Abstract
Objective Assessing excess adrenal hormones is important in patients with adrenal mass. Current screening tests for excess cortisol hormones are complex, so it cannot be done sometimes due to the limited medical resources. The aim of the study was to evaluate whether the neutrophil-lymphocyte ratio (NLR) can be used as an initial screening biomarker for Cushing's syndrome (CS) in patients with an adrenal mass. Methods This retrospective study included a total of 185 patients with CS and 185 patients with nonfunctional adrenal adenoma (matched 1 : 1 by sex, body mass index, and discharge date). The NLR was compared between the two groups. The association between NLR and serum and urinary cortisol concentrations was analyzed, and an NLR cut-off value for CS screening was calculated. Results NLR (3.38 (2.33, 5.45) vs. 2.13 (1.74, 3.00), P < 0.001) was significantly higher in the CS group than in the nonfunctional adenoma group. In CS patients, the NLR was positively associated with serum cortisol concentrations at 8 am, with 24-hour urine free cortisol and with serum cortisol after a 1 mg dexamethasone suppression test (P < 0.001 each). An NLR cut-off of 2.2 had a sensitivity of 80.0% and a specificity of 54.05%. The weighted Youden index for the NLR was similar to that of the 24-hour urine free cortisol and late-night serum cortisol tests, which are recommended initial tests for CS diagnosis. Conclusion The NLR may be useful for initial screening for CS among patients with an adrenal mass as an easy and convenient marker.
Highlights
The frequency of detection of adrenal masses has increased in recent years after the introduction of high-resolution crosssectional imaging
The European Society of Endocrinology and European Network for the Study of Adrenal Tumors guidelines on adrenal incidentaloma recommend that adrenal hormone concentrations in patients with adrenal incidentaloma are measured to identify those with adrenal hormone excess [6]
These patients were matched 1 : 1 by sex, BMI (±0.5 kg/m2), and discharge date, with 185 patients diagnosed with a nonfunctional adrenal mass
Summary
The frequency of detection of adrenal masses has increased in recent years after the introduction of high-resolution crosssectional imaging. Previous studies report a frequency of around 3% in subjects aged 50 years, increasing to about 10% in elderly individuals [1,2,3,4,5]. The European Society of Endocrinology and European Network for the Study of Adrenal Tumors guidelines on adrenal incidentaloma recommend that adrenal hormone concentrations in patients with adrenal incidentaloma are measured to identify those with adrenal hormone excess [6]. About 12% of patients with adrenal incidentaloma have Cushing’s syndrome (CS), a condition characterized by constitutive cortisol-secreting adenomas and associated with severe morbidity and elevated mortality.
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