scholarly journals Frailty in Patients With Mild Autonomous Cortisol Secretion is Higher Than in Patients with Nonfunctioning Adrenal Tumors

2020 ◽  
Vol 105 (9) ◽  
pp. e3307-e3315
Author(s):  
Sumitabh Singh ◽  
Elizabeth J Atkinson ◽  
Sara J Achenbach ◽  
Nathan LeBrasseur ◽  
Irina Bancos
Keyword(s):  
Outcome Measure ◽  
Adrenal Adenoma ◽  
Frailty Index ◽  
Adrenal Tumors ◽  
Cortisol Secretion ◽  
Comorbid Conditions ◽  
Sleep Difficulty ◽  
Deficit Model ◽  
Autonomous Cortisol Secretion ◽  
Dexamethasone Suppression

Abstract Context Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal adenomas. Frailty is a syndrome characterized by the loss of physiological reserves and an increase in vulnerability, and it serves as a marker of declining health. Objective To compare frailty in patients with MACS versus patients with nonfunctioning adrenal tumors (NFAT). Design Retrospective study, 2003-2018 Setting Referral center Patients Patients >20 years of age with adrenal adenoma and MACS (1 mg overnight dexamethasone suppression (DST) of 1.9-5 µg/dL) and NFAT (DST <1.9 µg/dL). Main outcome measure Frailty index (range 0-1), calculated using a 47-variable deficit model. Results Patients with MACS (n = 168) demonstrated a higher age-, sex-, and body mass index–adjusted prevalence of hypertension (71% vs 60%), cardiac arrhythmias (50% vs 40%), and chronic kidney disease (25% vs 17%), but a lower prevalence of asthma (5% vs 14%) than patients with NFAT (n = 275). Patients with MACS reported more symptoms of weakness (21% vs 11%), falls (7% vs 2%), and sleep difficulty (26% vs 15%) as compared with NFAT. Age-, sex- and BMI-adjusted frailty index was higher in patients with MACS vs patients with NFAT (0.17 vs 0.15; P = 0.009). Using a frailty index cutoff of 0.25, 24% of patients with MACS were frail, versus 18% of patients with NFAT (P = 0.028). Conclusion Patients with MACS exhibit a greater burden of comorbid conditions, adverse symptoms, and frailty than patients with NFAT. Future prospective studies are needed to further characterize frailty, examine its responsiveness to adrenalectomy, and assess its influence on health outcomes in patients with MACS.

scholarly journals SAT-LB37 Frailty in Patients With Mild Autonomous Cortisol Secretion Is Higher Than Patients With Nonfunctioning Adrenal Tumors

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
sumitabh singh ◽  
Elizabeth Atkinson ◽  
Sara Achenbach ◽  
Irina Bancos
Keyword(s):  
Adrenal Adenoma ◽  
Frailty Index ◽  
Adrenal Tumors ◽  
Cortisol Secretion ◽  
Sleep Difficulty ◽  
Deficit Model ◽  
Adrenal Hormone ◽  
Tertiary Center ◽  
Autonomous Cortisol Secretion ◽  
Missing Variables

Abstract Background: Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal adenomas. Frailty is a syndrome characterized by diminished strength and endurance and serves as a marker of declining health and dependency. We hypothesized that patients with MACS are more frail when compared to patients with nonfunctioning adrenal tumors (NFAT). Methods: This is a retrospective study of adult patients with adrenal adenoma evaluated at a tertiary center from 2004 to 2018. MACS and NFAT were defined as cortisol after 1 mg overnight dexamethasone suppression (DST) between 1.8-5 mcg/dl and <1.8 mcg/dl, respectively. Frailty index (FI, range 0-1) was calculated using a 47 variables -deficit model (20 comorbidities, 14 activities of daily living, and 13 symptoms). Patients were excluded if treated with exogenous glucocorticoids, if diagnosed with overt adrenal hormone excess, another adrenal disorder, or if missing variables of interest. Results: MACS was diagnosed in 168 patients (67% women) at a median age 65 (30-91) years and NFAT in 275 patients (61% women) at a median age of 59 (21-84) years. Patients with MACS demonstrated higher prevalence of hypertension (73% vs 62%), cardiac arrhythmias (50% vs 40%), and chronic kidney disease (25% vs 17%), but lower prevalence of asthma (5% vs 14%), when compared to patients with NFAT, p<0.05 for all. Patients with MACS reported more symptoms of weakness (21% vs 11%), falls (7% vs 2%), and sleep difficulty (26% vs 15%) as compared to patients with NFAT, p<0.05 for all. Age, sex and BMI-adjusted FI was higher in patients with MACS vs patients with NFAT (0.17 vs 0.15, p=0.009). Using cut-off FI of 0.2, 42% of patients with MACS were frail, versus 30% of patients with NFAT (p=0.01). Conclusion: Higher frailty in patients with MACS supports a more aggressive management, such as adrenalectomy over conservative follow up. Future prospective studies are needed to characterize frailty in greater detail in patients with MACS, as well as to examine frailty reversal by adrenalectomy.

