scholarly journals Adrenal incidentalomas: Effect of size on cortisol secretion and clinical features

2021 ◽  
Vol 26 (81) ◽  
pp. 7-32
Author(s):  
Mirjana Stojković ◽  
Jasmina Ćirić ◽  
Biljana Beleslin ◽  
Nemanja Trifunović ◽  
Miloš Stojanović ◽  
...  
Keyword(s):  
Tumour Size ◽  
Adrenal Incidentaloma ◽  
Significant Negative Correlation ◽  
Cortisol Secretion ◽  
T Score ◽  
Morning Cortisol ◽  
Adrenal Masses ◽  
Autonomous Cortisol Secretion ◽  
The Relationship ◽  
Adrenal Disease

Purpose: The aim of this study was to assess the relationship between adrenal incidentaloma size, cortisol secretion suppressibility by Dexamethasone and relevant clinical and laboratory parameters. Methods: This retrospective study included all patients diagnosed with adrenal incidentaloma and admitted to the single department of the Clinic of endocrinology, Diabetes and Diseases of Metabolism during the period from 2012 till the end of 2019. The inclusion criterion was the presence of an asymptomatic adrenal mass on imaging not performed for suspected adrenal disease. The study group included 197 subjects. Adrenal masses were detected using CT or NMR scan. We analysed the correlation between tumour size and relevant hormonal and clinical parameters. Results: We found a significant positive correlation between incidentaloma size and morning cortisol, cortisol after overnight Dexamethasone, and a significant negative correlation between incidentaloma size and morning ACTH, and hip T score. Also, there was a weak but statistically significant correlation between incidentaloma size and systolic blood pressure. Conclusions: Our study shows that the prevalence of adrenal autonomous cortisol secretion increases with incidentaloma size, and that prevalence of hypertension and osteoporosis also increases with an increase of incidentaloma size.

scholarly journals Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

2016 ◽  
Vol 175 (2) ◽  
pp. G1-G34 ◽  
Author(s):  
Martin Fassnacht ◽  
Wiebke Arlt ◽  
Irina Bancos ◽  
Henning Dralle ◽  
John Newell-Price ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adrenal Mass ◽  
Adrenal Incidentaloma ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Adrenal Masses ◽  
Autonomous Cortisol Secretion

By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called ‘subclinical’ Cushing’s syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed?Selected recommendations:(i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50nmol/L (1.8µg/dL)). (iii) For patients without clinical signs of overt Cushing’s syndrome but serum cortisol levels post 1mg dexamethasone >138nmol/L (>5µg/dL), we propose the term ‘autonomous cortisol secretion’. (iv) All patients with ‘(possible) autonomous cortisol’ secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with ‘autonomous cortisol secretion’ who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients with an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal incidentalomas

scholarly journals Cardiovascular events in patients with mild autonomous cortisol secretion: analysis with artificial neural networks

2017 ◽  
Vol 177 (1) ◽  
pp. 73-83 ◽  
Author(s):  
Valentina Morelli ◽  
Serena Palmieri ◽  
Andrea Lania ◽  
Alberto Tresoldi ◽  
Sabrina Corbetta ◽  
...  
Keyword(s):  
Neural Networks ◽  
Artificial Neural Networks ◽  
Characteristic Curve ◽  
Smoking Habit ◽  
Adrenal Incidentaloma ◽  
Cortisol Secretion ◽  
Autonomous Cortisol Secretion ◽  
Artificial Neural

Background The independent role of mild autonomous cortisol secretion (ACS) in influencing the cardiovascular event (CVE) occurrence is a topic of interest. We investigated the role of mild ACS in the CVE occurrence in patients with adrenal incidentaloma (AI) by standard statistics and artificial neural networks (ANNs). Methods We analyzed a retrospective record of 518 AI patients. Data regarding cortisol levels after 1 mg dexamethasone suppression (1 mg DST) and the presence of obesity (OB), hypertension (AH), type-2 diabetes (T2DM), dyslipidemia (DL), familial CVE history, smoking habit and CVE were collected. Results The receiver-operating characteristic curve analysis suggested that 1 mg DST, at a cut-off of 1.8 µg/dL, had the best accuracy for detecting patients with increased CVE risk. In patients with 1 mg-DST ≥1.8 µg/dL (DST+, n = 223), age and prevalence of AH, T2DM, DL and CVE (66 years, 74.5, 25.9, 41.4 and 26.8% respectively) were higher than that of patients with 1 mg-DST ≤1.8 µg/dL (61.9 years, 60.7, 18.5, 32.9 and 10%, respectively, P < 0.05 for all). The CVE were associated with DST+ (OR: 2.46, 95% CI: 1.5–4.1, P = 0.01), regardless of T2DM, AH, DL, smoking habit, gender, observation period and age. The presence of at least two among AH, T2DM, DL and OB plus DST+ had 61.1% sensitivity in detecting patients with CVE. By using the variables selected by ANNs (familial CVE history, age, T2DM, AH, DL and DST+) 78.7% sensitivity was reached. Conclusions Cortisol after 1 mg-DST is independently associated with the CVE occurrence. The ANNs might help for assessing the CVE risk in AI patients.

