Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects
Valentina Morelli1, Benedetta Masserini1, Antonio Stefano Salcuni1, Cristina Eller-Vainicher1, Chiara Savoca1, Raffaella Viti1,2, Francesca Coletti1,4, Giuseppe Guglielmi1,3, Claudia Battista1,2, Laura Iorio1,5, Paolo Beck-Peccoz1, Bruno Ambosi1,5, Maura Arosio1,4, Alfredo Scillitani1,2 & Iacopo Chiodini1
Objective: Subclinical hypercortisolism (SH) has been associated with increased prevalence of hypertension, type 2 diabetes mellitus, dyslipidemia, central obesity, osteoporosis and vertebral fractures. We aimed to investigate the accuracy of different SH diagnostic criteria in predicting the concomitant presence of these complications.
Patiets: In this retrospective study we evaluated data of 231 patients (120 females and 111 males) affected with adrenal incidentalomas (AI).
Methods: We studied the accuracy of different SH diagnostic criteria (cortisol after 1 mg overnight dexamethasone suppression test 1 mg-DST at different cut-off such as 50, 83, 138 nmol/l, elevated urinary free cortisol, reduced ACTH levels alone or various combination of these parameters) in predicting the concomitant presence of the following three complications: hypertension, type 2 diabetes and vertebral fractures.
Results: The criterion characterized by the presence of two out of 1 mg-DST >83 nmol/l, elevated UFC, reduced ACTH, struck the best balance between sensitivity and specificity reaching a good accuracy in predicting the cluster of complications (61.9; 77.1 and 75.8%, respectively). The presence of the cluster of complications was associated with this criterion (OR 4.75, 95% CI 1.812.7, P=0.002) regardless for gonadal status, BMI and age. Indeed, the SH diagnostic criterion defined as cortisol after 1 mg-DST >138 nmol/l, showed the higher specificity (93.3%) but a poor sensitivity (lower than 23.8%), whereas the criterion by cortisol after 1 mg-DST >50 nmol/l showed the higher sensitivity (71.4%) but a low specificity and accuracy (49.5 and 51.5 respectively).
Conclusions: The SH criterion characterized by the presence of two out of 1 mg-DST >83 nmol/l, elevated UFC, reduced ACTH, seems the best in predicting the presence of chronic manifestations of subtle cortisol excess.