Abstract
Autonomous cortisol secretion (ACS) affects up to 50% of patients with adrenal adenomas. Despite the limited evidence, clinical guidelines recommend measurement of serum concentrations of dehydroepiandrosterone-sulfate (DHEA-S) and corticotropin (ACTH) to aid in the diagnosis of ACS. Our objective was to determine the accuracy of serum concentrations of DHEA-S and ACTH in diagnosing ACS. We conducted a retrospective single center study of adults with adrenal adenoma evaluated between 2000−2020. Main outcome measure was diagnostic accuracy of DHEA-S and ACTH. ACS was defined as post-dexamethasone cortisol >1.8 mcg/dL. Of 468 patients, ACS was diagnosed in 256 (55%) patients with a median post-DST cortisol of 3.45 mcg/dL (range, 1.9–32.7). Patients with ACS demonstrated lower serum concentrations of DHEA-S (35 vs. 87.3 mcg/dL, p < 0.0001) and ACTH (8.3 vs. 16 pg/mL, p < 0.0001) compared to patients with non-functioning adrenal tumors (NFAT). Serum DHEA-S concentration <40 mcg/dL diagnosed ACS with 84% specificity and 81% PPV, while serum ACTH concentration <10 pg/mL diagnosed ACS with 75% specificity and 78% PPV. The combination of serum concentrations of DHEA-S <40 mcg/dL and ACTH <10 pg/mL diagnosed ACS with the highest accuracy with 92% specificity and 87% PPV. Serum concentrations of DHEA-S and ACTH provide additional value in diagnosing ACS.
Highlights
Introduction published maps and institutional affilAdrenal tumors are common incidental findings, detected on 7% of cross-sectional abdominal imaging studies [1]
The majority are benign adrenal cortical adenomas without overt hormone excess; up to 30–50% of patients with incidentally discovered adrenal tumors (AI) have mild autonomous cortisol secretion [1,2,3,4], which is characterized by cortisol excess from adrenal adenomas or hyperplasia without the obvious physical manifestations of Cushing syndrome [5]
We found that serum DHEA-S concentration cutoff of
Summary
Introduction published maps and institutional affilAdrenal tumors are common incidental findings, detected on 7% of cross-sectional abdominal imaging studies [1]. The majority are benign adrenal cortical adenomas without overt hormone excess; up to 30–50% of patients with incidentally discovered adrenal tumors (AI) have mild autonomous cortisol secretion [1,2,3,4], which is characterized by cortisol excess from adrenal adenomas or hyperplasia without the obvious physical manifestations of Cushing syndrome (e.g., facial plethora, proximal muscle weakness, supraclavicular fat pads, and wide purple-red striae) [5]. Recent studies have increasingly linked mild autonomous cortisol secretion to a variety of adverse clinical outcomes including abnormal body composition, increased risk of obesity, dyslipidemia, type 2 diabetes mellitus, osteoporosis, frailty, hypertension, cardiovascular events, and overall mortality [6,7,8,9,10]. Current clinical practice guidelines recommend that all patients with adrenal tumors undergo an overnight 1 mg dexamethasone suppression test (DST) to iations.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
