Cortisol Secretion In Patients Research Articles

Autonomous cortisol secretion in patients with primary aldosteronism is associated with left ventricular hypertrophy and diastolic dysfunction

Abstract Background and Aims: Autonomous cortisol secretion (ACS) constitutes a significant portion of patients diagnosed with primary aldosteronism (PA) and is potentially linked to adverse cardiovascular outcomes. This study aimed to explore the impact of ACS on cardiac remodeling and diastolic dysfunction in PA patients. Methods We prospectively enrolled 567 PA patients from March 2000 to March 2023. ACS was defined as a cortisol level >1.8 μg/dL after a 1 mg dexamethasone suppression test (DST). Clinical, biochemical, and echocardiographic data were collected at baseline and during one-year follow-up after targeted treatments including adrenalectomy and mineralocorticoid receptor antagonist administration. Results In this prospective cohort, 21.5% of PA patients had concurrent ACS. PA patients with ACS were older and had a higher prevalence of diabetes. They also exhibited significantly higher left ventricular mass index (LVMI) and worse diastolic function (E/e'). Baseline post-1 mg DST cortisol levels positively correlated with baseline LVMI and E/e' in restricted cubic spline analysis. Multivariable linear regression analysis showed that ACS presence was significantly associated with higher LVMI and worse E/e' after adjusting for significant variables. Among patients who underwent adrenalectomy, both those with and without ACS showed significant improvements in LVMI and E/e'. Patients who received mineralocorticoid receptor antagonist treatment also showed significant improvement in E/e', irrespective of ACS presence. However, significant LVMI improvement was observed only in PA patients without ACS who received mineralocorticoid receptor antagonist treatment. Conclusions The presence of ACS in PA patients was associated with worse left ventricular hypertrophy and diastolic dysfunction. Adrenalectomy and mineralocorticoid receptor antagonist treatment partially reversed cardiac remodeling in PA patients with ACS.

Myosteatosis and sarcopenia are linked to autonomous cortisol secretion in patients with aldosterone-producing adenomas.

Patients with adrenal aldosterone-producing adenomas (APA) face elevated cardiovascular risks, especially when cortisol is co-secreted, yet the impact on muscle health remains unclear. Myosteatosis, characterized by fatty infiltration into muscles, is linked to cardiometabolic diseases and decreased survival. We aimed to investigate the association between autonomous cortisol secretion (ACS) in APA and muscle quantity and quality. In this study, we analyzed data from 228 APA patients undergoing laparoscopic adrenalectomy between 2009 and 2024, assessing muscle composition via computed tomography. Intermuscular adipose tissue (IMAT), skeletal muscle area and density, visceral and subcutaneous adipose tissue area at L3 were measured. Comparisons were made between ACS and non-ACS groups. We found that among 228 patients, 76 (33.3%) had ACS. Those with ACS exhibited significantly higher IMAT area (P = 0.042) and lower skeletal muscle area (P = 0.002) and density (P < 0.001). Multivariable regression confirmed ACS positively associated with IMAT area and negatively associated with skeletal muscle area and density. At 1-year follow-up, ACS patients (n = 15) experienced decreased IMAT area (P = 0.001) and increased skeletal muscle area (P = 0.031) post-adrenalectomy, while those without ACS (n = 29) showed no IMAT change but increased visceral (P < 0.001) and subcutaneous (P = 0.008) adipose tissue area. In summary, myosteatosis and sarcopenia are linked to ACS in APA patients, and these parameters improve following adrenalectomy.

