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Cited by 83Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas.

Valli, N, Catargi, B, Ronci, N, Vergnot, V, Leccia, F, Ferriere, JM, Chene, G, Grenier, N +2 more·2001·European Journal of Endocrinology
DOI 10.1530/eje.0.1440401
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Abstract

OBJECTIVE: Biochemistry and I-6beta-iodomethyl norcholesterol scintigraphy (IMS) have both been used to assess cortisol secretion by adrenocortical incidentalomas. However, which biochemical abnormalities indicate subclinical corticoid excess is still debatable whilst IMS is expensive and cumbersome. The aim of the study was to evaluate prospectively patients with adrenal incidentalomas using both IMS and biochemical methods to examine whether the IMS pattern is associated with biochemical abnormalities and, if this is so, to find a biochemical parameter that could be used as a screening test to identify a subset of patients on whom IMS could subsequently be performed. METHODS: Thirty-one patients with benign cortical adenomas were recruited from 43 consecutive patients with adrenal incidentalomas. All 31 patients underwent IMS and measurement of (i) 0800 h serum cortisol, ACTH, dehydroepiandrosterone and 17-hydroxyprogesterone; (ii) midnight serum cortisol; (iii) 2400 h excretion of urinary free cortisol; (iv) cortisol after the overnight 1 mg dexamethasone (DEX) suppression test; (v) cortisol after an i.v. 4 mg DEX test; (vi) determination of the diurnal variation in serum cortisol. RESULTS: Sixty-one per cent of patients displayed unilateral uptake during IMS and 39% showed bilateral uptake. Patients with unilateral uptake exhibited significantly lower ACTH concentrations (P=0.0005), higher midnight cortisol concentrations (P=0.02), disrupted diurnal variation of serum cortisol (P=0.02) and higher cortisol concentrations after DEX suppression tests (P=0.01). Cortisol concentrations following the two DEX suppression tests correlated closely (r=0.80, P=0.0001). The i.v. 4 mg DEX test was clearly more sensitive for the diagnosis of unilateral uptake than the overnight 1 mg DEX test (76 vs 52%). Using various thresholds of cortisol concentration following the overnight 1 mg DEX test, it was found that the sensitivity of the test could be improved to 100% if the threshold was set at 60 nmol/l rather than the classical value of 138 nmol/l. All patients but one with post-test serum cortisol concentrations above 60 nmol/l as against none of patients with cortisol below 60 nmol/l exhibited at least one associated biochemical abnormality indicating subclinical glucocorticoid excess. CONCLUSION: In adrenocortical incidentalomas, unilateral uptake during IMS suggests subclinically excessive and/or autonomous cortisol secretion. A cortisol concentration above 60 nmol/l following the overnight 1 mg DEX test is highly correlated with unilateral uptake and is associated with biochemical abnormalities indicating subclinical glucocorticoid excess. Our results favour the use of the 1 mg overnight DEX test with revised criteria of interpretation as a screening test for subclinical hypercortisolism among patients with adrenocortical incidentalomas.

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Crossref · 10.1530/eje.0.1440401

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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 [48]

  • 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 [48]

  • Low serum ACTH levels are frequently found in patients with adrenal incidentalomas.

    “Low serum ACTH levels are frequently found in AI patients (19,21,32,36,40,43,44,48,49,56,60,61).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [48]

  • The 1-mg dexamethasone suppression test cutoff of 3.0 g/dl showed the best compromise between sensitivity (63%) and specificity (75%).

    “The 1-mg DST cutoff of 3.0 g/dl (83 nmol/liter) showed the best compromise between sensitivity (63%) and specificity (75%) (48).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [48]

  • 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 [48]

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Authors
Valli, N., Catargi, B., Ronci, N., Vergnot, V, Leccia, F., Ferriere, J., Chene, G., Grenier, N., Laurent, F., & Tabarin, A.
Affiliations
Centre Hospitalier Universitaire de Bordeaux (FR)
Corresponding author
Tabarin, A
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2001-04-01
Volume
144
Issue
4
Pages
401-408
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje.0.1440401
OpenAlex
W2002295185
Cited by
83
References
36
Citations by year
2025: 1 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 4 · 2014: 4 · 2013: 3 · 2012: 7
FWCI
4.63
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
dexamethasone suppression test, ACTH, urinary free cortisol, 17-hydroxyprogesterone, dehydroepiandrosterone, screening test
MeSH terms
Adenoma, Adosterol, Adrenal Cortex Hormones, Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Adult, Aged, Aged, 80 and over, Female, Humans, Hydrocortisone, Male, Middle Aged, Radionuclide Imaging, Radiopharmaceuticals

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