ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)
Dysregulation of salivary cortisol rhythm in non-secreting and mild cortisol-secreting adrenal incidentalomas
Kimberly Coscia 1,2 , Flaminia Fanelli 2 , Lorenzo Tucci 1,2 , Valentina Bissi 2 , Greta Galante 2 , Ilaria Improta 2 , Francesca Donnarumma 1,2 , Giacomo Colombin 1,2 , Laura Rotolo 1,2 , Claudia Lena 2 , Sobia Noreen 2 , Valentina Vicennati 1,2 , Uberto Pagotto 1,2 & Guido DiDalmazi 1,2
1Endocrinology and Diabetes Care and Prevention Unit, IRCCS Sant’Orsola-Malpighi Polyclinic, Bologna, Italy; 2Department of Medical and Surgical Sciences, Alma Mater Studiorum of Bologna University, Bologna, Italy
Background: Adrenal incidentalomas (AI) are classified into mild autonomous cortisol-secreting (MACS) and non-secreting (NS) based on the 1mg-dexamethasone suppression test (DST). However, the latter test fails to detect alterations in the cortisol rhythm, which might be present in both MACS and NS.
Aim: To characterize the cortisol secretion in terms of daily rhythm and exposure in healthy controls (HC) and patients with AI.
Methods: Benign unilateral and bilateral adrenal adenomas and/or hyperplasia were included. AI were classified in NS (n=25) for post-DST serum cortisol values ≤18 ng/ml, and as MACS (n=57) for post-DST serum cortisol values >18 ng/ml. Twenty-eight HC with a regular wake/sleep cycle and no recent or chronic disease nor medications were recruited from the general population. On an ordinary day, each subject collected saliva samples at 0700 (awakening), 07:15, 07:30, 10:00, 12:30, 14:00, 16:00, 19:30, 21:00 and 23:00 h (bedtime). Salivary cortisol was measured by liquid chromatography–tandem mass spectrometry. Cortisol rhythmicity was evaluated by the repeated measurements ANOVA and compared among groups through the calculation of the cortisol dynamic range (CDR=log (peak value/nadir value)) between 07 00 and 23 00 h. Cortisol AUC was calculated to evaluate the daily glucocorticoid exposure.
Results: HC (age 29±10 y) were younger than NS (age 61±14 y) and MACS (age 65±8 y) (P<0.001). Sex was evenly distributed in the overall cohort (51.8% females, n=57) and among groups. Each group exhibited a significant cortisol reduction over the day (P<0.001). The CDR was significantly different between the 3 groups (P<0.001), with both NS (1.20±0.30) and MACS (1.14±0.35) having a lower CDR compared to HC (1.56±0.26) (P<0.050). Cortisol AUC displayed an increasing trend in NS and MACS compared to HC (P=0.012). Cortisol levels among groups were similar from 07:00 h until 14:00 h, but different from 16:00 to 23:00 h (P: <0.001–0.044). Indeed, compared to HC, cortisol levels were higher at 21:00 h and 23:00 h in NS, and at 16:00, 19:30, 21:00 and 23:00 h in MACS. Moreover, values at 1930 and 2100 h were higher in MACS than NS (all P<0.050).
Conclusion: The salivary rhythm is preserved in both NS and MACS. However, we detected a reduced dynamicity in both AI groups. The overall glucocorticoid exposure increased with the functional status of the AI and is mainly related to the cortisol secretion from middle afternoon to evening. Notably, NS and MACS exhibited different secretion profiles before bedtime.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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