Endocrine Abstracts

Adrenal masses are among the most prevalent human tumors and are frequently detected unexpectedly by imaging studies performed for reasons unrelated to suspect of adrenal diseases.

Subclinical hypercortisolism (SH) is the most frequent endocrine dysfunction detected in patients with adrenal incidentalomas (AI), accounting from five to 20% of all cases depending on inclusion criteria. one mg overnight dexamethasone suppression test (one mg DST) should be the first screening test; however there is no consensus on the cutoff values to consider the test as positive.

In this study we investigated hormonal and metabolic aspects of patients with AI according to different cortisol suppression. We included 39 patients with AI and divided them into four groups based on cortisol levels after one mg DST: <50 nmol/l (group one, normal suppression) between 50 and 83 nmol/l (group two), between 83 and 138 nmol/l (group three) and >138 nmol/l (group four).

Since ACTH levels were <10 pg/ ml in 100% of patients in group four, these were considered affected by SH according to literature.

ACTH levels <10 pg/ ml were observed in 100% of patients in group three, in 67% of group two and in 31% of group one. ACTH and DHEA-S levels were significantly lower in groups three and four than in group one. Moreover, ACTH response to CRF and/or DDAVP was reduced in patients of groups three and four.

Prevalence of diabetes was 15% in group one, 25% in group two, 40% in group three and 33% in group four. Glycemia was higher in groups three and four than in group one. Triglycerides were higher in group three than in group one.

In conclusion, group three showed the same hormonal and metabolic alterations of group four, suggesting that in our patients SH was present in patients with cortisol levels after DST >83 nmol/l.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.