Prevalence of subclinical Cushing’s syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes
Open accessAbstract
Subclinical Cushing's syndrome (SCS) is being detected with increased frequency in patients with adrenal incidentaloma. In the current study, we evaluated the prevalence of SCS in 70 patients with adrenal incidentaloma and compared the main findings on them with other patients with nonfunctional adrenal incidentaloma (NFA). Overnight 3 mg dexamethasone (DXM) suppression test to exclude cortisol hypersecretion, and high dose DXM suppression test to find out patients with SCS, were applied to all subjects. Afterwards, biochemical and clinical findings of patients with SCS were compared with the other patients with NFA. Four of the 70 patients with adrenal incidentaloma were found to have SCS, with a prevalence of 5.7%. Basal ACTH and DHEA-S levels were significantly lower (p < 0.05 and p < 0.01, respectively), and midnight cortisol and 24-hour urinary free cortisol levels were significantly higher in patients with SCS (p < 0.001 and p < 0.05, respectively). Biochemical and metabolic bone parameters were similar in patients with SCS and in patients with NFA. Hypertension, diabetes mellitus, and obesity were more common in patients with SCS. One of the patients with SCS developed adrenocortical insufficiency following unilateral adrenalectomy which lasted for about 6 months. Suppressed ACTH and DHEA-S levels, and high midnight cortisol levels may be some clues for SCS in patients with adrenal incidentaloma. Since patients with SCS frequently have risk factors for atherosclerosis such as hypertension, diabetes, and obesity, and the surgical management of SCS with adrenalectomy may offer an advantage. Patients undergoing adrenalectomy should be followed for the development of adrenal insufficiency.
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The prevalence of impaired glucose tolerance or diabetes has been higher in patients with subclinical Cushing syndrome than in nonfunctioning adenoma or controls, but other studies did not confirm this.
“Focusing on glucose metabolism, the prevalence of IGT or DM has been higher in patients with SCS than in cases of nonfunctioning adenoma or controls (, , , , , , ), but these data were not confirmed by other studies that found much the same prevalence of these comorbidities in SCS as in the overall series of AI and in the general population (, -).”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [210]
Chronic mild cortisol secretion abnormality may be associated with classic metabolic and cardiovascular complications of hypercortisolism.
“A chronic mild cortisol secretion abnormality may be associated with classic metabolic and cardiovascular complications of hypercortisolism (, -).”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [210]
Higher dexamethasone doses of 3 or 8 mg did not show better performance for diagnosing subclinical hypercortisolism.
“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).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [54]
With lower 1-mg dexamethasone suppression test cutoffs of 1.8 and 2.2 g/dl, specificity decreased to 67-72% and sensitivity increased to 75-100%.
“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).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [54]
Several small studies suggested improvement of blood pressure, glucose metabolism, and body weight in surgically treated subclinical hypercortisolism patients.
“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.”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [54]
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References 54 · Cited by 104
Research works printed but not linked: 2
- Hensen J, Buhl M, Oelkers W (1990) Diagnostisches and therapeutisches Vorgehen bei Patienten mit hufallig entdeckten nebennierentumoren. In: Allolio B, Shulte HM (eds): Moderne Diagnostik und thera- peutitische Strategien bei Nebennierenerkrankungen. Stuttgart, Schattuer, pp. 210-215.
- Favus MJ (1993) Bone density reference data. In: Favus MJ (ed) Primer on the Metabolic Bone Disease and Disorders of Mineral Metabolism. New York, Raven Press, 426-430.
- Authors
- EMRAL, R., UYSAL, A. R., ASIK, M., GULLU, S., CORAPCIOGLU, D., TONYUKUK, V., & ERDOGAN, G.
- Affiliations
- Ankara University, School of Medicine, Department of Endocrinology and Metabolic Diseases
- Venue
- Endocrine Journal
- Publisher
- Japan Endocrine Society
- Published
- 2003
- Volume
- 50
- Issue
- 4
- Pages
- 399-408
- ISSN
- 0918-8959 (ISSN-L)
- 1348-4540
- OpenAlex
- W1990442726
- Cited by
- 104
- References
- 54
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 5 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 4 · 2014: 4 · 2013: 7 · 2012: 8
- FWCI
- 3.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrine Journal (publishedVersion)
- PubMed (publishedVersion)
- Çanakkale Onsekiz Mart University AVESIS (submittedVersion)
- 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
- subclinical Cushing's syndrome, adrenal incidentaloma, dexamethasone suppression test, urinary free cortisol, ACTH, dehydroepiandrosterone sulfate, adrenalectomy, adrenal insufficiency, hypertension, diabetes mellitus, obesity, atherosclerosis risk factors
- MeSH terms
- Adrenal Gland Neoplasms, Adrenalectomy, Adult, Aged, Cushing Syndrome, Female, Hormones, Humans, Male, Middle Aged, Prospective Studies, Incidence, Treatment Outcome, Incidental Findings
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