7822 Mild Autonomous Cortisol Secretion In High Suspicious Adrenal Incidentaloma

Abstract Disclosure: N. Zavrashvili: None. N. Margvelashvili: None. K. Chanturishvili: None. Mild Autonomous Cortisol Secretion in High Suspicious Adrenal IncidentalomaIntroduction: Incidentally discovered adrenal masses are common and mostly benign and non-functioning adenomas. However, evolving evidence suggests that a notable proportion of these adrenal adenomas may demonstrate mild autonomous cortisol secretion (MACS), which has been associated with an increased risk for hypertension, hyperglycemia, obesity, dyslipidemia, vertebral fractures, adverse cardiovascular events, and mortality. 55-year-old women with 5-year history of hypertension and hyperlipidemia. She was treated with a three-drug program: verapamil 250 mg daily, combined B-blocker, atenolol 100 mg and chlorthalidone 25 mg daily. Blood pressure control remained suboptimal. Her body mass index was 29,5 kg/m2. She had no signs or symptoms of overt Cushing syndrome.She was referred to CT coronary angiogram by her cardiologist, which revealed adrenal incidentaloma.Adrenal dedicated CT showed left-sided 3,4 cm high density node (41HU), with absolute washout &amp;lt;60. She was consulted by oncologist to exclude adrenal metastasis. The baseline laboratory test results excluded PA and Pheochromocytoma. The diagnosis of glucocorticoid secretory autonomy was based on positive low-dose dexamethasone suppression test (DST), low serum ACTH concentration, low-normal DHEA-S and lack of complete suppression of serum cortisol with an overnight 8-mg DST. Patient was referred to left-sided laparoscopic adrenalectomy with perioperative glucocorticoid coverage (100 mg hydrocortisone administered IV and again 8 hours later). Conclusion: Mild autonomous cortisol secretion is a term used to describe biochemical evidence of abnormal cortisol secretion in patients with adrenal incidentaloma, but without the classical external manifestations of overt CS, such as central muscle weakness, adipose tissue redistribution, and skin fragility. The management of patients with an incidentally discovered adrenal adenoma who do not have overt Cushing’s syndrome but who have MACS is more controversial as the available studies comparing outcomes of adrenalectomy vs conservative management have been generally small. It is associated with an increased risk of Type 2 diabetes mellitus, HBP, obesity, dyslipidemia, and global cardiovascular risk. Therefore, it is of great importance to correctly identify these patients. There are different tests for the screening of hypercortisolism. However, in the absence of a single test considered as the gold standard, it is necessary to combine the different tests to reach an adequate diagnostic capacity. The indication of surgery in ACS patients should be based mainly on the hormonal evaluation and the comorbidities potentially mediated by cortisol. Presentation: 6/1/2024

Fragility Fractures and Cortisol Secretion in Patients With Nonfunctioning Adrenal Incidentalomas.

The risk of vertebral fractures (VFx) in patients with nonfunctioning adrenal incidentalomas (NFAI) is unknown. This work aimed to assess in NFAI patients the prevalence and incidence of VFx and a hormonal marker to identify patients at risk. A retrospective, cross-sectional, and longitudinal study of outpatients was conducted. A total of 306 NFAI patients (cross-sectional arm) and 213 controls were evaluated for VFx prevalence; 85 NFAI patients (longitudinal arm, follow-up 30.3 ± 17.5 months) were evaluated for VFx incidence. Main outcome measures included serum cortisol after 1 mg-dexamethasone test (F-1mgDST), lumbar spinal (LS), and femoral neck (FN) bone mineral density (BMD) and VFx presence, by radiograph of the spine. Cross-sectional arm: prevalent VFx associated with F-1mgDST with a cutoff of 1.2 µg/dL (33 nmol/L, area under the curve 0.620 ± 0.39; P = .002). Compared with controls and NFAI patients with F-1mgDST less than 1.2 µg/dL (group A), NFAI patients with F-1mgDST greater than or equal to 1.2 µg/dL (group B) showed a higher VFx prevalence (10.8%, 12.6%, and 29.5%, respectively; P < .001 all comparisons), which was associated with F-1mgDST greater than or equal to 1.2 µg/dL (odds ratio 3.02; 95% CI, 1.63-5.58; P < .001) accounting to confounders. Longitudinal arm: the VFx incidence was higher in group B than in group A (19.3% vs 3.6%; P = .05). In group B, all incident VFx occurred in patients without low BMD. The F-1mgDST cutoff for predicting an incident VFx was 1.2 µg/dL, although statistical significance was not reached after adjustment for confounders (P = .061). In NFAI patients, F-1mgDST levels greater than or equal to 1.2 µg/L (33 nmol/L) are associated with prevalent VFx and may identify patients at risk of incident VFx.