scholarly journals Diagnostic Accuracy of Dehydroepiandrosterone Sulfate and Corticotropin in Autonomous Cortisol Secretion

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 741
Author(s):  
Lindsay E. Carafone ◽  
Catherine D. Zhang ◽  
Dingfeng Li ◽  
Natalia Lazik ◽  
Oksana Hamidi ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Adrenal Adenoma ◽  
Dehydroepiandrosterone Sulfate ◽  
Adrenal Tumors ◽  
Cortisol Secretion ◽  
Serum Concentrations ◽  
Single Center Study ◽  
Acth Concentration ◽  
Autonomous Cortisol Secretion ◽  
Additional Value

Autonomous cortisol secretion (ACS) affects up to 50% of patients with adrenal adenomas. Despite the limited evidence, clinical guidelines recommend measurement of serum concentrations of dehydroepiandrosterone-sulfate (DHEA-S) and corticotropin (ACTH) to aid in the diagnosis of ACS. Our objective was to determine the accuracy of serum concentrations of DHEA-S and ACTH in diagnosing ACS. We conducted a retrospective single center study of adults with adrenal adenoma evaluated between 2000−2020. Main outcome measure was diagnostic accuracy of DHEA-S and ACTH. ACS was defined as post-dexamethasone cortisol >1.8 mcg/dL. Of 468 patients, ACS was diagnosed in 256 (55%) patients with a median post-DST cortisol of 3.45 mcg/dL (range, 1.9–32.7). Patients with ACS demonstrated lower serum concentrations of DHEA-S (35 vs. 87.3 mcg/dL, p < 0.0001) and ACTH (8.3 vs. 16 pg/mL, p < 0.0001) compared to patients with non-functioning adrenal tumors (NFAT). Serum DHEA-S concentration <40 mcg/dL diagnosed ACS with 84% specificity and 81% PPV, while serum ACTH concentration <10 pg/mL diagnosed ACS with 75% specificity and 78% PPV. The combination of serum concentrations of DHEA-S <40 mcg/dL and ACTH <10 pg/mL diagnosed ACS with the highest accuracy with 92% specificity and 87% PPV. Serum concentrations of DHEA-S and ACTH provide additional value in diagnosing ACS.

The association between adrenal adenoma size, autonomous cortisol secretion and metabolic derangements

2021 ◽  
Author(s):  
Jonathan Bleier ◽  
Jana Pickovsky ◽  
Sara Apter ◽  
Boris Fishman ◽  
Zohar Dotan ◽  
...  
Keyword(s):  
Adrenal Adenoma ◽  
Cortisol Secretion ◽  
Autonomous Cortisol Secretion

scholarly journals Cardiovascular Outcomes in Autonomous Cortisol Secretion and Nonfunctioning Adrenal Adenoma: A Systematic Review

2019 ◽  
Vol 3 (5) ◽  
pp. 996-1008 ◽  
Author(s):  
Jane Park ◽  
Alyssa De Luca ◽  
Heidi Dutton ◽  
Janine C Malcolm ◽  
Mary-Anne Doyle
Keyword(s):  
Systematic Review ◽  
Adrenal Adenoma ◽  
Cardiovascular Outcomes ◽  
Cortisol Secretion ◽  
Autonomous Cortisol Secretion

scholarly journals OR25-06 Morning ACTH Levels as a Reliable Biomarker for Excluding Autonomous Cortisol Secretion in Incidetally Discovered Adrenal Adenomas. A Prospective Cohort

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Roberto Ignacio Olmos ◽  
Stefano Pietro Macchiavello ◽  
Anand Vaidya ◽  
Consuelo Robles ◽  
Javiera Gutierrez ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Prospective Cohort ◽  
Adrenal Adenoma ◽  
Negative Likelihood Ratio ◽  
Inverse Association ◽  
Cortisol Secretion ◽  
Morning Cortisol ◽  
Autonomous Cortisol Secretion

