A Survey on Adrenal Incidentaloma in Italy

Mantero, Franco; Terzolo, Massimo; Arnaldi, Giorgio; Osella, Giangiacomo; Masini, Anna Maria; Alı̀, Anna; Giovagnetti, M.; Opocher, Giuseppe; Angeli, Alberto

doi:10.1210/jc.85.2.637

Cited by 524 publications

(315 citation statements)

References 39 publications

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“…To circumvent the problem of false positive results, it has been advocated that two concomitant abnormal results in the tests used for screening should be demonstrated to diagnose subclinical Cushing's syndrome (11,12,26). Many combinations of abnormal tests may be demonstrated when the HPA axis is studied in detail (10)(11)(12)17), and it remains difficult, even with this approach, to define subclinical Cushing's syndrome.…”

Section: Diagnosismentioning

confidence: 99%

“…Several studies have correlated the scintigraphic pattern of unilateral uptake with cortisol hypersecretion by the adenoma and consequent pituitary ACTH suppression (15,21,26). Scintigraphic uptake may represent a very early sign of functional autonomy, because NP-59 uptake on the side of the mass without visualization of the contralateral adrenal gland (concordant uptake) occurs even with normal biochemical tests (12,17).…”

Section: Diagnosismentioning

confidence: 99%

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Subclinical Cushing's Syndrome

et al. 2004

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Subclinical Cushing's syndrome (CS) is attracting increasing interest since the serendipitous discovery of an adrenal mass has become a rather frequent event owing to the routine use of sophisticated radiologic techniques. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50% of cases in surgical series and even greater shares in medical series. Incidentally discovered adrenal adenomas may secrete cortisol in an autonomous manner that is not fully restrained by pituitary feedback, in 5 to 20% of cases depending on study protocols and diagnostic criteria. The criteria for qualifying subclinical cortisol excess are controversial and presently there is no consensus on a gold standard for the diagnosis of this condition. An increased frequency of hypertension, central obesity, impaired glucose tolerance, diabetes and hyperlipemia has been described in patients with subclinical CS; however, there is still no clear demonstration of the long-term complications of this condition whose management remains largely empirical. Either adrenalectomy or careful observation associated with treatment of the metabolic syndrome have been suggested as treatment options. RESUMO Síndrome de Cushing Subclínica.A síndrome de Cushing subclínica (SCS) tem atraído interesse cada vez maior desde que a descoberta casual de uma massa adrenal se tornou um evento freqüente devido ao emprego rotineiro de técnicas sofisticadas de imagem. O adenoma cortical é o tipo mais freqüente de incidentaloma adrenal, correspondendo a cerca de 50% dos casos em séries cirúrgicas e até mais do que isso em séries médicas. Adenomas adrenais descobertos incidentalmente podem secretar cortisol de maneira autônoma ou não controlada totalmente pelo feedback hipofisário, em 5 a 20% dos casos, dependendo do protocolo de estudo e dos critérios diagnósticos. Os critérios para qualificar um excesso subclínico de cortisol são controversos e atualmente não existe consenso a respeito de "padrão ouro" para o diagnóstico dessa condição. Em pacientes com SCS, tem sido descrita uma freqüência elevada de hipertensão, obesidade central, intolerância à glicose, diabetes e hiperlipemia; entretanto, ainda não existe uma evidente demonstração de complicações a longo prazo dessa condição, cujo manejo permanece amplamente empírico. Tanto a adrenalectomia como a observação cuidadosa, associada com o tratamento da síndrome metabólica, têm sido sugeridos como opções terapêuticas.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Subclinical Cushing's Syndrome

et al. 2004

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“…According to the definition of adrenal incidentaloma (i.e. an adrenal mass detected serendipitously by an imaging work-up performed for the evaluation of unrelated diseases in patients without clear signs or symptoms suggestive of adrenal disease), exclusion criteria a priori were severe or paroxysmal arterial hypertension, hypokalemia (<3.5 mEq/L), clinical signs of hypercortisolism or hyperandrogenism, and patients with previous or current history of malignancies known to metastasize commonly in the adrenal glands (4,12). When not histologically proven, the diagnosis of cortical adenoma rested on the following computed tomography (CT) criteria: size less than 6.0 cm, regular shape with well-defined margins, homogenous and hypodense content (13,14).…”

Section: Subjectsmentioning

confidence: 99%

“…When not histologically proven, the diagnosis of cortical adenoma rested on the following computed tomography (CT) criteria: size less than 6.0 cm, regular shape with well-defined margins, homogenous and hypodense content (13,14). The diagnosis of adenoma was confirmed by a repeat CT scan after 6 months showing no significant increase in mass size, or change in mass density, in any patient (4,12). Patient selection was also based on the results of an initial endocrine evaluation to exclude silent pheochromocytoma with equivocal imaging presentation, and normokalemic hyperaldosteronism (1)(2)(3)(4)12).…”

Section: Subjectsmentioning

confidence: 99%

“…The diagnosis of adenoma was confirmed by a repeat CT scan after 6 months showing no significant increase in mass size, or change in mass density, in any patient (4,12). Patient selection was also based on the results of an initial endocrine evaluation to exclude silent pheochromocytoma with equivocal imaging presentation, and normokalemic hyperaldosteronism (1)(2)(3)(4)12). None of the patients was suffering from depression or was taking any drug known to interfere with the HPA axis.…”

Section: Subjectsmentioning

confidence: 99%

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Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Reimondo

Allasino

Bovio

et al. 2011

J Endocrinol Invest

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The results of dexamethasone suppression tests (DST) in the screening of subclinical hypercortisolism are not readily comparable. Aim of the present study was to review the effectiveness of the overnight 1-mg DST and 8-mg DST to look for functional autonomy of clinically inapparent adrenal adenomas.Sixty-eight consecutive patients with clinically inapparent adrenal adenomas were enrolled. All patients underwent 1-mg DST. The 8-mg DST was performed in the 11 patients who had post 1-mg DST cortisol >138 nmol/L and in 11 patients who had post 1-mg DST cortisol between 50 -138 nmol/L. The a priori probability to have autonomous cortisol secretion was defined by the presence of at least two alterations of the HPA axis among reduced ACTH concentrations, elevated UFC or elevated midnight serum cortisol. Cortisol levels > 138 nmol/L after the 1-mg DST increases the post-test probability of adrenal functional autonomy to 55%, whereas cortisol levels <50 nmol/L reduce the post-test probability to 8%. Cortisol levels recorded after the 8-mg DST were non-significantly lower than after the 1-mg DST and all the patients with cortisol >138 nmol/L after the 1 mg DST maintained cortisol above this cut-point.The 1-mg DST should be considered as the more effective test to detect autonomous cortisol secretion by a clinically inapparent adrenal adenoma when cortisol levels are >138 nmol/l, while cortisol levels < 50 nmol/L reduces remarkably the post-test probability of this event. The 8-mg DST seems to replicate by large the results of the 1-mg DST.4

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