Steroid Profiling and Circadian Cortisol Secretion in Patients with Mild Autonomous Cortisol Secretion: A Cross-Sectional Study.

Mild autonomous cortisol secretion (MACS) is diagnosed based on post-dexamethasone cortisol>1.8 mcg/dL. Scarce evidence exists on steroid circadian secretion and steroid metabolome in MACS. To characterize 24-hour (h) urine steroid metabolome in patients with MACS and determine circadian differences in urine steroid profiling and cortisol concentrations in patients with MACS versus referent subjects. Cross-sectional study, 2018-2023. Referral center. Patients with MACS and age-, sex-, BMI-, and menopausal status-matched referent subjects. Urine was collected over 24h period as separate day- and night-time collections. High-resolution mass spectrometry assay was used to measure 25 steroids. A subgroup of patients and referent subjects were admitted for every 2h serum measurements of free and total cortisol. Steroids, sums, and ratios. Patients with MACS (n=72) had lower mcg/24h median androgens (2084 vs 3283, P<0.001), higher glucocorticoids (15754 vs 12936, P<0.001), and higher glucocorticoid/androgen ratio (8.7 vs 3.9, P<0.001), compared to referent subjects. Patients also had lower steroid day/night ratios compared to referent subjects, reflecting a higher relative nocturnal steroid production in MACS. In a subgroup of 12 patients with MACS and 10 referent subjects, the 24-hour area under the curves for total and free cortisol were similar. However, evening mean total (5.3 vs 4.0 mcg/dL, P=0.056) and free (0.2 vs 0.1 mcg/dL, P=0.035) cortisol was higher in patients vs referent subjects. Patients with MACS demonstrate an abnormal urine steroid metabolome, with a high glucocorticoid to androgen ratio, and a higher nocturnal steroid production.

Evidence of mild autonomous cortisol secretion in patients with adrenal incidentaloma is associated with increased cardiometabolic morbidity and relative risk of cardiovascular disease, compared to those with non-functional adrenal incidentalomas

Evidence of mild autonomous cortisol secretion in patients with adrenal incidentaloma is associated with increased cardiometabolic morbidity and relative risk of cardiovascular disease, compared to those with non-functional adrenal incidentalomas

Mild autonomous cortisol secretion in patients with adrenal incidentalomas - how common and what is the prevalence of co-morbidities?

Mild autonomous cortisol secretion in patients with adrenal incidentalomas - how common and what is the prevalence of co-morbidities?

Influence of autonomous cortisol secretion in patients with primary aldosteronism: subtype analysis and postoperative outcome.

Autonomous cortisol secretion (ACS) has a relatively high prevalence in patients with primary aldosteronism (PA). There is still a lack of relevant studies to analyze the influence of ACS on diagnosing and managing PA. To evaluate the influence of ACS on image-adrenal venous sampling (AVS) correlation and the postoperative results. This was a retrospective study using the Taiwan Primary Aldosteronism Investigation database from July 2017 to April 2020, with 327 PA patients enrolled. A total of 246 patients were included in the image-AVS analysis. Patients who had undergone unilateral adrenalectomy and a 12-month follow-up were included in the postoperative analysis. Sixty-five patients (26.4%) had ACS. The image-AVS discordance rate was higher in the ACS group compared to the non-ACS group (75.4% (n = 49) vs 56.4% (n = 102); odds ratio (OR) = 2.37 (CI: 1.26-4.48); P = 0.007). The complete biochemical success rate was higher in the non-ACS group than that in the ACS group (98.1% (n = 51) vs 64.3% (n = 9); OR = 28.333 (CI: 2.954-271.779); P = 0.001). In logistic regression analysis, ACS was the only factor associated with lower biochemical success (OR = 0.035 (CI: 0.004-0.339), P = 0.004). PA patients with ACS have higher image-AVS discordance rate and worse biochemical outcomes after surgery. ACS was the only negative predictor of postoperative biochemical outcomes. Further studies and novel biomarkers for AVS are crucial for obtaining better postoperative outcomes in PA patients with ACS.

Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes.

The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 µg/dL (confirmed ACS if >5 µg/dL and possible ACS if 1.8-5 µg/dL) in the absence of specific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS-PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS-PA and PA-only patients was similar, except for older age and larger tumor size of the adrenal lesion in the ACS-PA group. When comparing the ACS-PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64-22.32)) and cardiovascular events (OR 5.0 (2.29-11.07)) was higher in ACS-PA patients than in ACS patients. The coexistence of ACS in patients with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS-PA and PA-only groups. Co-secretion of cortisol and aldosterone affects almost one-third of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS-PA and PA-only are similar.

Clinical manifestations of functionally autonomous cortisol secretion in patients with adrenal masse

Introduction. The choice of tactics for patients with adrenal masses (AM) with functionally autonomous cortisol secretion (FASC) remains controversial.The aim of the study was to determine the most significant clinical manifestations of FASC in unoperated AM patients.Materials and methods Thirty unoperated AM patients aged 67.0 [59.25 to 71.0] years with a disease duration of 92.0 [46.75 to 112.0] months were included in the study.Results. We defined thresholds for morning blood cortisol levels to predict clinical manifestations of FASC: for obesity ≥ 300.7 nmol/L, (p = 0.02), DM2 ≥ 508.0 nmol/L, (p &lt; 0.001), dyslipidemia ≥ 450.0 nmol/L, (p = 0.02). Increases in AM size were determined: at 36 months − by 0.146 cm, at 60 months − by 0.169 cm, its positive marked direct correlation with the initial AM size.Discussion. According to the literature, FASC is diagnosed in 30−50 % of patients with AM. Our data are comparable with scientific sources: AH was observed in 86.7% (n = 26) of patients, obesity − 73.3 % (n = 22), T2DM − 36.7 % (n = 11), dyslipidemia − 60 % (n = 17), osteoporosis − 43.3 % (n = 13).Conclusion In unoperated outpatients with AM, obesity, DM2, and dyslipidemia are the most significant clinical manifestations of FASC. In patients over 60 years of age with a benign CT-phenotype of adrenal masses and controlled clinical manifestations of FASC, the treatment tactic is observation.

The utility of salivary cortisone in the overnight dexamethasone suppression test in adrenal incidentalomas.

Guidelines recommend the assessment of cortisol secretion in patients with adrenal incidentalomas (AI) using the overnight dexamethasone suppression test (ONDST). This requires attendance to a health care facility and venepuncture. Alternatively, the ONDST can be done by measuring salivary cortisol and cortisone which can be collected at home. We aimed to assess the utility of these measurements in patients with AI. A retrospective analysis of data from 173 patients with AI who underwent an ONDST and salivary cortisol/cortisone diurnal studies. Serum and salivary cortisol and salivary cortisone were collected at 09:00, late night and at 09:00 post dexamethasone. Dexamethasone levels were measured in the post dexamethasone samples. Serum and salivary samples were analysed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Stata. We identified a strong correlation between salivary cortisone and serum cortisol post 1 mg dexamethasone (r = 0.95). Stepwise multivariate regression showed that post-dexamethasone salivary cortisone, baseline serum cortisol, salivary cortisone suppression (pre: post-dexamethasone ratio) and sex as the only significant or near significant independent variables. Performance of predictive indices using these four parameters (sensitivity = 88.5%, specificity = 91.2%; kappa 0.80) and post-dexamethasone salivary cortisone alone (sensitivity = 85.3%, specificity = 91.7%; kappa 0.77) were comparable when used to predict an ONDST serum cortisol of ≤50 nmol/L.No correlation was observed with any of the other measured parameters. In AI patients, post dexamethasone, salivary cortisone correlates very strongly with serum cortisol in the ONDST and could therefore be used as an alternative sampling method which does not require venepuncture or attendance to hospital.

