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12th European Congress of Endocrinology

ea0022p1 | Adrenal | ECE2010

Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound

Friedrich-Rust Mireen , Glasemann Timo , Holzer Katharina , Kiener Susanne , Herrmann Eva , Polta Andreas , Zeuzem Stefan , Bojunga Joerg

Background: Adrenal masses can be detected by ultrasound with high sensitivity and specificity. However, a differentiation between benign and malignant adrenal masses is not possible with conventional ultrasound. Contrast-enhanced ultrasound (CEUS) is a established method for the characterization of focal liver lesions. A first pilot study (n=35) analyzing the dynamics of contrast-enhancement during CEUS reported a high sensitivity for differentiation of benign and mali...

ea0022p2 | Adrenal | ECE2010

Alterations in lipid and carbohydrate metabolism in patients with classic CAH due to 21-hydroxylase deficiency

Zimmermann Anca , Sido Paula Grigorescu , Khzouz Camelia Al , Patberg Karen , Bucerzan Simona , Schulze Egbert , Zimmermann Tim , Weber Matthias M

Background: Classic 21-hydroxylase deficiency (21HD) presents some traits of the metabolic syndrome. We aimed to characterize discrete alterations of lipid and carbohydrate metabolism in children and young adults with classic 21HD, which could predict early atherogenesis.Design: Cross-sectional comparative.Patients and methods: Of 27 Caucasian patients with classic 21HD (4–31 years); 27 sex-, age- and BMI-matched controls. Cli...

ea0022p3 | Adrenal | ECE2010

Glucocorticoid receptor polymorphisms and metabolic-cardiovascular impairment in adult patients with Addison's disease under glucocorticoid replacement therapy

Giordano Roberta , Falorni Alberto , Mandrile Giorgia , Gioachino Daniela , Balbo Marcella , Berardelli Rita , Karamouzis Ioannis , Marinazzo Elisa , Picu Andreea , Marzotti Stefania , Romagnoli Serena , Ghigo Ezio , Arvat Emanuela

Object: In Addison’s disease (AD), although glucocorticoid (GC) replacement is essential for health and, indeed, life, several studies showed that conventional GCs doses are involved in metabolic and cardiovascular alterations observed in this disease. As the effects of GCs are mediated by the glucocorticoid receptor (GR), encoded by NR3C1 gene, different polymorphisms in the NR3C1 gene have been linked to altered glucocorticoid sensitivity in general population as well a...

ea0022p4 | Adrenal | ECE2010

Clinically silent adrenal incidentalomas: their relation to metabolic syndrome and to GNB3 C825T gene polymorphism

Lazurova Ivica , Spisakova Daniela , Wagnerova Hedviga , Habalova Viera , Dravecka Ingrid , Petrasova Darina , Pundova Lydia

Objectives: Aim of the study was firstly to assess the prevalence of metabolic symptoms in patients with clinically silent and benign adrenal incidentalomas (AI) and secondly to determine the prevalence of C825T GNB3 gene polymorphism in AI as well as its relation to metabolic variables.Subject and methods: Group of patients consisted of 50 patients with AI of mean age 57.9±15 years and group of controls consisted of 22 subjects without AI and metab...

ea0022p5 | Adrenal | ECE2010

Evaluation of haemostatic and fibrinolytic markers in patients with Cushing's syndrome: a longitudinal study

Raffaelli Valentina , Manetti Luca , Ruocco Lucia , Giovannetti Clara , Genovesi Maura , Pellegrini Giovanni , Bogazzi Fausto , Martino Enio

Patients with active Cushing’s syndrome (CS) have an increased coagulability and thrombotic tendency. High glucocorticoids concentrations increase plasma clotting factors, especially von Willebrand factor (vWf) and reduced fibrinolytic capacity. Thromboemobolic complications, mainly in the postsurgical phase, have been reported.Aim of this longitudinal study was to evaluate haemostatic and fibrinolytic markers in patients with active Cushing’s ...

ea0022p6 | Adrenal | ECE2010

Supine and upright plasma renin (PR) and aldosterone (ALD) in patients with adrenal incidentaloma (AI)

Ivovic Miomira , Stojanovic Milos , Tancic-Gajic Milina , Marina Ljiljana , Barac Marija , Vujovic Svetlana

AI are incidentally discovered adrenal masses without any prior suspicions of adrenal disease. They are most frequently hormonally inactive, with arterial hypertension (AH) as a common finding.The aim was to determine upright and supine PR and ALD levels in patients with AI, normotensive and hypertensive.Two hundred and eight patients (148 women and 60 men, mean age 55.08±11.02 years, mean BMI 27.91±4.6 kg/m2) ...

ea0022p7 | Adrenal | ECE2010

Beneficial metabolic effects of surgical treatment in patients with an adrenal incidentaloma causing subclinical hypercortisolism

Chiodini Iacopo , Morelli Valentina , Salcuni Antonio Stefano , Vainicher Cristina Eller , Torlontano Massimo , Coletti Francesca , Iorio Laura , Cuttitta Antonello , Ambrosio Angelo , Vicentini Leonardo , Pellegrini Fabio , Copetti Massimiliano , Beck-Peccoz Paolo , Arosio Maura , Ambrosi Bruno , Trischitta Vincenzo , Scillitani Alfredo

Objective: In patients with adrenal incidentalomas (AI) the metabolic effect of the recovery of subclinical hypercortisolism (SH) is debated. The aim of this study was to determine the effect of the surgical and conservative approaches on the metabolic syndrome in AI patients with and without SH.Patients: One hundred and eight AI patients were studied; SH was diagnosed in the presence of >2 out of: urinary free cortisol >70 μg/24 h (193 nmol...

ea0022p8 | Adrenal | ECE2010

The consideration of external steroid therapy history and skin bruising sign with morning serum cortisol measurement predicts better results of rapid ACTH stimulation test than morning serum cortisol only

