Endocrine Abstracts

Aim: Autonomic cortisol secretion (ACS) is a clinical picture without overt signs of Cushing’s Syndrome despite adrenal adenoma and ACTH-independent cortisol secretion. These patients, who currently do not have a standard treatment, are followed up, especially for known comorbidities of hypercortisolemia such as obesity, diabetes mellitus (DM), hypertension, osteoporosis, and hyperlipidemia. However, it remains unclear how long the patients will be followed and when the treatment should be begun. This study aimed to evaluate the parameters to be examined in the clinical follow-up by comparing the metabolic and hormonal parameters of ACS patients with the control group with non-functional adenoma (NFA).

Material and methods: Our study included 54 female patients diagnosed with ACS (n= 30) and age-matched NFA (n= 24) as the control group. 1 mg overnight dexamethasone suppression test cut-off point was accepted as ≥1.8 mg/dL in ACS diagnosis. Age, body mass index, waist circumference, fasting blood glucose, HbA1c, AST, ALT, lipid profile, thyroid function tests, basal cortisol, ACTH, DHEAS, maximum mass size of adrenal adenoma, 25-hydroxyvitamin D, HOMA-IR measured, and visceral adiposity index (VAI) were calculated for both groups.

Results: The mean age of ACS was 52.13 ±8.8 years, while the mean age of NFA was 49.04 ±6.8 years (P>0.05). The prevalence of hypertension and DM was similar (P>0.05). There were significant differences between the two groups in terms of maximum adenoma size (P=0.007), DHEAS levels (P=0.013), and TSH levels (P=0.01). No significant difference was found in other comparisons (P>0.05). Maximum adenoma size showed a significant positive correlation with waist circumference (r= 0.331, P=0.018), and significant negative correlations with DHEAS and ACTH (r= -0.519, P<0.001, r=-0.289, P=0.049, respectively). There was no significant difference in VAI scores between the two groups (P>0.05).

Conclusion: In our study, no significant difference was found between ACS and NFA patients in terms of metabolic disease frequency. While the maximum adenoma size was found to be significantly higher in ACS patients than in NFA patients, DHEAS and TSH levels were shown to be lower in those patients. These results were consistent with the possible effects of mild hypercortisolemia. Our study showed that DHEAS and TSH levels might play a role in patient follow-up, and it was emphasized that the diagnosis of ACS should be considered, especially in patients with larger adenoma sizes. Further studies are needed to eliminate the uncertainties in the diagnosis and follow-up of ACS.