Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2010) 22 P21

1Unit of Endocrinology and Diabetology, Department of Medical Sciences, Università degli Studi di Milano, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy; 2Unit of Endocrinology ‘Casa Sollievo della Sofferenza’, IRCCS, San Giovanni Rotondo, Italy; 3Unit of Radiology ‘Casa Sollievo della Sofferenza’, IRCCS, San Giovanni Rotondo, Italy; 4Unit of Endocrinology, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy; 5Unit of Endocrinology, Department of Medical and Surgical Sciences, Università degli Studi di Milano, IRCCS Policlinico San Donato Institute, San Donato Milanese, Italy.


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 1.8–12.7, 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.

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