3
FWCI
10.87
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
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
adrenal incidentaloma, adrenal mass, dexamethasone suppression test, dehydroepiandrosterone sulfate, hypothalamic-pituitary-adrenal axis, ACTH response, cortisol rhythm, urinary catecholamines, aldosterone, Cushing's syndrome
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Adult, Aged, Aldosterone, Carcinoma, Catecholamines, Corticotropin-Releasing Hormone, Dehydroepiandrosterone, Dexamethasone, Female, Hormones, Humans, Hydrocortisone, Male, Middle Aged, Pheochromocytoma, Renin, Tomography, X-Ray Computed, Ultrasonography, Dehydroepiandrosterone Sulfate

About these checks

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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review