Song Sun Ok , Kim Se Hwa , Kim Hyeong Jin

The morning serum cortisol measurement has long been used as an index of adrenal function in the unstressed patient, but does not necessarily differentiate normal subjects from those with adrenal dysfunction. We investigate causes and clinical findings of adrenocortical insufficiency in this study, and will propose a model predicting results of rapid ACTH stimulation test. A consecutive series of 363 subjects who were examined rapid ACTH stimulation were recruited. Adrenocorti...

ea0022p9 | Adrenal | ECE2010

A high prevalence of primary hyperaldosteronism in hypertensive patients

Jagodzinska Agnieszka , Zieleniewski Wojciech , Michalak Renata

Hypertension remains one of the most common diseases affecting more than 25% of the whole population. It is associated with high mortality risk due to cardiovascular complications. Usually hypertension is of idiopathic origin, however, several other diseases, including hormonal abnormalities may cause hypertension.Here, we present the frequency of primary hyperaldosteronism in a group of 310 hypertensive patients.Previously, they h...

ea0022p10 | Adrenal | ECE2010

Cushing's syndrome: screening and diagnosis aspects

Crista Corina , Cismas Anda , Voicu Roxana , Manjunath Nagaraj , Bobu Maria Dana , Nes Bogdan Alin

The diagnosis of Cushing’s syndrome, in the clinical practice, requires investigations necessary for distinguishing it from obesity with reactive hypercorticism and for differentiating its forms.The study group was represented by 85 cases of hypercorticism (hospitalized in the Clinic of Endocrinology Timisoara during the period 2000–2009) divided in two groups: obesity with reactive hypercorticism (81.18%) respectively, Cushing’s syndrome ...

ea0022p11 | Adrenal | ECE2010

Effects of atenolol add-on treatment on plasma renin activity (PRA) and aldosterone escape in hypertensive patients with diabetes receiving valsartan

Yasuda Gen , Yatsu Keisuke , Hirawa Nobuhito , Yamamoto Yuichiro , Umemura Satoshi

Angiotensin II receptor antagonists (ARB) decrease plasma aldosterone concentration (PAC) for cardiovascular protection. However, long-term ARB therapy increases PRA and PAC, which is known as ‘aldosterone escape.’ β-Blockers are the noble antihypertensive agents to decrease PRA. Nevertheless, little is known about the effect of coadministration of both agents on PRA and aldosterone escape. The study was designed to compare the effects of adding atenolol (β...

ea0022p12 | Adrenal | ECE2010

Autoimmune disorders in Addison's disease and in isolated secondary adrenal insufficiency

Kasperlik-Zaluska Anna A , Czarnocka Barbara , Jeske Wojciech , Bednarek-Papierska Lucyna , Hulting Anna-Lena , Bensing Sophie , Crock-Ludecke Patricia , Kampe Olle

Autoimmunity is the most frequent cause of Addison’s disease (AD). Isolated secondary adrenal insufficiency (ISAI) in patients not treated with corticosteroids seems to be an autoimmune disease too. In the registry of the Department of Endocrinology in Warsaw we have 328 patients with AD and 305 patients with ISAI. Autoimmune AD was diagnosed in 262 of 328 patients (77%) and in 217 of them (83%) some associated autoimmune disorders were found, while in the group with ISAI...

ea0022p13 | Adrenal | ECE2010

Pharmacokinetic evidence for hydrococortisone under and over replacement in adrenal insufficiency

Castinetti Frederic , Simon Nicolas , Ouliac Floriane , Lesavre Nathalie , Brue Thierry , Oliver Charles

Aim and methods: Cortisol substitution in adrenal insufficiency (AI) is a matter of debate. We performed a pharmacokinetic analysis of plasma and salivary cortisol following oral hydrocortisone intake in patients with AI, and a pharmacokinetic modelling simulation. Fifty patients with primary (n=20) or secondary (n=30) AI were recruited. After 24-h plasma and salivary cortisol measurements under usual hydrocortisone treatment, a pharmacokinetic modelling with dif...

ea0022p14 | Adrenal | ECE2010

Serum dehydroepiandrosterone and dehydroepiandrosterone sulfate as markers of disease severity in community-acquired pneumonia

Blum Claudine A , Schuetz Philipp , Stolz Daiana , Bingisser Roland , Mueller Christian , Tamm Michael , Trummler Michael , Mueller Beat , Christ-Crain Mirjam

Background: Rapid and accurate risk stratification in patients with community-acquired pneumonia (CAP) is an unmet clinical need. Cortisol to DHEA ratio was put forward as a prognostic marker in sepsis. We herein validated the prognostic value of DHEA and DHEAS and of cortisol/DHEA- and cortisol-DHEAS – ratios, respectively, in patients with CAP as the most common (disease resulting) sepsis-defining illness.Methods: We assessed clinical parameters a...

ea0022p15 | Adrenal | ECE2010

Pheochromocytoma in an incidentally discovered cystic adrenal mass: a case report

Oguz Ayten , Ersoy Pamir Eren , Sugutlugil Melike Metin , Guler Gulnur , Ersoy Reyhan , Cakir Bekir

Introduction: Adrenal cysts are rare usually benign and asymptomatic. Histologically, they are classified as epithelial, endothelial, parasitic and pseudocysts. Although extremely rare and clinically more dramatic cystic adrenal carcinoma and cystic pheochromocytoma must be considered in the differential diagnosis of adrenal cysts. In this report, we presented a patient with a large cystic pheochromocytoma.Case report: A 30-year-old female patient admitt...

ea0022p16 | Adrenal | ECE2010

Secondary adrenal failure due to sepsis

Munir Atif , Nag Sath , Bilous Rudy

Introduction: Hypothalamic–pituitary adrenal axis dysfunction is common in severely ill patients. Even slight impairment of adrenal response to severe illness can increase morbidity and mortality. Relative adrenal insufficiency has been associated with severe sepsis.Case report: We report a case of 48-year-old lady who was admitted with septic shock secondary to epiglottitis requiring intubation and intensive care. Short synacthen test performed in ...

