Accuracy of the dexamethasone suppression test for the prediction of autonomous cortisol secretion-related comorbidities in adrenal incidentalomas

Araujo‐Castro, Marta; Ramírez, Paola Parra; Lázaro, Cristina Robles; Centeno, Rogelio García; Gimeno, Paola Gracia; Fernández-Ladreda, Mariana Tomé; Núñez, Miguel Antonio Sampedro; Marazuela, Mónica; Escobar-Morreale, Héctor F.; Valderrábano, Pablo

doi:10.1007/s42000-021-00308-z

Cited by 14 publications

(9 citation statements)

References 37 publications

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“…Thus, suggesting that the DST is not sensitive enough to detect subtle alterations in the steroidogenic pathway in patients with AIs. In line with this, our previous study on 823 patients with AIs showed that the diagnostic accuracy of the DST for the prediction of cardiometabolic comorbidities was poor, with areas under the ROC curve <0.61 for all the individual comorbidities 27 . Several limitations of the DST may contribute to this poor accuracy, such as patient compliance with the ingestion of dexamethasone, and individual differences in the intestinal absorption and hepatic metabolism of dexamethasone, among others 50 …”

Section: Discussionmentioning

confidence: 68%

“…These results are in conceptual agreement with our previous data that indicated a poor diagnostic accuracy of the DST for the prediction of cardiometabolic comorbidities in patients with AIs, highlighting the need of more precise markers of hypercortisolism. 27 Taken together, these findings might suggest that a majority of the so-called NFAIs overproduce hormones in an amount which, being insufficient to be detected by conventional methods, are actually deleterious for the cardiometabolic profile of these patients. In accordance, we observed an association between hypertension and type 2 diabetes prevalence with USP characteristic of NFAIs.…”

Section: Discussionmentioning

confidence: 96%

“…In line with this, our previous study on 823 patients with AIs showed that the diagnostic accuracy of the DST for the prediction of cardiometabolic comorbidities was poor, with areas under the ROC curve <0.61 for all the individual comorbidities. 27 Several limitations of the DST may contribute to this poor accuracy, such as patient compliance with the ingestion of dexamethasone, and individual differences in the intestinal absorption and hepatic metabolism of dexamethasone, among others. 50 The study has several limitations, which need to be acknowledged for accurate interpretation of the results.…”

Section: Discussionmentioning

confidence: 99%

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Characterisation of the urinary steroid profile of patients with nonfunctioning adrenal incidentalomas: A matched controlled cross‐sectional study

Araujo‐Castro

Casals

Hanzu

et al. 2022

Clinical Endocrinology

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Aim: To identify alterations in steroid metabolism in patients with nonfunctioning adrenal incidentalomas (NFAIs) through the analysis of their urinary steroid profile (USP).Methods: Cross-sectional study with one study group (NFAIs, cortisol post dexamethasone suppression test [DST] ≤ 1.8 µg/dl [49.7 nmol/L]) and 2 control groups: patients with autonomous cortisol secretion (ACS group, cortisol post-DST > 1.8 µg/dl (49.7 nmol/L) and patients without adrenal tumours (healthyadrenal group). Twenty-four-hour urine collections for USP measurement (total and free fraction of 51 24 h-urine specimens) were obtained from 73 participants (24 with NFAIs, 24 without AIs, and 25 with ACS). USP was determined by gas chromatography coupled to mass spectrometry. Patients of the three groups were matched according to sex, age (±5 years-old) and body mass index (±5 kg/m 2 ).Results: Compared to healthy-adrenal controls, patients with NFAIs had a lower excretion of androgen metabolites (230.5 ± 190.12 vs. 388.7 ± 328.58 µg/24 h, p = .046) and a higher excretion of urinary free cortisol (UFC) (54.3 ± 66.07 vs.25.4 ± 11.16 µg/24 h, p = .038). UFC was above the reference range in 20.8% of patients in the NFAI, compared to 0% in the healthy-adrenal group (p = .018).Patients with ACS had a higher prevalence of hypertension, dyslipidemia, and diabetes than patients with NFAIs or the control group. A lower excretion of androgen metabolites (218.4 ± 204.24 vs. 231 ± 190 µg/24 h, p = .041) and a nonsignificant higher excretion of glucocorticoid metabolites (2129.6 ± 1195.96 vs. 1550.8 ± 810.03 µg/24 h, p = .180) was found in patients with ACS compared to patients with NFAIs. Conclusion:NFAIs seem to secrete a subtle, yet clinically relevant, excess of glucocorticoids. Future studies are needed to confirm our findings; and to identify metabolic alterations associated with an increased cardiometabolic risk.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Characterisation of the urinary steroid profile of patients with nonfunctioning adrenal incidentalomas: A matched controlled cross‐sectional study

