Beneficial Metabolic Effects of Prompt Surgical Treatment in Patients with an Adrenal Incidentaloma Causing Biochemical Hypercortisolism

Objective: To investigate the possibility of a different prevalence of subclinical Cushing's syndrome (SCS) and potentially related morbidities between patients with unilateral adrenal incidentalomas (UAI) and bilateral adrenal incidentalomas (BAI), as existing data are few and controversial. Design: Prospective observational study. Methods: Clinical examination, biochemical tests, and hormonal evaluation were performed in 298 consecutive patients with adrenal incidentalomas, unilateral in 224 patients (75.2%), bilateral in 74 patients (24.8%), with apparently benign masses based on imaging characteristics and after exclusion of overt endocrine disease. The diagnosis of SCS was based on a post-dexamethasone suppression test (2 mg dexamethasone/24 h for 48 h), with serum cortisol level R1.8 mg/dl combined with at least one abnormal result of the other hormonal measurements. Results: SCS was diagnosed in 66 out of 298 (22.1%) patients, being more frequent in patients with BAI (35.1 vs 17.9%, PZ0.003, for BAI and UAI respectively). Hypertension, type 2 diabetes mellitus, impaired glucose tolerance, and dyslipidemia were of a similar frequency in both groups. SCS patients with UAI and BAI did not differ in age, gender, BMI, waist circumference, and mass size. Factors related to SCS were the presence of BAI (OR, 3.24; 95% CI, and mass size (OR, 2.63; 95% CI,. Conclusion: BAI patients present more often with SCS when compared with UAI patients; however, morbidities potentially related to subtle cortisol hypersecretion were of a similar frequency in both groups. Further studies are needed to clarify whether this difference in hormonal activity may be related to different pathophysiologies.

Section: European Journal Of Endocrinologymentioning

confidence: 74%

Section: European Journal Of Endocrinologymentioning

confidence: 80%

Bilateral adrenal incidentalomas differ from unilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications

Vassilatou

Vryonidou

Ioannidis

et al. 2014

“…It is reported in the 5-30% of patients with AI, accordingly to the various diagnostic criteria used in the literature (8,9,10). In patients with BAI, the prevalence of SH has been reported to be even higher, in relation to the tumour size (11).…”

Section: Introductionmentioning

confidence: 96%

Bilateral and unilateral adrenal incidentalomas: biochemical and clinical characteristics

Morelli

Palmieri

Salcuni

et al. 2013

Objective: The possible different prevalence of arterial hypertension (AH), type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and vertebral fractures (FX) between patients with bilateral and unilateral adrenal incidentalomas (BAI and UAI, respectively) with and without subclinical hypercortisolism (SH) is unknown. In this study we compared the prevalence of AH, T2DM, DL and FX in BAI and UAI patients in relation to SH. Design: Prospective study. Methods: In 175 UAI and 38 BAI patients, we evaluated BMI, spinal and femoral bone mineral density (LS and FN BMD, respectively) and the presence of AH, T2DM, DL and FX. SH was diagnosed in the presence of R2 of the following: urinary free cortisol levels O193 nmol/24 h, serum cortisol levels after 1 mg dexamethasone suppression test O83 nmol/l or ACTH levels !2.2 pmol/l. Results: Age, BMI and cortisol secretion were comparable, while FN BMD was lower in BAI than in UAI patients (K0.45G0.86 vs 0.09G1.07, PZ0.004). The prevalence of SH, AH, T2DM, and DL was comparable, while the prevalence of FX was higher in BAI than in UAI (52.6 vs 28%, PZ0.007). The presence of FX was associated with BAI (odds ratio (OR) 2.6, 95% confidence interval (95% CI) 1.2-5.6, PZ0.016), after adjusting for SH (OR 1.77, 95% CI 0.85-3.7, PZ0.12), BMI (OR 1.06, 95% CI 0.98-1.13, PZ0.1), age (OR 1.07, 95% CI 1.04-1.11, PZ0.0001) and LS BMD (OR 1.31, 95% CI 1.03-1.67, PZ0.03). Conclusion: BAI patients have an increased FX risk than UAI ones. Further studies should investigate the causes of bone involvement in BAI patients.

“…As widely accepted guidelines on this topic were not available, pituitary hypercortisolism was diagnosed in patients who presented abnormal DST, AH, together with at least one of the following two alterations: i) urinary free cortisol (UFC) levels O193 nmol/24 h (normal values nmol/24 h), which is the cutoff of both our own and international normal reference values (6,13) in at least two measurements; ii) high midnight serum or salivary cortisol levels (awake value, cutoff 207 and 2.8 nmol/l respectively).…”

Section: Subjectsmentioning

confidence: 99%

“…Recent studies have demonstrated a high prevalence (5-30%) of SH (defined as a condition of biochemical cortisol excess without the classical signs or symptoms of overt hypercortisolism) in patients with adrenal incidentalomas (5,6,7). Interestingly, these patients showed long-term complications of cortisol excess, such as hypertension, insulin resistance, type 2 diabetes, central obesity, dyslipidemia, and an increased risk of osteoporosis and vertebral fractures, that partially reverted by adrenalectomy (8,9,10,11).…”

Section: Introductionmentioning

confidence: 99%

Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma

Toini

Dolci

Ferrante

et al. 2015

Context: Pituitary incidentalomas (PIs) are commonly encountered in clinical practice. The management of these asymptomatic pituitary lesions is still controversial. Systematic screening for subclinical or mild ACTH-dependent hypercortisolism (AH) is not presently recommended, due to the limited data available thus far on the epidemiological and clinical relevance of this condition in patients with PIs. As subclinical hypercortisolism (SH) was considered to be associated with chronic complications of overt cortisol excess, such as hypertension, diabetes, and osteoporosis, this disorder should be diagnosed at the early stage. Objective: The objective of this study was to evaluate the prevalence of hypercortisolism in a population of subjects with PIs. Design, subjects, and methods: A total of 68 consecutive patients (48 females and 20 males, aged 18-82 years) without clinically overt hypercortisolism, who were referred for evaluation of PIs between January 2010 and March 2013, were prospectively investigated for AH. Pituitary hypercortisolism was diagnosed in the presence of cortisol O50 nmol/l after 1 mg dexamethasone suppression test, non-suppressed ACTH, and the additional finding of one of the following: urinary free cortisol (UFC) O193 nmol/24 h, and midnight serum and salivary cortisol levels O207 and 2.8 nmol/l respectively. Results: Among patients with PIs, we found a 7.3% rate of pituitary hypercortisolism diagnosed with biochemical criteria and a 4.4% rate of histologically confirmed AH. Conclusions: Subclinical or mild hypercortisolism may be more common than generally perceived in patients with PIs.