ea0022p17 | Adrenal | ECE2010

Salivary cortisol in the diagnosis of Cushing's syndrome: clinical experience with liquid chromatography/tandem mass spectrometry on outpatient basis

Erickson Dana , Singh Ravinder , Sathananthan Airani , Vella Adrian , Bryant Sandra

Late night salivary cortisol measurements have been increasingly used as an initial diagnostic test for the evaluation of patients with a clinical suspicion of Cushing syndrome (CS). Published studies include varying numbers of cases and controls and importantly various assay methods (usually immunoassays), as well as various methods of generating normative values.Materials and methods: We examined the diagnostic utility of salivary cortisol measurement ...

ea0022p18 | Adrenal | ECE2010

The aldosterone renin ratio based on the plasma renin activity and the direct renin assay for diagnosing aldosterone-producing adenoma

Rossi GianPaolo , Barisa Marlena , Desideri GiovanBattista , Letizia Claudio , Maccario Mauro , Morganti Alberto , Palumbo Gaetana , Patalano Anna , Realdi Anna , Roman Elisabetta , Seccia Teresa Maria , Pessina Achille Cesare

The screening for primary aldosteronism (PA) is based on the aldosterone/renin ratio (ARR), which is calculated with the plasma renin activity (PRA) as denominator. A direct measurement of active renin (DRA) is being used as an alternative to PRA, but its diagnostic performance remains uncertain.Aim of the study was to head-to-head compare the ARR based on PRA (ARR-P) to on DRA (ARR-D), at baseline and post-captopril, for identifying aldosterone-producin...

ea0022p19 | Adrenal | ECE2010

Adrenal incidentalomas accompanying malignant tumours: clinical study of 1888 patients

Kasperlik-Zaluska Anna A , Slowinska-Srzednicka Jadwiga , Roslonowska Elzbieta , Jeske Wojciech , Cichocki Andrzej , Otto Maciej , Zgliczynski Wojciech

Diagnostic procedures reveal that majority of incidentally found adrenal tumours (adrenal incidentalomas, AI) appear to be benign adenomas. However, AI accompanying malignant tumours must be diagnosed very carefully to take a proper decision concerning their management. In the registry of the Department of Endocrinology in Warsaw, there are 1888 patients (1388 women, 500 men, F/M ratio 2.8) with AI, 10–87 years old. Primary malignant tumours were diagnosed in 155 patients...

ea0022p20 | Adrenal | ECE2010

Comparison between ultrasonography versus other standard imaging procedure in diagnostics of pathological changes of adrenal glands

Pejicic Snjezana , Gotovac Vaskrsija , Pejicic Anja , Dunovic Severin

The aim of this study was to find out sensitivity and specificity of ultrasonography (US) versus other imaging modalities such as computed tomography (CT) and magnetic resonance (MR) in diagnostics of pathologic changes of adrenal glands. In a sample of 310 patients with pathological process in retroperitoneum, we diagnosed pathological changes of adrenal glands (adrenals tumor) in 57 patients. The patients were examined by US Aloka SSD 500 with convex transducer of 3.5 MHz an...

ea0022p21 | Adrenal | ECE2010

Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects

Morelli Valentina , Masserini Benedetta , Salcuni Antonio Stefano , Eller-Vainicher Cristina , Savoca Chiara , Viti Raffaella , Coletti Francesca , Guglielmi Giuseppe , Battista Claudia , Iorio Laura , Beck-Peccoz Paolo , Ambosi Bruno , Arosio Maura , Scillitani Alfredo , Chiodini Iacopo

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...

ea0022p22 | Adrenal | ECE2010

Comparison of the in vitro effects of ketoconazole and fluconazole on human primary adrenocortical cultures and on the adrenocortical carcinoma cell line HAC15

van der Pas Rob , Hofland Leo , Waaijers Marlijn , de Jong Frank , Uitterlinden Piet , de Herder Wouter , van Koetsveld Peter , Feelders Richard

Introduction: Ketoconazole is an antifungal agent that, in a high dose, suppresses adrenocortical steroidogenesis by inhibition of cytochrome P-450 dependent enzymes. Currently, ketoconazole is used to decrease cortisol production in patients with Cushing’s syndrome. However, ketoconazole often causes gastrointestinal side effects and hepatotoxicity. Fluconazole may also inhibit steroidogenesis and has the advantage over ketoconazole that it has less side effects. Therefo...

ea0022p23 | Adrenal | ECE2010

Sunitinib decreases adrenocortical cancer cell proliferation and specifically inhibits adrenal steroidogenesis

Reuss Miriam , Kroiss Matthias , Johanssen Sarah , Beyer Melanie , Zink Martina , Hartmann Michaela , Dhir Vivek , Wudy Stefan , Arlt Wiebke , Sbiera Silviu , Allolio Bruno , Fassnacht Martin

Background: The multi-tyrosine kinase inhibitor sunitinib is approved for advanced renal cell carcinoma and gastrointestinal stroma tumors. It targets both tumor vessels and malignant cells. Animal experiments have pointed to a direct adrenotoxic effect of the drug.Aims: We hypothesized that sunitinib may inhibit proliferation of adrenocortical cancer (ACC) cells and influence adrenal steroid hormone synthesis.Results: Sunitinib re...

ea0022p24 | Adrenal | ECE2010

Two cousins with 17-α hydroxylase enzyme deficiency

Ozsan Muge , Akarsu Ersin , Aktaran Sebnem , Araz Mustafa

We present two cases because 17OHD is the rare cause of congenital adrenal hyperplasia (1%) and our patients are first cousins (their fathers are brothers). Genetically female patients with congenital adrenal hyperplasia due to 17-α hydroxylase enzyme deficiency (17OHD) represent with sexual infantilism, hypertension and genetically male patients represent with male pseudohermaphroditisim, hypertension at pubertal age. The cousins applied for primer amenorrhea and hyperte...

ea0022p25 | Adrenal | ECE2010

Morphological, functional and metabolic features in a series of 63 patients with adrenal incidentalomas