Prevalence of autonomous cortisol secretion in patients with primary aldosteronism and its implications on the cardiometabolic profile and on surgical outcomes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Prevalence of Cortisol Cosecretion in Patients With Primary Aldosteronism: Role of Metanephrine in Adrenal Vein Sampling.

Adrenal venous sampling (AVS) is the gold standard procedure for subtype diagnosis in patients with primary aldosteronism (PA). Cortisol is usually adopted for the normalization of aldosterone levels in peripheral and adrenal samples. However, asymmetrical cortisol secretion can potentially affect the lateralization index, leading to subtype misdiagnosis. We aimed to assess the prevalence of asymmetrical cortisol secretion in patients undergoing AVS and whether variations in adrenal vein cortisol might influence AVS interpretations. We then evaluated the use of metanephrines for the normalization of aldosterone levels for lateralization index. We retrospectively included 101 patients with PA who underwent AVS: 49 patients underwent unstimulated AVS, while 52 patients underwent both unstimulated and cosyntropin-stimulated AVS. Eighty-eight patients had bilateral successful AVS according to metanephrine ratio. We assessed the prevalence of asymmetrical cortisol secretion through the cortisol to metanephrine (C/M) lateralization index (LI). We then evaluated whether the use of aldosterone to metanephrine (A/M) LI can improve the diagnostic accuracy of AVS compared with aldosterone to cortisol (A/C) LI. Asymmetrical cortisol secretion is present in 18% of patients with PA. Diagnosis with A/M LI and A/C LI is discordant in 14% of patients: 9% had a diagnosis of unilateral PA with A/M LI instead of bilateral PA with A/C LI and 5% had a diagnosis of bilateral PA with A/M LI instead of unilateral PA. The assessment of metanephrine levels in AVS is useful for the determination of selectivity and lateralization, allowing an accurate diagnosis, especially in patients with asymmetrical cortisol secretion.

Case Report: Management of Mild Autonomous Cortisol Secretion

Mild autonomous cortisol secretion is a term used to describe biochemical evidence of abnormal cortisol secretion in patients with ACA, but without the classical external manifestations of overt CS, such as central muscle weakness, adipose tissue redistribution, and skin fragility. Materials and methods: In this study, we report a case of patient who presents mild autonomous cortisol secretion among incidentally discovered adrenal masses; followed in unit of the endocrinology, diabetology, metabolic diseases and nutrition department of the Mohammed VI University Hospital of Marrakesh. Case report: A 68-year-old woman with a history of well-controlled hypertension and diabete presents to our department for etiological assessment of an adrenal incidentaloma. adrenal scan confirms a diagnosis of an incidental right adrenal nodule measuring 27x26mm is also identified having an density of 33UH and washout &gt; 50%, the patient’s physical examination is unremarkable and she does not have any overt Cushingoid features or midline back pain or paroxysmal attacks. Biochemical investigations revealed a morning cortisol following 1 mg of dexamethasone is 2 ug/dL. A normal serum potassium and methoxylated derivatives in urine are normal. A diagnosis of a mild autonomous cortisol secretion was made and given the relatively mild degree of cortisol excess and well-controlled Comorbidities a conservative management is chosen, she should undergo annual clinical reassessments. If she develops new or worsening cortisol-related comorbidities, she should undergo further biochemical testing and reconsideration of adrenalectomy. Conclusion: Future studies with adequate randomization and follow-up to assess adverse clinical endpoints are needed to determine the optimal management and follow-up of patients with MACS.

