Nonfunctional Adrenal Adenomas: Truth or Myth? Presentation and Treatment of 2 Patients

Abstract

ABSTRACT Objective: Autonomous adrenal cortisol secretion is associated with increased frequency of cardiovascular events; however, there is little consensus on what clinical/biochemical criteria should be employed to establish its diagnosis and treatment. Reported here are two cases of autonomous adrenal cortisol secretion that challenge the currently recommended post-dexamethasone suppression test (post-DST) threshold (>1.8 μg/dL) for diagnosing hypercortisolism. Methods: Patient 1, a 64-year-old Caucasian man, presented with hypertension, nephrolithiasis, obesity, and history of a left adrenal tumor (2.1 × 2.9 cm). Baseline morning adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEA-S) were normal; 2-day low-dose DST (LDDST) cortisol was 1.2 μg/dL. Patient 2, a 58-year-old Caucasian woman, presented with bilateral adrenal hyperplasia, obesity, depression, and diabetes. Biochemical evaluation showed low-normal morning ACTH (9 pg/mL), low DHEA-S (<15 μg/dL), and 2-day LDDST cortis...