Clinical and laboratory characteristics of patients with adrenal incidentalomas in the differential diagnosis of subclinical hypercortisolism

O. Tretyak

DOI: http://dx.doi.org/10.12775/JEHS.2020.10.11.023

Abstract


Clinical and laboratory characteristics of patients with adrenal incidentalomas in the differential diagnosis of subclinical hypercortisolism. O. E. Tretyak.

Purpose. Determination of the prevalence of subclinical Cushing's syndrome among patients with adrenal incidentalomas; determination of the diagnostic consideration of clinical and laboratory parameters used for the diagnosis of endogenous subclinical hypercortisolism.

Methods. Retrospective analysis of data from 310 patients, who underwent a surgery for unilateral/bilateral adrenal masses. A comparative analysis of the two groups was carried out; the groups were divided based on the results of postoperative pathohistological study. Group 1 included 244 patients with hormonally active masses - adenomas (210), PBMAH (31), PPNAD (3); Group 2 included 66 patients with inactive masses. There were assessed the prevalence of hypertension, DM 2, overweight and the results of laboratory studies of the cortisol level after dexamethasone suppressive test, ACTH, and daily urine-free cortisol excretion.

Results. Patients with hormonally active masses are older (mean age is 52.7 years); 68.4% of patients in group 1 haveAH, 27% haveDM2 (group 2, respectively, 36.4% and 13.6%). There are no differences between groups as to the presence of overweight and obesity. 22.5% of patients of group 1 were confirmed to havePA, in most cases against the background of bilateral masses. The parameter of cortisol after DST has the best diagnostic consideration – sensitivity 90.2%, specificity 74% at a cut-off point level of 1.7 μcg/dL; for ACTH <10 pg/mL, the sensitivity is 71.4% and the specificity is 92.6%. Daily cortisol urine-free excretion has the third most significant diagnostic consideration (sensitivity 71.4%, specificity 81.8%, COP 238 mg/24 h.), which limits the application of this parameter for the confirmation of high levels of cortisol in patients with incidentalomas. Cases of bilateral adrenal hyperplasia should be considered as a probable variant of PBMAH syndrome, requiring further laboratory testing for PA.


Keywords


adrenal incidentaloma; subclinical hypercortisolism; subclinical Cushing's syndrome; autonomic cortisol secretion; primary hyperaldosteronism

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References


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