Endocrine Abstracts

Background

Adrenal incidentalomas (AI) are present in 3–10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS). However, subclinical hypercortisolism isn’t clearly defined. The 1mg dexamethasone suppression test (ODST) is the most widely accepted for the screening of these patients. Recent data suggest that hair cortisol should be considered as a routine test for the screening of Cushing syndrome.

Aim

To compare hair cortisol levels in patients with AIs and healthy controls along with the ’classical’ functional diagnostic tests.

Methods

Twenty-nine consecutive patients with AIs followed in the 1^st Department of the Endocrine Unit of Laiko Hospital were included in our protocol. Hormonal functional tests were analysed and compared to 29 matched healthy controls. Primary or secondary adrenal malignant lesions were excluded. Hair cortisol measurement was also performed and compared with baseline morning (8.00) cortisol, adrenocorticotropic hormone (ACTH), and 1-mg ODST. Hair cortisol samples (2 cm length) were collected according to SoHT guidelines and measured by liquid chromatography tandem–mass spectrometry (LC–MS/MS). ACS was defined in patients displaying at least two biological abnormal markers including increased urinary free cortisol, or suppressed plasma ACTH, or 1 mg-ODST > 1.8 µg/dl in patients with adrenal tumors.

Results

Age, sex and BMI didn’t differ between two groups. Hypertension, hyperlipidemia and diabetes mellitus prevalence was similar in both groups. The studied population included 22 cases of non-functional AIs (NFAIs), 6 cases with ACS and 2 cases with aldosterone-producing adenomas (1 patient had concomitant secretion of cortisol and aldosterone). Although mean baseline blood cortisol levels were found higher and ACTH levels lower in patients with AIs compared to controls, no statistical significant difference was reported. 1-mg ODST was not statistical significant different between patients with NFAIs and controls groups. However, DHEAS levels were statistically significant suppressed in patients with AIs compared to controls. Mean hair cortisol levels were within the normal range and found similar in both groups. Hair cortisol showed no correlation with blood cortisol levels, ACTH and 1 mg ODST.

Conclusions

Our series didn’t find significant differences in baseline blood serum cortisol, ACTH and post-1 mg-ODST cortisol levels between patients with AIs and healthy controls. Hair cortisol levels confirmed blood analyses and were similar in patients with AIs and controls. Hair cortisol could be a simple and low-cost routine test for screening and follow-up patients with AIs and studies with larger sample size should be conducted.