Abstract
Background: The role of adrenal scintigraphy (AS) in the diagnosis of subclinical hypercortisolism (SH) in adrenal incidentaloma (AI) is debated. Aim: To evaluate the possible role of AS in identifying SH in AI patients. Subjects and methods: In the retrospective phase (2000–2004), 102 AI patients [71 females (F)/31 males (M)] referred to our center were reevaluated for SH. In the prospective phase (2005–2006), 42 patients (32F/10M) with suspected SH were evaluated performing AS and biochemical assessment of cortisol secretion. We report data of the prospective phase of the study. In these patients AS was performed at baseline; the difference between the uptake of the affected and the controlateral gland [mean Δ uptake (MΔu)] was calculated. Cortisol secretion was evaluated in 3 different occasions. Patients were considered affected with SH if they presented at least twice 2 of the following criteria: urinary free cortisol >193 nmol/l, cortisol after 1 mg dexamethasone suppression test >83 nmol/l, ACTH levels <2.2 pmol/l. Results: MΔu was higher in patients with SH (no.=27, 5/22 M/F) than in patients without SH (83.7±12.5 vs 54.7±24.1%, p<0.001), and directly correlated with UFC (β=0.387, p=0.015) and was predictive of SH (odds ratio 1.12, 95% confidence interval 1.03-1.22, p=0.009) regardless of age, body mass index, and diameter of the mass. A 75% MΔu cut-off has 86.7% specificity and 81.5% sensitivity in diagnosing SH. Conclusions: AS is not recommended as screening test in AI patients, but it can be useful to exclude the presence of a subtle cortisol excess in patients with unclear biochemical diagnosis of SH.
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References
Ross NS, Aron DC. Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 1990, 323: 1401–5.
Chidiac RM, Aron DC. Incidentalomas. A disease of modern technology. Endocrinol Metab Clin North Am 1997, 26: 233–53.
Griffing G. A-I-D-S: the new endocrine epidemic. J Clin Endocrinol Metab 1994, 79: 1530–1.
Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995, 16: 460–84.
Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000, 85: 637–44.
Reincke M, Nieke J, Krestin GP, Saeger W, Allolio B, Winkelmann W. Preclinical Cushing’s syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab 2002, 75: 826–32.
Caplan RH, Strutt PJ, Wickus GG. Subclinical hormone secretion by incidentally discovered adrenal masses. Arch Surg 1994, 129: 291–6.
Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003, 149: 273–85.
Chiodini I, Guglielmi G, Battista C, et al. Spinal volumetric bone mineral density and vertebral fractures in female patients with adrenal incidentalomas: the effects of subclinical hypercortisolism and gonadal status. J Clin Endocrinol Metab 2004, 89: 2237–41.
Chiodini I, Mascia ML, Muscarella S, et al. Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med 2007, 147: 541–8.
Chiodini I, Torlontano M, Scillitani A, et al. Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients. Eur J Endocrinol 2005, 153: 837–44.
Terzolo M, Pia A, Alí A, et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab 2002, 87: 998–1003.
Fernández-Real JM, Engel WR, Simó R, Salinas I, Webb SM. Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma. Clin Endocrinol (Oxf) 1998, 49: 53–61.
Bernini G, Moretti A, Iacconi P, et al. Anthropometric, hemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery. Eur J Endocrinol 2003, 148: 213–9.
Reincke M. Subclinical Cushing’s syndrome. Endocrinol Metab Clin North Am 2000, 29: 43–56.
Barzon L, Fallo F, Sonino N, Boscaro M. Development of overt Cushing’s syndrome in patients with adrenal incidentaloma. Eur J Endocrinol 2002, 146: 61–6.
Tauchmano`a L, Rossi R, Biondi B, et al. Patients with subclinical Cushing’s syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 2002, 87: 4872–8.
Terzolo M, Bovio S, Reimondo G, et al. Subclinical Cushing’s syndrome in adrenal incidentalomas. Endocrinol Metab Clin North Am 2005, 34: 423–39.
Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2003, 88: 5593–602.
Tsagarakis S, Vassiliadi D, Thalassinos N. Endogenous subclinical hypercortisolism: Diagnostic uncertainties and clinical implications. J Endocrinol Invest 2006, 29: 471–82.
Gross MD, Avram A, Fig LM, Rubello D. Contemporary adrenal scintigraphy. Eur J Nuc Med Mol Imaging 2007, 34: 547–57.
Avram AM, Fig LM, Gross MD. Adrenal gland scintigraphy. Semin Nucl Med 2006, 36: 212–27.
Maurea S, Caracò C, Klain M, Mainolfi C, Salvatore M. Imaging characterization of non-hypersecreting adrenal masses. Comparison between MR and radionuclide techniques. Q J Nucl Med Mol Imaging 2004, 48: 188–97.
Osella G, Terzolo M, Borretta G, et al. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J Clin Endocrinol Metab 1994, 79: 1532–9.
Valli N, Catargi B, Ronci N, et al. Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas. Eur J Endocrinol 2001, 144: 401–8.
Catargi B, Rigalleau V, Poussin A, et al. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab 2003, 88: 5808–13.
Fagour C, Bardet S, Rohmer V, et al. Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study. Eur J Endocrinol 2009, 160: 257–64.
Annals of the ICRP 80. Radiation dose to patients from radiopharmaceuticals. Addendum to ICRP 53. Pergamon Press 1998.
Cook DM. Adrenal mass. Endocrinol Metab Clin North Am 1997, 26: 829–52.
Terzolo M, Osella G, Alì A, et al. Subclinical Cushing’s Sindrome in adrenal incidentaloma. Clin Endocrinol (Oxf) 1998, 48: 89–97.
Young WF Jr. The incidentally discovered adrenal mass. N Engl J Med 2007, 356: 601–10.
Barzon L, Scaroni C, Sonino N, et al. Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab 1998, 83: 55–62.
Bardet S, Rohmer V, Murat A, et al. 131I-6 beta-iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas. Clin Endocrinol (Oxf) 1996, 44: 587–96.
Orth DN. Cushing’s syndrome. N Engl J Med 1995, 33: 791–803.
Rossi R, Tauchmanova L, Luciano A. Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 2000, 85: 1440–8.
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Donadio, F., Morelli, V., Salcuni, A.S. et al. Role of adrenal gland scintigraphy in patients with subclinical hypercortisolism and incidentally discovered adrenal mass. J Endocrinol Invest 32, 576–580 (2009). https://doi.org/10.1007/BF03346511
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DOI: https://doi.org/10.1007/BF03346511