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Endocrine Abstracts (2023) 90 EP56 | DOI: 10.1530/endoabs.90.EP56

1Royal Victoria Infirmary, Endocrinology and Diabates, Newcastle upon Tyne, United Kingdom; 2Royal Victoria Infirmary, Endocrine Surgery, Newcastle upon Tyne, United Kingdom


Background: Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessments. Once steroid excess is biochemically confirmed, the diagnostic serum ACTH threshold for determining ACTH-independent Cushing is debatable. A threshold of less than 15 ng/l has been adopted in our regional guidelines.

Aims: To investigate serum ACTH levels in patients with proven adrenal Cushing and to assess the clinical utility of 24-hour UFC and urine steroid profiling (USP) in the work-up for CS.

Methods: All patients undergoing unilateral adrenalectomy from January 2019 to February 2022 at the RVI were included. Data extracted: demographics, preoperative biochemical assessment, radiological & histological findings, post-operative short Synacthen test (SST)

Results: 27 patients had unilateral adrenalectomy for CS. F:M was 8:1 with a mean age of 59 years at diagnosis. 16 patients had a left-sided adrenal lesion, 10 had a right-sided one and 1 patient had bilateral lesions. Pre-operative random ACTH levels were <5, 5-9 and 10-12 in 56%, 37% and 7% of patients respectively. 22 patients had CS confirmed on either dynamic testing (20) or 24-hr UFC (1) or USP (1). The other 5 patients all failed their SST soon after surgery, thereby confirming previous adrenal Cushing. 24-hr UFC was elevated in only 36% of patients. USP was diagnostic in 25% of cases. Atrophy of the adrenal cortex was observed in 48% of resected adrenal glands. 3 patients passed their SST relatively soon post-surgery and histological examination in 2 out of these 3 cases demonstrated focally expanded or nodular adrenal cortex. 1 out of these 3 patients demonstrated ongoing steroid excess on biochemical retesting.

Conclusions: Majority of patients with adrenal Cushing have a random serum ACTH level of <10 ng/l. Pre-operative diagnostic yield from 24-hr UFC and USP is poor. Post-operative failed SST confirms prior ACTH-independent Cushing. For those patients who pass their SST soon after surgery, reassessment for steroid excess is warranted, especially if histology does not demonstrate atrophy of adrenal cortex.

Volume 90

25th European Congress of Endocrinology

Istanbul, Turkey
13 May 2023 - 16 May 2023

European Society of Endocrinology 

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