Tsentidis Charalampos , Antoniou-Tsigos Athanasios , Skarpa Vasiliki , Dimarakis Vasilios , Prokovas Ioannis , Argyropoulos Argyris

Background: The prevalence of incidentally discovered adrenal masses has increased during last decades, due to longer life expectancy and to the extended use of new imaging techniques like high definition C/T and MRI. Diagnostic approach and possible therapeutic management are considered nowadays fascinating challenges for clinical practice, not only for the probability of hormonal hypersecretion but also for the risc of malignancy.Methods: We investigat...

ea0022p26 | Adrenal | ECE2010

Confirmation of vitamin D receptor polymorphism TaqI and detection of a new single nucleotide polymorphism (SNP) in the CTLA4-region (CTLA4-CT60) as susceptibility markers for Addison's disease

Meyer Gesine , Ramos-Lopez Elizabeth , Penna-Martinez Marissa , Kahles Heinrich , Willenberg Holger , Badenhoop Klaus

Objective: Addison’s disease (AD) is a rare and complex endocrine disorder. Genetic susceptibility loci known so far are predominantly shared with other, more frequent autoimmune endocrinopathies. We therefore investigated polymorphisms of the CTLA4-region, the vitamin D system (vitamin D receptor VDR, CYP24 and CYP27B1 gene) as well as cytokine CXCL10 gene for their association in AD.Methods: Patients with AD (n=203) and healthy controls (<i...

ea0022p27 | Adrenal | ECE2010

Spontaneous recovery of bone mass after cure of endogenous hypercortisolism

Grossrubatscher Erika , Ciaramella Paolo Dalino , Randazzo Maria Elena , Vanzulli Angelo , Loli Paola

Patients with Cushing’s syndrome (CS) commonly develop osteopenia–osteoporosis; the recovery of bone mass after remission of hypercortisolism is not well documented. The present study addresses this issue.Patients and methods: Twenty patients (6M, 14F, 2 post-menopausal), aged 15–64 years (median 36), 15 with Cushing’s disease, 2 with ectopic ACTH syndrome, 3 with ACTH-indipendent CS were studied. BMD (t and z scores) at...

ea0022p28 | Adrenal | ECE2010

Predictors for cure and normotension after adrenalectomy for primary aldosteronism

Volpe Cristina , Thoren Marja , Backdahl Martin , Calissendorff Jan , Falhammar Henrik , Wahrenberg Hans , Hamberger Bertil , Enberg Ulla

Background: Primary aldosteronism (PA) accounts for 5–10% of all hypertension. In about 30% of PA patients the disease is unilateral caused by an adenoma or rarely unilateral hyperplasia. Cure rate from unilateral adrenalectomy, defined as normalized aldosterone secretion, is high but only 30–35% will obtain complete resolution of hypertension. We have studied pre- and postoperative characteristics potentially important for biochemical cure and normotension after adr...

ea0022p29 | Adrenal | ECE2010

Benefit to risk ratio of mitotane high starting dose strategy in 22 patients with adrenocortical carcinoma (ACC): a prospective evaluation

Mauclere-Denost Sophie , Leboulleux Sophie , Borget Isabelle , Al Ghuzlan Abir , Young Jacques , Drouard Laurence , Paci Angelo , Chanson Philippe , Schlumberger Martin , Baudin Eric

Background: The benefit to risk ratio of mitotane high starting dose regimen in ACC remains unknown.Methods: To evaluate a high starting dose strategy, we performed a single-center, prospective study with three main objectives: 1) to assess the time taken to reach a mitotane plasma level above 14 mg/l (benefit); 2) to evaluate mitotane tolerance (risk) in the first 3 months of treatment and 3) to analyse the correlation using a regression analysis test b...

ea0022p30 | Adrenal | ECE2010

Primary adrenocortical sarcomatous carcinoma: case report

Kun Imre Zoltan , Szanto Zsuzsanna , Let Emilia , Bud Vasile , Milutin Doina

Adrenocortical carcinoma is a rare disease, its estimated incidence being 1–2/million per year in general population. Age distribution shows two peaks: the first in early childhood (70% of patients having a benign evolution), and the second between 40 and 50 years of age (with a dismal prognosis).The 38-years-old male patient (C A) hospitalized in our Clinic in September 2008 presented hypertension (to 250/150 mmHg) for about 3 months, lumbar pain w...

ea0022p31 | Adrenal | ECE2010

Adrenocortical cancer: any hope? case reports

Valkusz Zsuzsanna , Magony Sandor , Csajbok Eva , Gardi Janos , Kiss Ildiko , Julesz Janos

Adrenocortical cancer is a rare and heterogenous malignancy with incompletely understood pathogenesis and poor prognosis. Sometimes patients present with hormonal excess symptoms (e.g. virilization, Cushing’s syndrome) or local symptoms consistent with abdominal space-occupation (median tumor size at the time of diagnosis may be >10 cm). Three cases are presented to give an overview of how adrenocortical cancer is currently managed. Tumors typically appear inhomogenou...

ea0022p32 | Adrenal | ECE2010

Utility of midnight salivary cortisol measurement in the diagnosis of overt and subclinical Cushing's syndrome

Sereg Marta , Toke Judit , Patocs Attila , Igaz Peter , Szucs Nikolett , Varga Ibolya , Szappanos Agnes , Glaz Edit , Racz Karoly , Toth Miklos

Background: Midnight salivary cortisol (SalC2400) measurement has been recently suggested as one of the first-line screening tests for hypercortisolism.Aims: In our present study, we evaluated the clinical utility of the salivary cortisol (SalC) measurement in the diagnosis of both overt and subclinical Cushing’s syndrome.Patients and methods: Patients with overt Cushing’s syndrome (n=23, group A) and those with su...

ea0022p33 | Adrenal | ECE2010

Adrenal incidentalomas and low grade hormonal activity

Stefanopoulos Dimitris , Kostoglou-Athanassiou Ifigenia , Michou Aikaterini , Chronaiou Aikaterini , Badila Razvan Alexandros , Vassiliou Georgia , Loi Vassiliki , Karfi Areti

