Advertisement

Journal of Endocrinological Investigation

, Volume 32, Issue 7, pp 576–580 | Cite as

Role of adrenal gland scintigraphy in patients with subclinical hypercortisolism and incidentally discovered adrenal mass

  • F. Donadio
  • V. Morelli
  • A. S. Salcuni
  • C. Eller-Vainicher
  • M. Carletto
  • M. Castellani
  • L. Dellavedova
  • A. Scillitani
  • P. Beck-Peccoz
  • I. Chiodini
Original Articles

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.

Key-words

Adenoma adrenal cortex adrenal scintigraphy incidentaloma subclinical hypercortisolism 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ross NS, Aron DC. Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 1990, 323: 1401–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Chidiac RM, Aron DC. Incidentalomas. A disease of modern technology. Endocrinol Metab Clin North Am 1997, 26: 233–53.PubMedCrossRefGoogle Scholar
  3. 3.
    Griffing G. A-I-D-S: the new endocrine epidemic. J Clin Endocrinol Metab 1994, 79: 1530–1.PubMedGoogle Scholar
  4. 4.
    Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995, 16: 460–84.PubMedGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    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.Google Scholar
  7. 7.
    Caplan RH, Strutt PJ, Wickus GG. Subclinical hormone secretion by incidentally discovered adrenal masses. Arch Surg 1994, 129: 291–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003, 149: 273–85.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Chiodini I, Mascia ML, Muscarella S, et al. Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med 2007, 147: 541–8.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.CrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Reincke M. Subclinical Cushing’s syndrome. Endocrinol Metab Clin North Am 2000, 29: 43–56.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    Terzolo M, Bovio S, Reimondo G, et al. Subclinical Cushing’s syndrome in adrenal incidentalomas. Endocrinol Metab Clin North Am 2005, 34: 423–39.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    Tsagarakis S, Vassiliadi D, Thalassinos N. Endogenous subclinical hypercortisolism: Diagnostic uncertainties and clinical implications. J Endocrinol Invest 2006, 29: 471–82.PubMedCrossRefGoogle Scholar
  21. 21.
    Gross MD, Avram A, Fig LM, Rubello D. Contemporary adrenal scintigraphy. Eur J Nuc Med Mol Imaging 2007, 34: 547–57.CrossRefGoogle Scholar
  22. 22.
    Avram AM, Fig LM, Gross MD. Adrenal gland scintigraphy. Semin Nucl Med 2006, 36: 212–27.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedGoogle Scholar
  24. 24.
    Osella G, Terzolo M, Borretta G, et al. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J Clin Endocrinol Metab 1994, 79: 1532–9.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Catargi B, Rigalleau V, Poussin A, et al. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab 2003, 88: 5808–13.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Annals of the ICRP 80. Radiation dose to patients from radiopharmaceuticals. Addendum to ICRP 53. Pergamon Press 1998.Google Scholar
  29. 29.
    Cook DM. Adrenal mass. Endocrinol Metab Clin North Am 1997, 26: 829–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Terzolo M, Osella G, Alì A, et al. Subclinical Cushing’s Sindrome in adrenal incidentaloma. Clin Endocrinol (Oxf) 1998, 48: 89–97.CrossRefGoogle Scholar
  31. 31.
    Young WF Jr. The incidentally discovered adrenal mass. N Engl J Med 2007, 356: 601–10.PubMedCrossRefGoogle Scholar
  32. 32.
    Barzon L, Scaroni C, Sonino N, et al. Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab 1998, 83: 55–62.PubMedGoogle Scholar
  33. 33.
    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.CrossRefGoogle Scholar
  34. 34.
    Orth DN. Cushing’s syndrome. N Engl J Med 1995, 33: 791–803.CrossRefGoogle Scholar
  35. 35.
    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.PubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2009

Authors and Affiliations

  • F. Donadio
    • 1
  • V. Morelli
    • 1
  • A. S. Salcuni
    • 1
  • C. Eller-Vainicher
    • 1
  • M. Carletto
    • 2
  • M. Castellani
    • 2
  • L. Dellavedova
    • 2
  • A. Scillitani
    • 3
  • P. Beck-Peccoz
    • 1
  • I. Chiodini
    • 1
  1. 1.Dept. of Medical SciencesUniversity of Milan, Endocrinology and Diabetology Unit, Fondazione Ospedale Maggiore Policlinico IRCCSMilanItaly
  2. 2.Department of Nuclear MedicineFondazione Ospedale Maggiore Policlinico IRCCSMilan
  3. 3.Unit of Endocrinology“Casa Sollievo della Sofferenza”, IRCCSFoggiaItaly

Personalised recommendations