The Clinical Conundrum of Corticotropin-independent Autonomous Cortisol Secretion in Patients with Bilateral Adrenal Masses

2007 ◽  
Vol 32 (5) ◽  
pp. 856-862 ◽  
Author(s):  
William F. Young ◽  
Hendrick du Plessis ◽  
Geoffrey B. Thompson ◽  
Clive S. Grant ◽  
David R. Farley ◽  
...  
Keyword(s):  
Cortisol Secretion ◽  
Adrenal Masses ◽  
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 High prevalence of smoking in patients with adrenal incidentalomas: causality or case selection?

2020 ◽  
Vol 183 (3) ◽  
pp. 335-341
Author(s):  
Henrik Olsen ◽  
Albin Kjellbom ◽  
Magnus Löndahl ◽  
Ola Lindgren
Keyword(s):  
Risk Factor ◽  
Adrenal Incidentaloma ◽  
Cortisol Secretion ◽  
Adrenal Incidentalomas ◽  
Current Smoking ◽  
Established Risk Factor ◽  
Case Selection ◽  
High Prevalence ◽  
Suppression Test ◽  
Autonomous Cortisol Secretion

Objective: Autonomous cortisol secretion and possible autonomous cortisol secretion (ACS/pACS) are associated to an increase of cardiovascular risk factors such as hypertension, diabetes mellitus and dyslipidaemia. To our knowledge, the prevalence of smoking, another well-established risk factor for cardiovascular disease, has not been studied in detail in people with ACS/pACS or adrenal incidentalomas. Methods: Patients with adrenal incidentalomas were examined with the 1-mg overnight dexamethasone suppression test (cortisolONDST). Information about current smoking was collected from the patient’s records. Results: We studied 1044 patients, of whom 370 (35%) were current smokers. Of these, 22% had bilateral AI compared to 12% of the non-smokers (P < 0.001). Among patients with unilateral adrenal incidentalomas, smokers had larger adrenal incidentalomas than non-smokers (22 mm vs 19 mm, P < 0.001). Smokers also more often had cortisolONDST ≥50 nmol/L than non-smokers, 54% vs 40% (P < 0.001), a finding independent of the size of the adrenal incidentaloma in patients with unilateral adrenal incidentalomas. Conclusions: In the present study of patients with adrenal incidentalomas, the prevalence of current smoking was higher than in the general population. Furthermore, smokers had larger unilateral adrenal incidentalomas, more often bilateral adrenal incidentalomas, and more frequently ACS/pACS. Whether smoking is a risk factor for adrenal incidentalomas and ACS/pACS or our findings are due to case selection needs to be further studied.

Assessment of Plasma-Free Cortisol Concentrations by LC-MS/MS in Patients with Autonomous Cortisol Secretion

2021 ◽  
Vol 53 (11) ◽  
pp. 752-758
Author(s):  
Serkan Yener ◽  
Gamze Tuna ◽  
Melis Kant ◽  
Merve Akis ◽  
Ozlem Kara ◽  
...  
Keyword(s):  
Metabolic Profile ◽  
Smoking Habit ◽  
Free Fraction ◽  
Adrenal Incidentaloma ◽  
Serum Cortisol ◽  
Total Serum ◽  
Cortisol Secretion ◽  
Cross Sectional ◽  
Free Cortisol ◽  
Autonomous Cortisol Secretion