Adrenal incidentalomas are increasingly recognized today as a result of technology use, such as computed tomography and magnetic resonance imaging. Adrenal incidentalomas are of diverse nature and their secretory activity is currently on research focus.The aim was to describe 39 consecutive patients with adrenal incidentalomas presenting over a period of 1 year.Materials and methods: A group of 39 consecutive patients with adrenal ...

ea0022p34 | Adrenal | ECE2010

Aberrant adrenal LH receptors leading to subclinical Cushing's syndrome: long-term effect of medical treatment with leuprolide acetate

Stratigou Theodora , Tsatlidis Vasileios , Sangova-Grigoriadi Sylvina , Kypraios Nikolaos , Papadopoulou Katerina , Tampourlou Metaxia , Tsagarakis Slylianos

Aberrant adrenal LH expression is a rare cause of adrenal Cushing’s syndrome (CS) leading to transient hypercortisolism during pregnancies and ACTH-independent macronodular adrenal hyperplasia (AIMAH) after the sustained postmenopausal increase of LH secretion. Subclinical CS due to aberrant LH expression has very rarely been described. Herein, we report a case with aberrant LH/hCG adrenal receptor mediated subclinical CS in a patient with incidentally discovered AIMAH an...

ea0022p35 | Adrenal | ECE2010

Conservation and divergence in transcriptional regulation of human CYP11B1 and CYP11B2 genes

Li Lih-Ann , Cheng Li-Chuan , Pai Tun-Wen

CYP11B1 and CYP11B2 are responsible for the final steps in cortisol and aldosterone synthesis, respectively, in human. These two genes share 95% identity in coding regions and 90% identity in introns, but have very dissimilar promoter regions. To investigate whether there is a regulatory link between human CYP11B1 and CYP11B2 genes, we analyzed their upstream sequences using a pattern-search program termed multiple index sequence alignment. Three co...

ea0022p36 | Adrenal | ECE2010

Free cortisol in plasma and saliva samples after synacthen testing in a routine exploration of patients in endocrinology

Brossaud Julie , Dolomie Laurence , Gatta Blandine , Tabarin Antoine , Corcuff Jean-Benoit

Cortisol ([C]) biological activity depends on its free fraction diffusion into the intracellular compartment. The diagnosis of adrenal insufficiency requires investigations such as the synacthen test and studies in intensive care units suggest that free plasma [C] could provide a better indicator of efficient [C] than total plasma [C]. We undertook this study to compare various determinations of free [C] levels with regard to adrenal status evaluated on total plasma [C] after ...

ea0022p37 | Adrenal | ECE2010

Inactivation of PRKARIA or PRKAR2B increases cell proliferation and decreases apoptosis, delineating distinct molecular mechanisms in adrenocortical human H295R cell line

Ragazzon Bruno , Bertherat Jerome , Rizk-Rabin Marthe

The cAMP signaling cascade is one of the main pathways involved in the pathogenesis of adrenocortical tumors (ACT). Protein kinase A (PKA) is a key element of this pathway. The R1A and R2B proteins are the most abundant regulatory subunits in endocrine tissues. Inactivating mutations of PRKAR1A are observed in Carney complex and a subset of ACT. We have recently reported that inactivation of PRKAR1A dysregulates cAMP pathway and reduces TGFβ-induced apoptosi...

ea0022p38 | Adrenal | ECE2010

Cortisol resistance in a HIV infected patient

Djrolo Francois

A few endocrine disturbances had been reported in HIV infected patients but cortisol resistance was exceptional.A 24 years old lady was admitted in the internal medicine unit of the teaching hospital in Cotonou (Bénin) unconscious. Her illness has began since 3 months ago with hyperthermia, diarrhoea, wasting and recurrent convulsive crisis and was unsuccessful treated by traditional healers. At physical examination, there was a severe dehydration, ...

ea0022p39 | Adrenal | ECE2010

The measurement of epicardial fat thickness is an index of cardiometabolic risk in patients with adrenal incidentaloma

Iorio Laura , Zelaschi Roberta , Coman Calin , Malavazos Alexis Elias , Dogliotti Giada , Corsi Massimiliano Marco , Ambrosi Bruno

An augmented cardiovascular risk is present in adrenal incidentalomas (AI), as in overt hypercortisolism. Recent studies recommended epicardial fat (EF) thickness as a new marker of visceral adiposity and an indicator of cardiometabolic risk.In this study, we evaluated the possible relationship between EF thickness, indices of left ventricular (LV) hypertrophy and adipocytokines levels in AI.We studied 26 patients with AI (62.3&#17...

ea0022p40 | Adrenal | ECE2010

Higher cortisol response to glucose load in patient with adrenal adenomas and subclinical Cushing (SC)

Vicennati Valentina , di Dalmazi Guido , Casadio Elena , Repaci Andrea , Pagotto Uberto , Pasquali Renato

Aims: SC can be discovered in 5–20% of the incidentalomas. Subclinical secretion is defined by the failure to suppress plasma cortisol after 1 mg-overnight dexamethasone <50 nmol/l, but there is no agreement in literature. The aim of our study was to evaluate cortisol response to oral glucose tolerance test (OGTT) as potential marker of autonomous activity of these adenomas.Methods: Ninety subjects, 47 females and 43 males, underwent the protoco...

ea0022p41 | Adrenal | ECE2010

Response of human adrenocortical carcinoma to mitotane treatment in vitro

van Koetssveld Peter , van Rutte Karlijn , Waaijers Marlijn , de Krijger Ronald , Lamberts Steven , Feelders Richard , de Herder Wouter , Hofland Leo

Introduction: Adrenocortical carcinoma (ACC) is a rare, but highly malignant endocrine tumor. Surgery is the primary choice of treatment. In case of inoperable disease or tumor recurrence, therapy with the adrenolytic drug mitotane is usually applied. Plasma mitotane concentrations of >14 mg/l (50 μM) seem required for an effect on tumor mass. Despite its clinical use, the effects of mitotane on cell proliferation and hormone production have been poorly investigated <...

