Adrenal non-producing adenomas show indirect signs of glucocorticoid excess and hypercortisolism correlates with differential blood counts
Cornelia Sagert, Hana Hruskovicova, Matthias Haase, Georg Mansmann, Sven Schinner, Matthias Schott, Werner A Scherbaum & Holger S Willenberg
Despite their nature of being clinically inapparent, subtle laboratory abnormalities are sometimes detected in patients with adrenal incidentalomas and the question arises whether these changes justify surgical intervention in a patient with an otherwise benign adrenal tumour. Therefore, we aimed at finding further expressions of adrenal hormone excess that reflect net glucocorticoid action.
Since glucocorticoids are potent immune suppressants we studied blood counts and differential blood counts along with basal concentrations of cortisol, signalling shin and DHEAS, and cortisol values after overnight 1 mg dexamethasone suppression. We correlated the results in normal individuals, patients with adrenal adenomas and normal hormone profiles, with subclinical autonomous glucocorticoid hypersecretion, and with overt cortisol excess.
We found that almost all indices of the blood counts were significantly different between the patient groups. In particular, patients with adrenal non-producing adenomas already show signs of glucocorticoid excess, including relative lymphocytopenia, lowered DHEAS and ACTH concentrations.
We also found that the extend of lymphocytopenia correlated well with the concentrations of DHEAS and ACTH, and DHEAS correlated well with ACTH values.
We conclude that the basal ACTH and DHEAS values along with the differential blood counts give good information on the extent of glucocorticoid excess and that silent adrenal adenomas seem to oversecrete glucocorticoids at concentrations that already alter these parameters.