Results confirming the efficacy of oral L-dopa on cortisol secretion in patients being evaluated for suspected growth hormone deficiency

Objective: Adrenal insufficiency is a life-threatening disease and therefore, accurate diagnosis and prompt treatment are life-saving. The main purpose of this study was to retrospectively evaluate the serum cortisol levels measured during the L-dopa test in cases suspected GH deficiency and to compare the effect of L-dopa on cortisol secretion with the results of previous studies. Method: Between January 2019 and January 2021, patients who underwent the L-dopa test for the evaluation of GH deficiency in our Pediatric Endocrinology Clinic and whose basal cortisol levels were measured at the baseline and at the 120th minutes of the test were included. The clinical, anthropometric, and laboratory data of the patients were obtained from the medical records. Results: Eighty-five patients (38 girls, 47 boys) were included in the study. The mean age of the patients was 10.3 ± 3.5 years (range, 4.1 - 14.9 years). The mean serum cortisol level was 11.1 ± 3.6 µg/dL at baseline and 20.9 ± 3.8 µg/dL at 120th minutes (the mean cortisol increase was 9.8 ± 4.1 µg/dL). Cortisol response was adequate (&gt; 18 µg / dL) in 76 cases (89.4%). Nausea/vomiting was observed in 53 (62.4%) of the patients during the L-dopa test. Peak cortisol responses of the cases with and without side effects were similar (20.9 ± 3.8; 20.8 ± 3.7; p = 0.945). Conclusion: In conclusion, the L-dopa test is easy to apply, effective, and safe and can be performed to evaluate cortisol adequacy at least in patients being evaluated for suspected GH deficiency.

New-onset diabetes mellitus risk associated with concurrent autonomous cortisol secretion in patients with primary aldosteronism.

Concurrent autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA patients) is not uncommon. This work aimed to determine the effect of cortisol levels on incident new-onset type 2 diabetes mellitus (NODM) in PA patients. Using the prospectively designed observational TAIPAI cohort, the PA patients were grouped by cortisol level after an overnight low-dose dexamethasone suppression test (1-mg DST). Of the 476 PA patients, 387 (43.7% men; mean age 52.8 years) did not have baseline DM. After a mean follow-up of 4.3 ± 2.9 years, 32 patients (8.3%) developed NODM. The cutoff value obtained via a generalized additive model showed that a serum cortisol level ≥ 2.65 µg/dL after 1-mg DST was a risk factor for developing NODM (HR, 3.5, p = 0.031) by Cox proportional- hazards model.. In PA patients with a higher body mass index (>25 kg/m2; HR, 3.16), lower estimated glomerular filtration rate (<90 ml/min/1.73 m2; HR, 3.18), longer hypertension duration (>7 years; HR, 3.34), and higher waist-to-hip ratio (>0.9; HR, 3.07), a concomitant cortisol level ≥ 2.65 μg/dL after 1-mg DST were more likely to develop NODM. The high-cortisol group of patients with aldosterone-producing adenoma (APA) using mineralocorticoid receptor antagonist (MRA) was associated with an increased risk of NODM (HR, 5.72). Our results showed that PA patients with a concomitant cortisol level ≥ 2.65 µg/dL after 1-mg DST, independent of the aldosterone level, had a higher incidence of NODM. Such PA patients should be carefully evaluated and managed to achieve better glucose control and prevent metabolic syndrome.

Mild autonomous cortisol secretion in patients with adrenal incidentalomas and raised cardiovascular risk

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Cortisol as a Biomarker of Mental Disorder Severity.

