Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas
Objective: Autonomous cortisol secretion (ACS) is a condition with ACTH-independent cortisol overproduction from adrenal incidentalomas (AI) or adrenal hyperplasia. The hypercortisolism is often mild, and most patients lack typical clinical features of overt Cushing’s syndrome (CS). ACS is not well...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2020-10-01
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| Series: | Endocrine Connections |
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| Online Access: | https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0419.xml |
| _version_ | 1818368836931420160 |
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| author | Grethe Å Ueland Thea Grinde Paal Methlie Oskar Kelp Kristian Løvås Eystein S Husebye |
| author_facet | Grethe Å Ueland Thea Grinde Paal Methlie Oskar Kelp Kristian Løvås Eystein S Husebye |
| author_sort | Grethe Å Ueland |
| collection | DOAJ |
| description | Objective: Autonomous cortisol secretion (ACS) is a condition with ACTH-independent cortisol overproduction from adrenal incidentalomas (AI) or adrenal hyperplasia. The hypercortisolism is often mild, and most patients lack typical clinical features of overt Cushing’s syndrome (CS). ACS is not well defined and diagnostic tests lack validation.
Methods: Retrospective study of 165 patients with AI evaluated clinically and by assay of morning plasma ACTH, late-night saliva cortisol, serum DHEA sulphate (DHEAS), 24-h urine-free cortisol, and cortisol after dexamethasone suppression.
Results: Patients with AI (n = 165) were diagnosed as non-functioning incidentalomas (NFI) (n = 82) or ACS (n = 83) according to current European guidelines. Late-night saliv a cortisol discriminated poorly between NFI and ACS, showing a high rate of false-positive (23/63) and false-negative (38/69) results. The conventional lo w-dose dexamethasone suppression test (LDDST) did not improve the diagnostic specific ity, compared with the 1 mg overnight DST. Receiver operating characteristic curve analysis of DHEAS in the two cohorts demonstrated an area under the curve of 0.76 (P < 0.01) with a sensitivity for ACS of 58% and a specificity of 80% using the recommended cutoff at 1.04 μmol/L (40 μg/dL).
Conclusion: We here demonstrate in a large retrospective cohort of incidentaloma patients, that neither DHEAS, late-night saliva cortisol nor 24-h urine free cortisol are useful to discriminate between non-functioning adrenal incidentalomas and ACS. The conventional LDDST do not add further information compared with the 1 mg ove rnight DST. Alternative biomarkers are needed to improve the diagnostic workup of ACS. |
| first_indexed | 2024-12-13T23:14:17Z |
| format | Article |
| id | doaj.art-8f3f40495aca4f87a8ef467cf2187a52 |
| institution | Directory Open Access Journal |
| issn | 2049-3614 2049-3614 |
| language | English |
| last_indexed | 2024-12-13T23:14:17Z |
| publishDate | 2020-10-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrine Connections |
| spelling | doaj.art-8f3f40495aca4f87a8ef467cf2187a522022-12-21T23:28:00ZengBioscientificaEndocrine Connections2049-36142049-36142020-10-01910963970https://doi.org/10.1530/EC-20-0419Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomasGrethe Å Ueland0Thea Grinde1Paal Methlie2Oskar Kelp3Kristian Løvås4Eystein S Husebye5Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, NorwayDepartment of Clinical Science, University of Bergen, Bergen, NorwayDepartment of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway; K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, NorwayDepartment of Medicine, Akershus University Hospital, Nordbyhagen, NorwayDepartment of Medicine, Haukeland University Hospital, Bergen, Norway; K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, NorwayDepartment of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway; K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, NorwayObjective: Autonomous cortisol secretion (ACS) is a condition with ACTH-independent cortisol overproduction from adrenal incidentalomas (AI) or adrenal hyperplasia. The hypercortisolism is often mild, and most patients lack typical clinical features of overt Cushing’s syndrome (CS). ACS is not well defined and diagnostic tests lack validation. Methods: Retrospective study of 165 patients with AI evaluated clinically and by assay of morning plasma ACTH, late-night saliva cortisol, serum DHEA sulphate (DHEAS), 24-h urine-free cortisol, and cortisol after dexamethasone suppression. Results: Patients with AI (n = 165) were diagnosed as non-functioning incidentalomas (NFI) (n = 82) or ACS (n = 83) according to current European guidelines. Late-night saliv a cortisol discriminated poorly between NFI and ACS, showing a high rate of false-positive (23/63) and false-negative (38/69) results. The conventional lo w-dose dexamethasone suppression test (LDDST) did not improve the diagnostic specific ity, compared with the 1 mg overnight DST. Receiver operating characteristic curve analysis of DHEAS in the two cohorts demonstrated an area under the curve of 0.76 (P < 0.01) with a sensitivity for ACS of 58% and a specificity of 80% using the recommended cutoff at 1.04 μmol/L (40 μg/dL). Conclusion: We here demonstrate in a large retrospective cohort of incidentaloma patients, that neither DHEAS, late-night saliva cortisol nor 24-h urine free cortisol are useful to discriminate between non-functioning adrenal incidentalomas and ACS. The conventional LDDST do not add further information compared with the 1 mg ove rnight DST. Alternative biomarkers are needed to improve the diagnostic workup of ACS.https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0419.xmlautonomous cortisol secretionadrenal incidentalomacushing’s syndromedheassaliva cortisol |
| spellingShingle | Grethe Å Ueland Thea Grinde Paal Methlie Oskar Kelp Kristian Løvås Eystein S Husebye Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas Endocrine Connections autonomous cortisol secretion adrenal incidentaloma cushing’s syndrome dheas saliva cortisol |
| title | Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas |
| title_full | Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas |
| title_fullStr | Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas |
| title_full_unstemmed | Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas |
| title_short | Diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas |
| title_sort | diagnostic testing of autonomous cortisol secretion in adrenal incidentalomas |
| topic | autonomous cortisol secretion adrenal incidentaloma cushing’s syndrome dheas saliva cortisol |
| url | https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0419.xml |
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