ECE2010 Poster Presentations Adrenal (66 abstracts)
Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects
Valentina Morelli 1 , Benedetta Masserini 1 , Antonio Stefano Salcuni 1 , Cristina Eller-Vainicher 1 , Chiara Savoca 1 , Raffaella Viti 1, , Francesca Coletti 1, , Giuseppe Guglielmi 1, , Claudia Battista 1, , Laura Iorio 1, , Paolo Beck-Peccoz 1 , Bruno Ambosi 1, , Maura Arosio 1, , Alfredo Scillitani 1, & Iacopo Chiodini 1
1Unit of Endocrinology and Diabetology, Department of Medical Sciences, Università degli Studi di Milano, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy; 2Unit of Endocrinology ‘Casa Sollievo della Sofferenza’, IRCCS, San Giovanni Rotondo, Italy; 3Unit of Radiology ‘Casa Sollievo della Sofferenza’, IRCCS, San Giovanni Rotondo, Italy; 4Unit of Endocrinology, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy; 5Unit of Endocrinology, Department of Medical and Surgical Sciences, Università degli Studi di Milano, IRCCS Policlinico San Donato Institute, San Donato Milanese, Italy.
Objective: Subclinical hypercortisolism (SH) has been associated with increased prevalence of hypertension, type 2 diabetes mellitus, dyslipidemia, central obesity, osteoporosis and vertebral fractures. We aimed to investigate the accuracy of different SH diagnostic criteria in predicting the concomitant presence of these complications.
Patiets: In this retrospective study we evaluated data of 231 patients (120 females and 111 males) affected with adrenal incidentalomas (AI).
Methods: We studied the accuracy of different SH diagnostic criteria (cortisol after 1 mg overnight dexamethasone suppression test – 1 mg-DST – at different cut-off such as 50, 83, 138 nmol/l, elevated urinary free cortisol, reduced ACTH levels alone or various combination of these parameters) in predicting the concomitant presence of the following three complications: hypertension, type 2 diabetes and vertebral fractures.
Results: The criterion characterized by the presence of two out of 1 mg-DST >83 nmol/l, elevated UFC, reduced ACTH, struck the best balance between sensitivity and specificity reaching a good accuracy in predicting the cluster of complications (61.9; 77.1 and 75.8%, respectively). The presence of the cluster of complications was associated with this criterion (OR 4.75, 95% CI 1.8–12.7, P=0.002) regardless for gonadal status, BMI and age. Indeed, the SH diagnostic criterion defined as cortisol after 1 mg-DST >138 nmol/l, showed the higher specificity (93.3%) but a poor sensitivity (lower than 23.8%), whereas the criterion by cortisol after 1 mg-DST >50 nmol/l showed the higher sensitivity (71.4%) but a low specificity and accuracy (49.5 and 51.5 respectively).
Conclusions: The SH criterion characterized by the presence of two out of 1 mg-DST >83 nmol/l, elevated UFC, reduced ACTH, seems the best in predicting the presence of chronic manifestations of subtle cortisol excess.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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