ea0022p42 | Adrenal | ECE2010

Increased prevalence of metabolic syndrome in patients with subclinical autonomous cortisol hypersecretion by adrenal incidentalomas

Vryonidou Andromachi , Ioannidis Dimitrios , Vassilatou Evangelina , Katsoulis Kostas , Panagou Maria , Panayiotopoulos Kostas , Michalopoulou Stamatina , Tzavara Ioanna

Background: Subclinical autonomous cortisol hypersecretion is the most common hormonal abnormality in patients with adrenal incidentalomas, which is characterized by subtle abnormalities of the hypothalamic–pituitary–adrenal axis (HPA) due to adrenal autonomy. Possible detrimental effects of subclinical hypercortisolism in these patients are still under investigation.Objective: To investigate the prevalence of the metabolic syndrome (MS) in pat...

ea0022p43 | Adrenal | ECE2010

Comparison of physiological and endocrine responses of rainbow trout (Oncorhynchus mykiss) after electroanesthesia and anesthesia with MS222 and clove oil

Sattari Amir , Mirzargar Saed , Abrishamifar Adib , Mosavi Hoseinali Ebrahimzadeh

This study investigated electro-anesthesia of rainbow trout (Oncorhynchus mykiss) in comparison with MS222 and clove oil by using plasma cortisol and glucose level as stress indicators. A microcontroller-based apparatus was designed and constructed to allow a programmable voltage-time pulse-width modulated (PWM) electrical wave (AC) application through 19×20 cm submersible electrodes for 91 s in a 33 cm long tank to induce loss of equilibrium and immobility with re...

ea0022p44 | Adrenal | ECE2010

Pheochromocytoma of the adrenal gland scaled score (PASS) as a predictor of aggressive biologic behaviour

Fernandez Maria Riestra , Pallares Pedro Boix , Torre Edelmiro Menendez , Ragnarsson Cecilia Sanchez , Granda Javier Aller , Artal Antonio Rabal , Alvarez Elias Delgado , Corcovado Antonio Lavilla , Petierra de la Uz Joaquin , Felechosa Marta Dieguz , Castaneda Virginia Bellido

Background: Up to 15% of pheochromocytomas are malignant. The only definite criterion for malignancy is the presence of metastases. The histological differentiation between benign and malignant tumours is difficult, being a challenging problem nowadays.Aim: To asses if postoperative histological evaluation using the previously proposed pheochromocytoma of the adrenal gland scales scored (PASS) can predict malignancy.Methods: Twenty...

ea0022p45 | Adrenal | ECE2010

High prevalence of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas: implications to management

Vassiliadi Dimitra , Ntali Georgia , Vicha Eirini , Tsagarakis Stylianos

Although the prevalence of subclinical hypercortisolism (SH) in unilateral incidentalomas (UI) has been extensively reported, patients with bilateral incidentalomas (BI) have not been thoroughly investigated. Moreover, the management of BI poses great dilemmas if surgery is considered, since bilateral adrenalectomy leads to life-long replacement. In the present study, we aimed to describe the characteristics of patients with BI in comparison to their unilateral counterparts. W...

ea0022p46 | Adrenal | ECE2010

Profile of cortisol changes during early stages of development in rainbow trout

Ghaedi Gholam Reza , Yavari Vahid , Falahatkar Bahram , Salati Amir Parviz , Sahraeian Reza

Whole-body cortisol content was measured in oocyte, embryo and larvae of rainbow trout by extraction and RIA. The cortisol content of oocyte was 2.55±0.06 ng/ml that probably has a mathernal origin. After fertilization cortisol level decreased to 1.84±0.07 ng/ml, then reached to the lowest level (0.30±0.06 ng/ml) by day 10 where it remained unchanged until eyed stage on day 18. After that cortisol increased at hatching to 0.60±0.06 ng/ml, suggested that cor...

ea0022p47 | Adrenal | ECE2010

Genomic DNA alterations in adrenocortical tumors (ACTs): diagnostic and prognostic value

Assie Guillaume , Barreau Olivia , De Reynies Aurelien , Tissier Fredrique , Groussin Lionel , Bertagna Xavier , Bertherat Jerome , Clauser Eric

The outcome of ACTs can be determined by gene expression level at the RNA level. However RNA handling is challenging. In contrast tumor DNA is robust and therefore easier to use.Aim: To characterize the ACTs DNA alterations; to identify markers with diagnostic and prognostic value using tumor DNA.Methods: The mapping of chromosomal gains and losses of 60 ACTs (39 adenomas (ACAs), 21 carcinomas (ACCs)) was performed with CGH arrays ...

ea0022p48 | Adrenal | ECE2010

Combined primary aldosteronism and preclinical Cushing's syndrome due to a large adrenocortical adenoma

Ciric Jasmina , Beleslin Biljana , Stojkovic Mirjana , Trbojevic Bozo , Zarkovic Milos

The rarest causes of primary aldosteronism are aldosterone producing carcinoma, ectopic aldosterone secretion and familial aldosteronism. There are also few cases reported of aldosterone and cortisol tumor cosecretion. We present a 38-year-old woman admitted to our hospital because of resistant hypertension, large adrenal tumor and hypokalemia. At age 32 hypertension was diagnosed, but routine laboratory and abdominal ultrasound examination were normal. Few months before admis...

ea0022p49 | Adrenal | ECE2010

In vitro effect of dopastatins on hormone secretion in adrenal tumors

Pivonello Claudia , Napolitano Tiziana , De Leo Monica , Cozzolino Alessia , Vitale Pasquale , Lombardi Gaetano , Colao Annamaria , Pivonello Rosario

Somatostatin (SSTRs) and dopamine (DRs) receptors are expressed in adrenal tumors. It has been demonstrated in pituitary and neuroendocrine tumors that somatostatin-dopamine chimeric molecules, namely dopastatins, which bind both somatostatin (SST2 and/or SST5) and dopamine (D2) receptors, exert a more potent action compared with the single receptor agonists in experimental settings. The aims of this study were to evaluate the expression of DRs and SSTRs, and the effects of do...

