Subclinical Hormone Secretion by Incidentally Discovered Adrenal Masses

Caplan, Robert H.; Strutt, Pamela J.; Wickus, Gary G.

doi:10.1001/archsurg.1994.01420270067016

Cited by 121 publications

(62 citation statements)

References 19 publications

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“…Blunting of the circadian rhythm of cortisol seems more frequent than elevation of UFC and this confirms the view that derangement of the daily secretory pattern of cortisol is an early marker of (subclinical) hypercortisolism (12,13,17). Also low to unde- Figure 1.…”

Section: Diagnosissupporting

confidence: 74%

“…The reported prevalence of subclinical Cushing's syndrome among patients with adrenal incidentaloma ranges from 5% to 20% (2,3,(11)(12)(13)(14)(15)(16)(17). The sources of this heterogeneity may be found in the different work-up protocols and variable criteria used to define subclinical cortisol excess as well as in different inclusion criteria and size of the reported series (table 1).…”

Section: Diagnosismentioning

confidence: 99%

“…[Terzolo et al,ref. 3] tectable ACTH levels have been frequently reported (11)(12)(13) even if technical problems associated with measurement of ACTH concentrations close to the detection limits of the assay affect the utility of ACTH determination to demonstrate functional autonomy of an adrenal adenoma (9). Use of CRH test does not seem to add significant information to baseline ACTH levels (11,12,17,18).…”

Section: Diagnosismentioning

confidence: 99%

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Subclinical Cushing's syndrome

Terzolo

Bovio

Pia

et al. 2007

Arq Bras Endocrinol Metab

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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: Diagnosissupporting

confidence: 74%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Subclinical Cushing's syndrome

Terzolo

Bovio

Pia

et al. 2007

Arq Bras Endocrinol Metab

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“…By using contemporary high-resolution CT scanning technology, the prevalence should approach that of autopsy studies. Indeed, the most recent report from Caplan et al (21) shows a higher prevalence of adrenal incidentalomas, similar to that observed at autopsy.…”

Section: Radiological Seriessupporting

confidence: 59%

“…Aldosteronomas have been reported in 1.5-3.3% of adrenal incidentalomas (12,16,21,42,69). A recent study on normokalemic patients with adrenal incidentalomas found primary aldosteronism in 4.0% of all patients with adrenal incidentalomas and in 5.5% of those with hypertension (95), a prevalence higher than that found in the general hypertensive population.…”

Section: Subclinical Hyperfunctionmentioning

confidence: 99%

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

564

414

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Clinically silent adrenal masses discovered by imaging studies performed for unrelated reasons, i.e. adrenal incidentalomas, have become a rather common finding in clinical practice. However, only limited studies of incidence, prevalence, and natural history of adrenal incidentalomas are available. A comprehensive review of the literature shows the prevalence of adrenal incidentalomas to be 2.3% at autopsy and 0.5 -2% at abdominal computed tomography scan. Most lesions are adrenocortical adenomas at histology, whereas the prevalence of adrenocortical carcinomas is relatively low. The risk of malignancy over time for masses defined as benign at diagnosis is estimated at about 1/1000, even though 5-25% of masses increase in size during follow-up. Hyperfunction develops in about 1.7% of cases and the risk is higher in patients with lesions larger than 3 cm. Cortisol hypersecretion is the most likely disorder that may ensue, and it remains subclinical in about two-thirds of cases. The lack of controlled studies precludes making specific management recommendations. Large perspective controlled studies to define the epidemiology, natural history, and possible associated morbidity of adrenal incidentalomas and their impact on the quality of life of patients are needed.

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