Abstract Adrenal incidentalomas are common with a prevalence of 3-10% and in up to 30% of cases may have probable autonomous cortisol secretion. Hypercortisolism is associated with substantial cardiometabolic morbimortality and can physiologically decrease ACTH levels. Objective: To determine the sensitivity, specificity, and positive and negative predictive values of ACTH levels in evaluating autonomous cortisol secretion in a prospective cohort of incidentally discovered adrenal adenomas. Methods: We prospectively evaluated 224 consecutive adult subjects with incidentally discovered adrenal masses on computed tomography. Finally, 168 participants with radiographic adenoma criteria underwent systematic hormonal assessment, including measurements of morning cortisol and ACTH on day 1, and a 1 mg dexamethasone suppression test (DST) on day 2. Hypercortisolism was excluded if the DST was &lt; 1.8 mcg/dL. Autonomous cortisol secretion was defined as a DST &gt; 5.0 mcg/dL and DST levels of 1.8-5.0 mcg/dL were considered to be possibly autonomous hypercortisolism. We evaluated the correlation of ACTH levels with clinical, radiographic, and endocrine variables. In order to identify the most sensitive threshold value for diagnosing autonomous cortisol secretion, we determined ROC curves and negative likelihood ratio (NLR). Concordance of repeated ACTH was assessed using Bland Altman analysis. Results: The characteristics of the cohort were mean age 56 (+/- 11.8) years, 76% female, adenoma size 19 (+/- 7) mm, and 13% bilateral adenomas. Mean ACTH was 15 (+/- 11) pg/ml (range 5-72) and the mean DST was 2.2 (+/- 3.0) ug/dL (range 0.4-25.9). Fifty-four (32%) participants had a DST ≥1.8mcg/dL and 13 (8%) a DST≥5.0 mcg/dL. We found no correlation between ACTH levels and age, gender or body mass index. ACTH was inversely associated with adrenal adenoma diameter (r=-3.3 p=0.002) and volume (r=-2.9 p=0.008). There was an inverse association between ACTH and DST values (r=-3.1 p=0.01). In the subgroup of patients with a second ACTH measurement we found high concordance, with mean difference of 0.16+/-3.6 pg/ml (p=0.83). ROC analysis showed that an ACTH ≥20 pg/ml had a sensitivity of 98% to exclude hypercortisolism, with a negative predictive value of 97% and a negative likelihood ratio of 0.06. The only case with DST≥1.8 and ACTH≥20 had Cushing′s phenotype with both an adrenal adenoma and a pituitary ACTH-producing adenoma. Systematic evaluation of morning cortisol and ACTH allowed the detection of 5 cases of false negative low DST values due to the use of non-oral corticosteroids. Conclusion: In this cohort, an ACTH ≥20pg/ml excluded autonomous cortisol secretion with excellent sensitivity and negative predictive value, providing strong reassurance that there is no clinically relevant hypercortisolism. Therefore, subjects with a normal DST and ACTH ≥20pg/ml should be candidates for relaxed surveillance.

scholarly journals Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test

2017 ◽  
Vol 176 (6) ◽  
pp. 705-713 ◽  
Author(s):  
Grethe Å Ueland ◽  
Paal Methlie ◽  
Ralf Kellmann ◽  
Marit Bjørgaas ◽  
Bjørn O Åsvold ◽  
...  
Keyword(s):  
Simultaneous Measurement ◽  
High Sensitivity ◽  
Cortisol Secretion ◽  
Replication Cohort ◽  
Non Invasive ◽  
Liquid Chromatography Tandem Mass ◽  
Suppression Test ◽  
Autonomous Cortisol Secretion ◽  
Design And Methods ◽  
Dexamethasone Suppression

