ACTH-Induced Cortisol Secretion Is Mediated by cAMP and PKC in Various Adrenocortical Adenomas.

Ishizuka, Tatsuo; Daidoh, Hisashi; Morita, Hiroyuki; Mune, Tomoatsu; Miura, Asako; Suwa, Tetsuya; Shibata, Toshiroh; Yamada, Kouji; Itaya, Satomi; Kajita, Kazuo

doi:10.1507/endocrj.44.661

Cited by 4 publications

(1 citation statement)

References 26 publications

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“…It is therefore suggested that ACTH-dependent cortisol secretion in these 8 patients with preclinical Cushings syndrome originates from the tumor tissue rather than the nonadenoma tissues. ACTH has been shown to stimulate cortisol secretion from the adenoma tissue of Cushings syndrome in vitro [18]. In addition, expression of ACTH receptor mRNA has been demonstrated in the adenoma tissues of Cushings syndrome [19].…”

Section: Discussionmentioning

confidence: 99%

Autonomy of Cortisol Secretion in Clinically Silent Adrenal Incidentaloma

Tanabe¹,

Naruse²,

Nishikawa³

et al. 2001

Horm Metab Res

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Recent progress in non-invasive imaging techniques have resulted in an increasing frequency of adrenal incidentaloma discovery. In addition, even clinically silent adrenal tumor has been suggested to possess a subtle production of adrenal hormones. The aim of the study was to ascertain the autonomy of cortisol production in clinically silent adrenocortical incidentaloma. We investigated the hypothalamic-pituitary-adrenal axis in 38 patients with adrenal incidentaloma. Basal plasma cortisol level was reproducibly within normal range in all the patients with adrenal incidentaloma, but was also normal in half of the Cushing's syndrome cases studied. Eighteen of 38 patients showed plasma cortisol above 3 microg/dl after 1 mg dexamethasone (Dex) and above 1 microg/dl after 8 mg Dex, respectively, and were defined as preclinical Cushing's syndrome. These patients were subjected to further evaluation of the autonomy of cortisol production. The incidence of positive findings indicating autonomy of cortisol secretion was as follows: suppressed basal plasma ACTH level in 44%, loss of normal diurnal rhythm in 79%, lack of ACTH response to CRF in 35%, decreased plasma DHEA-S level in 28%, significant laterality of 131I-adosterol uptake in 75%, atrophy of the contralateral side of the adrenal on CT scan in 6%, and histological atrophy of the adjacent adrenal cortex in 56%, respectively. The endocrine feature relevant to the hypothalamic-pituitary-adrenal axis varied from patient to patient, ranging from the non-functioning adrenal adenoma to Cushing's syndrome. In addition, the results of each test did not coincide with others in each patient. These results clearly demonstrated that the incidence of autonomy of cortisol production in the clinically silent adrenal incidentaloma is not infrequent, showing significant diversity. Systemic evaluation of the hypothalamic-pituitary-adrenal axis before adrenal surgery is warranted for an appropriate glucocorticoid replacement after adrenal surgery.

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Section: Discussionmentioning

confidence: 99%