Cortisol—the most important steroid hormone with a significant effect on body metabolism—strongly affects peripheral tissues and the central nervous system. Fluctuations in cortisol secretion often accompany psychiatric disorders, and normalization of its levels correlates with improvement in the patient’s health. This indicates that cortisol may be useful as a biological marker that can help determine the likelihood of mental illness, its impending onset, and the severity of symptoms, which is especially important in the face of the increasing prevalence of mental disorders, including those associated with social isolation and anxiety during the COVID-19 pandemic. This publication reviews recent reports on cortisol levels in healthy participants and shows the current state of knowledge on changes in the levels of this hormone in people at risk for depression, bipolar disorder, and psychosis. It shows how people with psychiatric disorders react to stressful situations and how the applied therapies affect cortisol secretion. The influence of antidepressants and antipsychotics on cortisol levels in healthy people and those with mental disorders is also described. Finally, it reviews publications on the patterns of cortisol secretion in patients in remission.

Association Between Mortality and Levels of Autonomous Cortisol Secretion by Adrenal Incidentalomas

Autonomous cortisol secretion in patients with adrenal incidentalomas is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available. To measure the association between mortality and levels of autonomous cortisol secretion in patients with adrenal incidentalomas. Retrospective cohort study. (ClinicalTrials.gov: NCT03919734). Two hospitals in southern Sweden. Consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 and were followed for up to 14 years. Outcome data were collected from national registers. Patients were grouped according to plasma cortisol level after a 1-mg dexamethasone suppression test (cortisolDST; <50, 50 to 82, 83 to 137, or ≥138 nmol/L). During a median follow-up of 6.4 years, 170 of 1048 patients died. Compared with a cortisolDST less than 50 nmol/L, a cortisolDST of 50 to 82 nmol/L was not associated with increased mortality (hazard ratio [HR], 1.15 [95% CI, 0.78 to 1.70]). However, a cortisolDST of 83 to 137 nmol/L (n = 119) had an HR of 2.30 (CI, 1.52 to 3.49), and a cortisolDST of 138 nmol/L or higher (n = 82) had an HR of 3.04 (CI, 1.86 to 4.98). Analyses using restricted cubic splines indicated that the association between cortisolDST and mortality was linear up to a cortisolDST of 200 nmol/L. The results are not based on verified autonomous cortisol secretion; thus, the association may be underestimated. The association between mortality and cortisolDST increased linearly until cortisolDST reached 200 nmol/L. A cortisolDST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisolDST of 138 nmol/L or higher was associated with a 3-fold increase in mortality. Additional studies should be done, and until those studies are completed some clinicians may consider these findings when deciding which patients to recommend for surgery. Lisa and Johan Grönberg Foundation and Gyllenstiernska Krapperup Foundation.

Can abdominal CT features predict autonomous cortisol secretion in patients with adrenal nodules?

To determine if CT features of adrenal nodules and of the remainder of the abdomen can predict autonomous cortisol secretion (ACH) in patients with adrenal nodules, and to identify a nodule size threshold below which ACH is unlikely. Retrospective review of adult patients with adrenal nodules who underwent CT of abdomen and 1-mg Dexamethasone suppression test within 1 year of each other. Patients were considered to have no ACH if serum cortisol was ≤ 1.8 µg/dL after the 1-mg dexamethasone suppression test and to have possible or definite autonomous cortisol secretion if serum cortisol was > 1.8 µg/dL. The following CT features were assessed: Adrenal nodule length, nodule width, unenhanced nodule attenuation, contralateral adrenal gland thickness, visceral and subcutaneous adipose tissue area, skeletal muscle area and density, and unenhanced liver attenuation. 29 patients had no autonomous cortisol secretion and 29 patients had possible or definite autonomous cortisol secretion. Nodule length and width were the only two variables that significantly differed between patients with nonfunctional nodules and those with possibly or definitely functional nodules. Using a threshold nodule length of 1.5 cm, the sensitivity and specificity for predicting possible or definite autonomous cortisol secretion was 93.1% and 37.9%, respectively. Autonomous cortisol secretion in patients with adrenal nodules correlates with increasing nodule size. A nodule length threshold of 1.5 cm provides 93.1% sensitivity for predicting possible or definite ACH based on the 1-mg Dexamethasone suppression test.