ObjectivesThe overnight dexamethasone (DXM) suppression test (DST) has high sensitivity, but moderate specificity, for diagnosing hypercortisolism. We have evaluated if simultaneous measurement of S-DXM may correct for variable DXM bioavailability and increase the diagnostic performance of DST, and if saliva (sa) is a feasible adjunct or alternative to serum.Design and methodsProspective study of DST was carried out in patients with suspected Cushing’s syndrome (CS) (n = 49), incidentaloma (n = 152) and healthy controls (n = 101). Cortisol, cortisone and DXM were assayed by liquid chromatography–tandem mass spectrometry (LC–MS/MS).ResultsThree hundred and two subjects underwent DST; S-cortisol was ≥50 nmol/L in 83 patients, of whom 11 had CS and 27 had autonomous cortisol secretion. The lower 2.5 percentile of S-DXM in subjects with negative DST (n = 208) was 3.3 nmol/L, which was selected as the DXM cut-off level. Nine patients had the combination of low S-DXM and positive DST. Of these, three had been misdiagnosed as having autonomous cortisol secretion. DST results were highly reproducible and confirmed in a replication cohort (n = 58). Patients with overt CS had significantly elevated post-DST sa-cortisol and sa-cortisone levels compared with controls; 23 of 25 with autonomous cortisol secretion had elevated sa-cortisone and 14 had elevated sa-cortisol.ConclusionsSimultaneous measurement of serum DXM and cortisol reduced false-positive DSTs by 20% and improved the specificity. S-DXM >3.3 nmol/L is sufficient for the suppression of cortisol <50 nmol/L. Measurement of glucocorticoids in saliva is a non-invasive and easy procedure and post-DST sa-cortisone was found particularly useful in the diagnosis of CS.

scholarly journals MON-222 Cardiovascular Risk Factors, Morbidity, and Overall Mortality in Patients with Adrenal Adenomas: A Population-Based Study of 1,003 Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Catherine D Zhang ◽  
Elizabeth J Atkinson ◽  
Sara J Achenbach ◽  
Andreas Ladefoged Ebbehøj ◽  
Dingfeng Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Population Based ◽  
Dexamethasone Suppression Test ◽  
Adrenal Tumors ◽  
Cortisol Secretion ◽  
Peripheral Vascular ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Age And Sex

Abstract Background: Benign adrenal tumors are frequently diagnosed on imaging and may pose health risks to patients regardless of functional status. Both non-functioning adrenal tumors (NFAT) and tumors with mild autonomous cortisol secretion (MACS) have been associated with increased cardiovascular events and risk factors. However, limited data exist on the association of adrenal adenomas with cardiometabolic outcomes in the population-based setting. Aim: 1) To determine the prevalence of cardiovascular co-morbidities and events and 2) to assess mortality in a population-based cohort of patients with adrenal adenomas. Methods: We identified adult patients living in the community diagnosed with an adrenal tumor from 1995-2017 using a medical records linkage system. Adrenal tumors were classified as MACS if cortisol was ≥1.8mcg/dL after 1 mg dexamethasone suppression test, NFAT if cortisol was &lt;1.8 mcg/dL, and adenoma with unknown cortisol secretion (AUCS) if dexamethasone suppression test was not performed. Cardiovascular co-morbidities and events were assessed at baseline. Patients were then followed until death, migration out of the community, or through December 31, 2018. Results were compared to age and sex matched reference subjects without adrenal tumors and adjusted for tobacco use and BMI. Results: A total of 1,003 patients had adrenal adenomas with 136 (14%) NFAT, 86 (9%) MACS, and 781 (78%) AUCS. The median age of diagnosis was 63 years (range, 20-96) and 581 (58%) were women. At baseline, patients with adrenal adenomas were more likely to have hypertension (92% vs 81%, p&lt;0.001), overweight/obesity (89% vs 82%, p&lt;0.001), pre-diabetes/diabetes (82% vs 70%, p&lt;0.001), dyslipidemia (89% vs 82%, p&lt;0.001), and chronic kidney disease (11% vs 7%, p=0.004) than age and sex matched reference subjects. Myocardial infarctions (13% vs 8%, p &lt;0.001), coronary intervention (9% vs 6%, p= 0.007), heart failure (12% vs 6%, p&lt;0.001), peripheral vascular disease (26% vs 15%, p&lt;0.001), and thromboembolic disease (7% vs 3%, p&lt;0.001) were more prevalent in patients with adrenal adenomas, whereas overall survival was lower compared to reference subjects (60% vs 65%, p value = 0.013). Subgroup analysis (adjusted for age, sex, BMI, and smoking) demonstrated prevalence of cardiovascular events including peripheral vascular disease was highest in those with MACS (44.7%), followed by AUCS (40.1%), and then NFAT (36.6%), although differences between groups were not significant. Overall survival was lower in patients with MACS (62%) and AUCS (59%) compared to NFAT (71%), p&lt;0.001. Conclusions: Adrenal adenomas are associated with significantly higher prevalence of cardiovascular risk factors and morbidity at the time of diagnosis and with increased morality during follow-up. Results are potentially related to abnormal cortisol secretion but are limited by suboptimal evaluation for hormone excess.

Sign in / Sign up

Export Citation Format

Share Document