Abstract
Several studies demonstrated the diagnostic accuracy of hair glucocorticoid measurement in patients with overt Cushing syndrome, but few data are available for patients with adrenal incidentaloma (AI) and cortisol autonomy. The aim of our study was to assess whether measurement of 5 corticosteroid hormones with the ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method in the keratin matrix is useful to stratify patients with AI by the presence of autonomous cortisol secretion [ACS] (defined as serum cortisol after 1 mg dexamethasone suppression test (DST) > 138 nmol/l) or possible ACS [PACS] (defined as serum cortisol after 1 mg DST > 50 nmol/l but ≤138 nmol/l). We analysed data of 67 AI patients (32 with cortisol autonomy) and 81 healthy subjects. We did not find any significant statistical difference comparing hair cortisol, cortisone, and 20β-dihydrocortisol concentrations between healthy controls and AI patients, while 6β-hydroxycortisol and 11-deoxycortisol were undetectable. Moreover, no significant difference was found in hair cortisol, cortisone, and 20β-dihydrocortisol levels of AI patients with or without cortisol autonomy. Finally, we did not find any correlation in patients with AI between hormonal concentrations in the keratin matrix and serum, salivary, and urinary cortisol levels, or with body mass index. In conclusion, our findings suggest that hair glucocorticoid measurement is not suitable as a diagnostic test for cortisol autonomy (ACS and PACS).
Highlights
Adrenal incidentalomas (AIs) are masses incidentally and unexpectedly found in patients who undergo radiological exams due to diagnostic process or follow-up of extra-adrenal diseases [1]
The diagnosis of autonomous cortisol secretion (ACS) and possible ACS (PACS) is challenging in practice and it can remain unrecognized for a long time, due to the subtle and heterogeneous clinical presentation and some methodological issues in laboratory screening tests [6]
No significant statistical difference was found in the hair concentrations of cortisol, 20b-dihydrocortisol, and cortisone between controls and patients (Figure 2). 6b-Hydroxycortisol and 11deoxycortisol were undetectable in all samples
Summary
Adrenal incidentalomas (AIs) are masses incidentally and unexpectedly found in patients who undergo radiological exams due to diagnostic process or follow-up of extra-adrenal diseases [1]. Since in the last decades the use of high-resolution cross-sectional imaging has become increasingly widespread, the serendipitous detection of adrenal tumours is common in clinical practice, accounting for 4.2%–7.3% in recent computed tomography (CT) series, up to 10% in elder patients [2,3,4,5]. AI are benign adenomas, which secrete cortisol autonomously in up to 50% of patients [6, 7]. Cortisol excess is mild and patients present without a typical phenotype, a condition previously called subclinical Cushing [8, 9] and defined as autonomous cortisol secretion (ACS) or possible ACS (PACS) [1]. Recent studies have demonstrated that this chronic, low-grade hypercortisolism can be associated with several cardio-metabolic comorbidities [5, 10,11,12,13,14,15] and increased mortality [16,17,18].
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