Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors
ContextAdrenal incidentaloma (AI) is commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion is the most common functional disorder detected in AI.ObjectiveTo delineate the association between radiological characteristics of benign adrenocortical tumors and hypothalamus-pi...
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| Format: | Article |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1199875/full |
| _version_ | 1797772885930016768 |
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| author | Hongyuan Zhu Luming Wu Tingwei Su Lei Jiang Weiwei Zhou Yiran Jiang Cui Zhang Xu Zhong Weiqing Wang Weiqing Wang |
| author_facet | Hongyuan Zhu Luming Wu Tingwei Su Lei Jiang Weiwei Zhou Yiran Jiang Cui Zhang Xu Zhong Weiqing Wang Weiqing Wang |
| author_sort | Hongyuan Zhu |
| collection | DOAJ |
| description | ContextAdrenal incidentaloma (AI) is commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion is the most common functional disorder detected in AI.ObjectiveTo delineate the association between radiological characteristics of benign adrenocortical tumors and hypothalamus-pituitary-adrenal (HPA) axis.MethodsIn the study, 494 patients diagnosed with benign unilateral adrenocortical tumors were included. Mild autonomous cortisol secretion (MACS) was diagnosed when cortisol after 1mg-dexamethasone suppression test (1-mg DST) was in the range of 1.8-5ug/dl. Non-functional adrenocortical tumor (NFAT) was diagnosed as cortisol following 1-mg DST less than 1.8ug/dL. We performed Logistics regression and causal mediation analyses, looking for associations between radiological characteristics and the HPA axis.ResultsOf 494 patients, 352 (71.3%) with NFAT and 142 (28.7%) with MACS were included. Patients with MACS had a higher tumor diameter, thinner contralateral adrenal gland, and lower plasma ACTH and serum DHEAS than those with NFAT. ACTH (OR 0.978, 0.962-0.993) and tumor diameter (OR 1.857, 95%CI, 1.357-2.540) were independent factors associated with decreased serum DHEAS (all P<0.05). ACTH was also associated with decreased contralateral adrenal diameter significantly (OR 0.973, 95%CI, 0.957-0.988, P=0.001). Causal mediation analysis showed ACTH mediated the effect significantly for the association between 1-mg DST results and DHEAS level (Pmediation<0.001, proportion=22.3%). Meanwhile, we found ACTH mediated 39.7% of the effects of 1-mg DST on contralateral adrenal diameter (Pmediation=0.012).ConclusionsPatients with MACS had thinner contralateral adrenal glands and disturbed HPA axes compared with NFAT. ACTH may partially be involved in mediating the mild autonomous cortisol secretion to DHEAS and the contralateral adrenal gland. |
| first_indexed | 2024-03-12T21:58:09Z |
| format | Article |
| id | doaj.art-86aacf2da19b4ee39c519d07d026f33b |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-12T21:58:09Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-86aacf2da19b4ee39c519d07d026f33b2023-07-25T14:36:50ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-07-011410.3389/fendo.2023.11998751199875Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumorsHongyuan Zhu0Luming Wu1Tingwei Su2Lei Jiang3Weiwei Zhou4Yiran Jiang5Cui Zhang6Xu Zhong7Weiqing Wang8Weiqing Wang9Shanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaShanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Centre for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaLaboratory for Endocrine and Metabolic Diseases of Institute of Health Science, Shanghai Jiaotong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, ChinaContextAdrenal incidentaloma (AI) is commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion is the most common functional disorder detected in AI.ObjectiveTo delineate the association between radiological characteristics of benign adrenocortical tumors and hypothalamus-pituitary-adrenal (HPA) axis.MethodsIn the study, 494 patients diagnosed with benign unilateral adrenocortical tumors were included. Mild autonomous cortisol secretion (MACS) was diagnosed when cortisol after 1mg-dexamethasone suppression test (1-mg DST) was in the range of 1.8-5ug/dl. Non-functional adrenocortical tumor (NFAT) was diagnosed as cortisol following 1-mg DST less than 1.8ug/dL. We performed Logistics regression and causal mediation analyses, looking for associations between radiological characteristics and the HPA axis.ResultsOf 494 patients, 352 (71.3%) with NFAT and 142 (28.7%) with MACS were included. Patients with MACS had a higher tumor diameter, thinner contralateral adrenal gland, and lower plasma ACTH and serum DHEAS than those with NFAT. ACTH (OR 0.978, 0.962-0.993) and tumor diameter (OR 1.857, 95%CI, 1.357-2.540) were independent factors associated with decreased serum DHEAS (all P<0.05). ACTH was also associated with decreased contralateral adrenal diameter significantly (OR 0.973, 95%CI, 0.957-0.988, P=0.001). Causal mediation analysis showed ACTH mediated the effect significantly for the association between 1-mg DST results and DHEAS level (Pmediation<0.001, proportion=22.3%). Meanwhile, we found ACTH mediated 39.7% of the effects of 1-mg DST on contralateral adrenal diameter (Pmediation=0.012).ConclusionsPatients with MACS had thinner contralateral adrenal glands and disturbed HPA axes compared with NFAT. ACTH may partially be involved in mediating the mild autonomous cortisol secretion to DHEAS and the contralateral adrenal gland.https://www.frontiersin.org/articles/10.3389/fendo.2023.1199875/fullcontralateral adrenalnonfunctional adrenocortical tumormild autonomous cortisol secretionhypothalamus-pituitary-adrenal (HPA) axiscausal mediation analysis |
| spellingShingle | Hongyuan Zhu Luming Wu Tingwei Su Lei Jiang Weiwei Zhou Yiran Jiang Cui Zhang Xu Zhong Weiqing Wang Weiqing Wang Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors Frontiers in Endocrinology contralateral adrenal nonfunctional adrenocortical tumor mild autonomous cortisol secretion hypothalamus-pituitary-adrenal (HPA) axis causal mediation analysis |
| title | Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors |
| title_full | Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors |
| title_fullStr | Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors |
| title_full_unstemmed | Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors |
| title_short | Association between contralateral adrenal and hypothalamus-pituitary-adrenal axis in benign adrenocortical tumors |
| title_sort | association between contralateral adrenal and hypothalamus pituitary adrenal axis in benign adrenocortical tumors |
| topic | contralateral adrenal nonfunctional adrenocortical tumor mild autonomous cortisol secretion hypothalamus-pituitary-adrenal (HPA) axis causal mediation analysis |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1199875/full |
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