Araujo‐Castro

Casals

Hanzu

et al. 2022

Clinical Endocrinology

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“…However, their studies included non-suppressed DST data (post-DST cortisol >50 nmol/L). In a study by Castro et al that evaluated 593 adults with non-functioning adrenal incidentaloma, those with DST >1.4 µg/dL were older than those with ≤1.4 µg/dL [18]. They stated that this was probably due to the agedependent changes in the sensitivity of the HPA to both exogenous and endogenous stimulants.…”

Section: Discussionmentioning

confidence: 98%

Relationship Between Overnight Dexamethasone Suppression Test and Aging

Ciftel,

Mercantepe

2023

Cureus

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BackgroundThis study aims to investigate the relationship between suppressed cortisol levels measured after the 1-mg dexamethasone suppression test (DST) and age based on the hypothesis that aging can alter the activity of the hypothalamic-pituitary-adrenal (HPA) axis. MethodologyData obtained by the retrospective evaluation of suppressed 1-mg overnight DST results of adults aged ≥18 years with adrenal incidentaloma or suspected endogenous hypercortisolemia between December 2021 and March 2023 were subjected to age-dependent correlation analysis. Individuals aged between 18 and 90 years (n = 1111) were classified into the following four groups: <30 years, 30-49 years, 50-69 years, and >70 years. DST results were compared according to age groups. ResultsMedian post-DST cortisol was 18.49 nmol/L, with a level of 17.9 nmol/L in females and 20.7 nmol/L in males. The overall rate of DST suppression was 62.7%, with a rate of 63.8% in females and 59.7% in males. On pairwise comparisons of all age groups, there was a difference in post-DST cortisol levels (p = 0.000). Our statistical analysis revealed a strong positive correlation between age and cortisol levels after DST. ConclusionsThe negative feedback mechanism for cortisol may be altered in older patients. Therefore, the 1-mg DST may yield a higher rate of false positives in the elderly.

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“…Nevertheless, the retrospective design is a limitation that reduces the possibility of drawing conclusions in terms of causality. Another weakness of the study is the fact that only a minority of patients underwent AVS, which limits the power to determine if the prevalence of ACS is different between unilateral and bilateral PA. Another limitation, inherent to all studies using DST for the definition of ACS, is the potential false positive results in this test due to other circumstances such as drugs, obesity, type 2 diabetes, and other comorbidities ( 36 ). In addition, we are aware that the staining of CYP11B1, DHEA-sulfotransferase, and CYP11B2 would be useful for a better characterization of the surgical outcomes in our cohort, but these determinations were not available in most of the cases ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

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

Araujo-Castro

Fano

Peris

et al. 2023

Endocrine Connections

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Purpose: To evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods: A retrospective multicenter study of PA patients who underwent 1mg-dexamethasone suppression test (DST) during diagnostic work-up in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8µg/dL (confirmed ACS if >5µg/dL and possible ACS if 1.8-5µg/dL) in 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. Results: 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. Conclusion: Cortisol and aldosterone secretion 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.

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Accuracy of the dexamethasone suppression test for the prediction of autonomous cortisol secretion-related comorbidities in adrenal incidentalomas

Cited by 14 publications

References 37 publications

Characterisation of the urinary steroid profile of patients with nonfunctioning adrenal incidentalomas: A matched controlled cross‐sectional study

Characterisation of the urinary steroid profile of patients with nonfunctioning adrenal incidentalomas: A matched controlled cross‐sectional study

Relationship Between Overnight Dexamethasone Suppression Test and Aging

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

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