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Cited by 73Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma.

Eller-Vainicher, Cristina, Morelli, Valentina, Salcuni, Antonio Stefano, Battista, Claudia, Torlontano, Massimo, Coletti, Francesca, Iorio, Laura, Cairoli, Elisa +5 more·2010·European Journal of Endocrinology
DOI 10.1530/eje-10-0602
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Abstract

CONTEXT: It is unknown whether the metabolic effects of the removal of an adrenal incidentaloma (AI) can be predicted by the assessment of cortisol hypersecretion before surgery. OBJECTIVE: To evaluate the accuracy of several criteria of hypothalamic-pituitary-adrenal axis activity in predicting the metabolic outcome after adrenalectomy. DESIGN: Retrospective longitudinal study. PATIENTS: In 55 surgically treated AI patients (Group 1) before surgery and in 53 nontreated AI patients (Group 2) at the baseline, urinary free cortisol (UFC), cortisol after 1 mg overnight dexamethasone-suppression test (1 mg-DST), ACTH, and midnight serum cortisol (MSC) were measured. In Groups 1 and 2, metabolic parameters were evaluated before and 29.6 ± 13.8 months after surgery and at the baseline and after 35.2 ± 10.9 months respectively. MAIN OUTCOME MEASURES: The improvement/worsening of weight, blood pressure, glucose, and cholesterol levels (endpoints) was defined by the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATP III criteria respectively. The accuracy of UFC, 1 mg-DST, ACTH, and MSC, singularly taken or in combination, in predicting the improvement/worsening of ≥ 2 endpoints was calculated. RESULTS: The presence of ≥ 2 among UFC>70 μg/24 h (193 nmol/l), ACTH<10 pg/ml (2.2 pmol/l), 1 mg-DST>3.0 μg/dl (83 nmol/l) (UFC-ACTH-DST criterion) had the best accuracy in predicting the endpoints' improvement (sensitivity (SN) 65.2%, specificity (SP) 68.8%) after surgery. In the nontreated AI patients, this criterion predicted the worsening of ≥ 2 endpoints (SN 55.6%, SP 82.9%). CONCLUSIONS: The UFC-ACTH-DST criterion seems to be the best for predicting the metabolic outcome in surgically treated AI patients.

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Crossref · 10.1530/eje-10-0602

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  • In more than 25% of patients with adrenal incidentalomas, cortisol is not suppressed after 1-mg or 3-mg overnight dexamethasone suppression testing or 2-day low-dose dexamethasone suppression testing.

    “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)”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [60]

  • Few studies have reported elevated urinary free cortisol levels in more than 25% of patients with adrenal incidentalomas.

    “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).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [60]

  • Midnight serum cortisol is a promising tool for diagnosing subclinical hypercortisolism, but its use is limited by the need for hospital admission.

    “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).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [60]

  • In a recent retrospective study of 55 surgically treated and 33 conservatively treated adrenal incidentaloma patients, the DST-UFC-ACTH combination criterion showed the best accuracy in predicting improvement (sensitivity 65.2%, specificity 68.8%) in surgical patients and worsening (sensitivity 55.6%, specificity 82.9%) in conservative patients.

    “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.”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [60]

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

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

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [60]

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Authors
Eller-Vainicher, C., Morelli, V., Salcuni, A. S., Battista, C., Torlontano, M., Coletti, F., Iorio, L., Cairoli, E., Beck-Peccoz, P., Arosio, M., Ambrosi, B., Scillitani, A., & Chiodini, I.
Affiliations
  • University of Milan (IT)
  • Casa Sollievo della Sofferenza (IT)
  • MultiMedica (IT)
Corresponding author
Chiodini, Iacopo
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2010-12
Volume
163
Issue
6
Pages
925-935
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-10-0602
OpenAlex
W2160895897
Cited by
73
References
42
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 8 · 2020: 2 · 2019: 2 · 2018: 7 · 2017: 2 · 2016: 10 · 2015: 9 · 2014: 7 · 2013: 2 · 2012: 7
FWCI
4.72
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
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, adrenalectomy, hypothalamic-pituitary-adrenal axis, cortisol hypersecretion, urinary free cortisol, dexamethasone suppression test, ACTH, weight change, blood pressure, glucose, cholesterol
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Adult, Aged, Dexamethasone, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Longitudinal Studies, Male, Middle Aged, Pituitary-Adrenal System, Predictive Value of Tests, Retrospective Studies, Sensitivity and Specificity, Incidental Findings

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