Adrenocortical Hyperplasia Associated with ACTH-dependent Cushing's Syndrome: Comparison of the Size of Adrenal Glands with Clinical and Endocrinological Data

Abstract

Abstract. Diffuse or nodular hyperplasia of adrenal glands is associated frequently with ACTH-dependent Cushing's syndrome. We carried out a retrospective analysis of 28 patients with ACTH-dependent Cushing's syndrome admitted to our institution between 1984 and 1999 in order to clarify the incidence of adrenal hyperplasia in ACTH-dependent Cushing's syndrome and also to determine the correlation between adrenal gland images and clinical, biochemical and endocrinological data. Of the 28 patients, 16 (57%) showed diffuse adrenal hyperplasia while only 3 had focal adrenal nodules in the hypertrophied adrenals. There was a positive, significant correlation between the width of the adrenal glands measured on CT and circulating plasma ACTH, cortisol levels and urinary free cortisol (UFC) levels. Duration of the disease also correlated positively with adrenal width. No correlation was found between age and adrenal size and there was no difference in the prevalence of diffuse hyperplasia between normotensive and hypertensive patients. These results suggest that chronic ACTH hypersecretion may lead to diffuse adrenal hyperplasia in patients with ACTH-dependent Cushing's syndrome.

Adrenal masses falsely diagnosed as adenomas on unenhanced and delayed contrast-enhanced computed tomography: Pathological correlation

“…Patients with ACTH-dependent Cushing syndrome or Conn's syndrome can manifest as macronodular adrenal hyperplasia [11][12][13][14]. However, no radiological study has reported whether these lesions can show as low an attenuation as lipid-rich adenomas on unenhanced CT.…”

Increased extracellular signal regulated kinases phosphorylation in the adrenal gland in response to chronic ACTH treatment

“…There have been reports that ACTH can induce increased proliferation, particularly under stress conditions (Lotfi & Armelin 1998, Pignatelli et al 2002. Notably, adrenocortical hyperplasia can occur after prolonged ACTH exposure in patients suffering from pituitary tumours producing ACTH, a situation known as Cushing's disease (CD; McNicol 2000, Imaki et al 2004). However, it must not be ruled out that other POMC-derived peptides could be responsible for such effects on adrenocortical hyperplasia (Bicknell et al 2001, Fassnacht et al 2003.…”

Erratum to “Urinary high performance reverse phase chromatography cortisol and cortisone analyses before and at the end of a race in elite cyclists”

“…during sport training or competition [5]. Urinary free F (UF) excretion has been shown to be a reliable single index of adrenal/cortical secretion and has been accepted as a measurement of the free fraction in plasma [6,7]. Recently, the 24-h urinary F/E ratio has been proposed as a useful indicator for monitoring the overreaching state in elite swimmers [8].…”