ea0022p50 | Adrenal | ECE2010

Under-expression of the TWIK-related acid-sensitive K+ channel 2 (TASK-2) gene is a hallmark of aldosterone producing adenoma causing human primary aldosteronism

Lenzini Livia , Seccia Teresa Maria , Caroccia Brasilina , Recarti Chiara , Pelizzo Maria Rosa , Rossi GianPaolo

Background: Primary aldosteronism is a common cause of arterial hypertension, but its underlying molecular mechanisms are unknown. K+ is a key regulator of aldosterone secretion: it interacts with physiological secretagogues of aldosterone as angiotensin II (Ang II) end endothelin-1. In vivo genetic manipulation of a widely distributed class of channels, which generate background or ‘leak’ potassium (K+) currents, the twik-related acid-se...

ea0022p51 | Adrenal | ECE2010

In vitro effect of serotonin (5-HT) on cortisol secretion in primary pigmented nodular adrenal disease

Louiset Estelle , Duparc Celine , Perraudin Veronique , Renouf Sylvie , Libe Rossella , Stratakis Constantine A , Bertherat Jerome , Lefebvre Herve

Illegitimate membrane receptors are known to play a role in cortisol secretion in adrenal adenomas and ACTH-independent macronodular adrenal hyperplasia (AIMAH) causing Cushing’s syndrome. Conversely, illegitimate receptors have never been described in primary pigmented nodular adrenal disease (PPNAD). In the normal adrenal gland, serotonin (5-HT) has been shown to stimulate cortisol secretion through activation of 5-HT receptor type 4 (5-HT4) whereas, in some AIMAH tissu...

ea0022p52 | Adrenal | ECE2010

Expression of mTOR and IGF2 and in vitro effects of mTOR inhibitor drugs on cell proliferation and cortisol production in human adrenocortical cancer cells

De Martino Maria Cristina , van Koetsveld P M , Sprij-Mooij D M , Feelders Richard A , de Herder Wouter W , Lamberts Steven W J , Colao Annamaria , Pivonello Rosario , Hofland Leo J

Background: Adrenocortical carcinoma (ACC) is an uncommon malignancy with a still scantily understood pathogenesis and generally poor prognosis. Many patients with ACC need new treatment options. mTOR inhibitors, as sirolimus (S) and temsirolimus (T), are promising antineoplastic drugs in several kinds of tumors.Methods: In three human ACC cell lines (H295, HAC15 and SW13), we evaluated the mTOR and IGF2 expression at mRNA level (by qPCR) and at protein ...

ea0022p53 | Adrenal | ECE2010

Primary bilateral adrenal lymphoma without adrenal insufficiency: a case report

Culha Cavit , Uc Ziynet Alphan , Ademoglu Esra Nur , Yildirim Ahmet , Dellal Dilek , Gorar Suheyla , Koc Gonul , Aral Yalcin

Although adrenal gland involvement may be seen in patients with diffuse (non-Hodgkin) lymphoma, primary adrenal lymphoma is quite rare and adrenal insufficiency accompanies the clinical picture in 2/3 of cases.Case: A 70-year-old male patient presenting with anorexia and weight loss was referred to our clinic for bilateral adrenal masses, which were detected by abdominal computerized tomography (CT) as 5.2×5.2×2.7 cm in the right adrenal and 11...

ea0022p54 | Adrenal | ECE2010

Cushing's syndrome in children: new faces of the old one

Dautovic Slavica , Katanic Dragan , Vlaski Jovan

The incidence of endogenous Cushing’s syndrome (CS) is ~2–5 new cases per million people per year; ~10% of these new cases occur in children. The most common cause of endogenous CS in children is an ACTH-secreting pituitary adenoma (~75% of all cases in children older than 7 years). CS is still diagnostic and therapeutic challenge, especially in childhood. One of the most important diagnostic steps is thinking about it. The evaluation of children with the clinical ma...

ea0022p55 | Adrenal | ECE2010

Influence of various clinical variables and storage conditions on urinary cortisol levels: gas chromatography–mass spectrometry (GC–MS) versus immunoassay

Deutschbein Timo , Broecker-Preuss Martina , Hartmann Michaela , Wudy Stefan , Althoff Ricarda , Mann Klaus , Petersenn Stephan

Introduction: Measurement of urinary cortisol is often used to assess disease activity in patients with suspected or proven hypercortisolism. However, specific reference ranges are lacking for some of the newer assays. This study analyzed upper limits of normal (ULN, mean+2S.D.) for two analytical procedures (GC–MS, ECLIA) in relation to various independent variables. Besides, the influence of different storage conditions was investigated (by ECLIA).<p ...

ea0022p56 | Adrenal | ECE2010

Arterial and venous thrombotic events in Cushing's syndrome

Poiana Catalina , Chirita Corina , Carsote Mara , Ene Cristina , Samoila Ramona , Trifanescu Raluca , Gheorghiu Monica , Coculescu Mihail

Background: Cushing’s syndrome (CS) is associated with a hypercoagulable state and an increased risk for acute coronary syndromes, stroke, and deep vein thrombosis (DVT).Aim: To assess the prevalence of thrombotic events in a series of patients with CS.Patients and methods: Notes of 113 patients with CS were retrospectively reviewed.Results: Instable angina was diagnosed in ten women, aged 52.1±12.2...

ea0022p57 | Adrenal | ECE2010

Influence of short-term glucocorticoid therapy on regulatory T cells

Dexneit Thomas , Sbiera Silviu , Schmull Sebastian , van den Brandt Jens , Kraus Luitgart , Beyer Melanie , Mlynski Robert , Reichardt Holger , Allolio Bruno , Fassnacht Martin

Introduction: Glucocorticoids (GC) are used for immunosuppression in many clinical conditions. Pre-clinical and early clinical studies suggested that the induction of regulatory T (Treg) cells contributes to the immunosupressive effects of GCs. However, in the hitherto reported clinical studies only patients with ongoing autoimmune diseases were included. Our goal, therefore, was to determine the influence of exogenous GCs in vivo in immunocompetent subjects and mice.</...