AbstractAutonomous cortisol secretion (ACS) of an adrenal incidentaloma (AI) is associated with mild cortisol excess that could result in poor metabolic and cardiovascular outcomes. The biological activity of glucocorticoids depends on the unbound, free fraction. We aimed to evaluate plasma free cortisol (FC) concentrations in patients with ACS in this cross-sectional study. One hundred and ten AI patients in 3 groups; non-functioning (NFA, n=33), possible ACS (n=65), ACS (n=12) were enrolled. Following measurements were conducted: Clinical data and total serum cortisol (TC), plasma corticotrophin (ACTH), serum dehydroepiandrosterone sulfate (DHEA-S), cortisol after 1 mg dexamethasone by both immunoassay and LC-MS/MS (DexF), serum corticosteroid binding globulin (CBG), plasma dexamethasone concentration [DEX] and plasma FC by LC-MS/MS. Patients with ACS featured an unfavorable metabolic profile. Plasma [DEX] and serum CBG levels were similar between groups. Plasma FC was significantly higher in ACS when compared to NFA and possible ACS groups p<0.05 and p<0.01, respectively. In multiple regression analysis DexF (beta=0.402, p<0.001) and CBG (beta=−0.257, p=0.03) remained as the independent predictors of plasma FC while age, sex, BMI, smoking habit, and existing cardiovascular disease did not make a significant contribution to the regression model. In conclusion, the magnitude of cortisol excess in ACS could lead to increased plasma FC concentrations. Further studies in AI patients are needed to demonstrate whether any alterations of cortisol affinity for CBG exist and to establish whether plasma FC concentrations predict the unfavorable metabolic profile in ACS.

scholarly journals Frequently asked questions and answers (if any) in patients with adrenal incidentaloma

2021 ◽  
Author(s):  
F. Ceccato ◽  
M. Barbot ◽  
C. Scaroni ◽  
M. Boscaro
Keyword(s):  
Imaging Study ◽  
Adrenal Incidentaloma ◽  
Evidence Based ◽  
Careful Evaluation ◽  
Adrenal Hormones ◽  
Questions And Answers ◽  
Adrenal Masses ◽  
Practical Guidance ◽  
A Minor ◽  
Adrenal Disease

Abstract Purpose Adrenal incidentalomas (AIs) are incidentally discovered adrenal masses, during an imaging study undertaken for other reasons than the suspicion of adrenal disease. Their management is not a minor concern for patients and health-care related costs, since their increasing prevalence in the aging population. The exclusion of malignancy is the first question to attempt, then a careful evaluation of adrenal hormones is suggested. Surgery should be considered in case of overt secretion (primary aldosteronism, adrenal Cushing’s Syndrome or pheochromocytoma), however the management of subclinical secretion is still a matter of debate. Methods The aim of the present narrative review is to offer a practical guidance regarding the management of AI, by providing evidence-based answers to frequently asked questions. Conclusion The clinical experience is of utmost importance: a personalized diagnostic-therapeutic approach, based upon multidisciplinary discussion, is suggested.

scholarly journals The Evaluation of Serum Endocan, ADAMTS-13 and P-Selectin Levels in Predicting Subclinical Atherosclerosis in Patients with Adrenal Incidentaloma

2021 ◽  
Author(s):  
Gulsum Gonulalan ◽  
Ummugulsum Can ◽  
Mehmet Akif Bor ◽  
Umut Gonulalan
Keyword(s):  
Subclinical Atherosclerosis ◽  
Adrenal Incidentaloma ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Dehydroepiandrosterone Sulfate ◽  
Control Group ◽  
Adrenocortical Adenoma ◽  
Laboratory Findings ◽  
Morning Cortisol ◽  
The Relationship

Objectives: To investigate the cardiometabolic risk factors as endocan, dehydroepiandrosterone sulfate (DHEAS), ADAMTS-13, p-selectin as a predictor of atherosclerosis in patients with non-functional adrenocortical adenoma (NFAI). Methods: We included 44 patients with NFAI and 44 healthy individuals as the control group. The demographic, laboratory findings and anthropometric measurements were evaluated. The levels of serum endocan, p-selectin, ADAMTS-13 and carotid intima-media thickness (CIMT) measurement were evaluated. Results: There was no difference between the control group and the patients with NFAI in terms of BMI, WC, systolic and diastolic blood pressure, HDL-C, ACTH, morning cortisol, ADAMTS-13 and p-selectin levels. However, the levels of waist-hip ratio, total cholesterol, insulin, HOMA-IR, LDL-C, CIMT, endocan were significantly higher in the NFAI group in comparison with the control group (p< 0.05). The levels of DHEAS were found significantly lower in the patients with NFAI (p<0.05). There was a positive correlation between ADAMTS-13, and endocan and p-selectin (r=0.436; p=0.003, r=0.414; p=0.005). Conclusions: This is the first study investigating the relationship between endocan, p-selectin, ADAMTS-13 levels and NFAI. Increased endocan levels and decreased DHEAS levels might be used as the indicators of atherosclerosis in patients with NFAI. CIMT was also found as an independent predictor for NFAI. Evaluation of cardiac and metabolic parameters is important in conservative treatment of patients with NFAI. Key Worlds: Adrenal Incidentaloma, Endocan, P-Selectin, ADAMTS-13

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