Considering that adrenal tumors are frequent in patients with congenital adrenal hyperplasia (82% in homozygote and 45% in heterozygote), Synacten test was at first introduced as marker of congenital adrenal deficiency in patient with adrenal incidentaloma. Recent studies showed normal and exaggerated cortisol response in more than 50% of patient with nonhypersecretory adrenal incidentaloma and more than 70% of patients with adrenal incidentaloma and subclinical hypercorticism, witch can not be explained by variant form of 21 hydroxylase deficiency.
The aim of our study was to test cortisol response in patients with adrenal incidentaloma.
Of 208 patients (148 women and 60 men, mean age 55.08±11.02 years and mean BMI: 27.91± 4.6 kg/m2 with adrenal incidentaloma-CT/MR confirmed were admitted to our Instiute, tested and divided in two subgroups: First: 46 patients (38 women and 8 men, mean age 56.6±9.25 years and mean BMI 27.83±4.37 kg/m2) with confirmed subclinical CS; Second: 162 patients (110 women and 52 men, mean age 54.66±11.45 years and mean BMI 27.93±4.67 kg/m2) with nonhypersecreting adrenal tumors. Cortisol response to ACTH stimulation was tested in 110 patients. Our results shows mean cortisol value significantly higher in group with subclinical CS (Mann Whitney Test: W=513; P<0.01). AUC for cortisol during the test were significantly higher in patients with SCS (64 846, 15 vs 44 337, 59; Mann Whitney Test: W=621.5; P<0.01).
In conclusion, enhanced cortisol response to ACTH stimulation can be partially explained by altered intratumoral steroidogenesis maybe due to presence of some glucocorticoid receptor (GR) gene polymorphisms.
25 - 29 Apr 2009
European Society of Endocrinology