ea0022p58 | Adrenal | ECE2010

Long-term follow-up of patients with adrenal incidentalomas: a single center experience

Anagnostis Panagiotis , Efstathiadou Zoe , Polyzos Stergios , Tsolakidou Konstantina , Litsas Ioannis , Panagiotou Athanasios , Kita Marina

Introduction: Adrenal incidentalomas (AIs) constitute an emerging clinical entity due to the increased use of abdominal imaging for diagnostic purposes.Objective: To investigate the morphological and hormonal alterations of AIs in a cohort of patients, who were followed-up in a single centre.Methods: Sixty-four patients (22 males and 42 females; mean age 61.6±1.2 years), with AIs and follow-up of 3.1±0.4 years (range 0&#1...

ea0022p59 | Adrenal | ECE2010

QTc and P wave dispersion in patients with Cushing's syndrome

Bayram Nihal Akar , Ersoy Reyhan , Tuzun Dilek , Inancli Serap Soytac , Bozkurt Engin , Cakir Bekir

Introduction: The clinical implications of QTc and P wave dispersion in patients with Cushing’s syndrome have not been studied previously. In this study, we aimed to compare QTc dispersion and P wave dispersion in patients with Cushing’s syndrome and healthy subjects.Material and method: Sixteen patients with Cushing’s syndrome diagnosed on clinical, laboratory and imaging findings and 16 age and sex matched control subjects were included....

ea0022p60 | Adrenal | ECE2010

Laparoscopic adrenalectomy: 12-year experience in a single institution

Hartmann Igor , Student Vladimir , Frysak Zdenek , Smakal Oldrich , Grepl Michal

Introduction: Laproscopic adrenalectomy (LA) was first described in the literature in 1992 and has become the preferred method for the removal of functioning and non-functioning tumours. More than 75% of Las are performed for endocrine causes of hypertension such as Conn’s or Cushing’s syndrome and pheochromocytoma. The majority of centers (80%) perform laparoscopic transabdominal adrenalectomy. The first LA in our institution was performed in 1998 and the procedure ...

ea0022p61 | Adrenal | ECE2010

Comparison of plasma aldosterone/signal activity and aldosterone/active signal ratios in different clinical conditions

Locsei Zoltan , Toldy Erzsebet , Horvath Dora , Nagy Rita , Racz Karoly , Szabolcs Istvan , Kovacs Gabor L

Because measurement of plasma signal activity (PRA) is time-consuming an automated method directly measuring active signal (REN) may be more suitable for clinical practice. The aim of the study was to analyse the diagnostic utility of REN and aldosterone (ALD)/REN ratio as compared to PRA and ALD/PRA ratio.Materials and methods: PRA, REN (DiaSorin) and ALD (Immunotech) were simultaneously measured in 123 plasma samples (83 females and 40 males; mean age,...

ea0022p62 | Adrenal | ECE2010

Adrenal incidentaloma; a case report

Reddy Danda Vijay Shekar , Srinivas Paidipally

Incidentally found adrenal tumour is one of the most frequent adrenal disorders due to increased availability and use of imaging studies. But a well circumscribed, homogenous calcified adrenal incidentaloma are extremely rare.We present a case of 68-year-old women who underwent X-ray chest examination for routine health check up, which revealed hyper intense lesion in left sub diaphragmatic area. Further evaluation by a CT scan abdomen revealed hyper den...

ea0022p63 | Adrenal | ECE2010

Adrenal non-producing adenomas show indirect signs of glucocorticoid excess and hypercortisolism correlates with differential blood counts

Sagert Cornelia , Hruskovicova Hana , Haase Matthias , Mansmann Georg , Schinner Sven , Schott Matthias , Scherbaum Werner A , Willenberg Holger S

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 ...

ea0022p64 | Adrenal | ECE2010

Endothelial cell-derived products regulate β-catenin-dependent transcription in human adrenocortical cells

Schwafertz Carolin , Schinner Sven , Kuhn Markus , Ansurudeen Ishrath , Oetjen Elke , Schott Matthias , Scherbaum Werner A , Willenberg Holger S

Objective: Recently, we have shown that endothelial cell-conditioned medium (ECCM) stimulates aldosterone secretion and the expression of proteins, essential for steroidogenesis and adrenal development. Also, we have found that fat cells regulate adrenal steroidogenesis through the wnt-signaling pathway. In addition, β-catenin was implicated in adrenal tumorigenesis, including aldosterone-producing adenomas.Methods: We studied the influence of endot...

ea0022p65 | Adrenal | ECE2010

Sporadic solitary aldosterone- and cortisol-cosecreting adenomas: a subtype of primary aldosteronism

Willenberg Holger S , Spath Martin , Maser-Gluth Christiane , Engers Rainer , Anlauf Martin , Dekomien Gabriele , Schott Matthias , Scherbaum Werner A

Subtype identification is necessary for making diagnostic and therapeutic decisions in primary aldosteronism. We studied clinical, hormonal and histological features of sporadic solitary aldosterone- and cortisol-cosecreting (C/APA) adenomas in detail.We here present the endocrine evaluation at baseline, after suppression with fludrocortisone and dexamethasone as well as after therapy with spironolactone and after unilateral adrenalectomy in two patients...

ea0022p66 | Adrenal | ECE2010

The HLA-DRB1 shared epitope and trans-encoded HLA-DQ-heterodimers hypothesis in autoimmune Addison disease

Pura Mikulas , Kuba Daniel , Kentos Peter , Chrenova Silvia , Vanuga Peter

Background: The MHC is the most important susceptibility locus for human autoimmune diseases (AID). Although associations between MHC class II DRB1 alleles and Addison disease (AD) have been repeteadly proven in various populations, the biological mechanisms underlying this association remains unknown. Peptide presentation to T cells may be important in the initiation or progression of AID. Disease-linked polymorphisms map to the peptide-binding sites of MHC molecules class II...