Endocrine Abstracts

JOINT1916

Introduction: Bilateral macronodular adrenal cortical disease (BMACD) is a heterogeneous condition characterized by the presence of multiple nodules larger than a centimeter in diameter and is associated with mild autonomous cortisol secretion. Its prevalence has recently increased due to the wide use of imaging studies.

Purpose: This study aimed to describe the clinical and biochemical characteristics, as well as comorbidities and responses to dynamic tests aiming to investigate paradoxical adrenal cortical receptor expression, in a series of patients with BMACD monitored at our center.

Methods: This study included a series of patients referred for investigation of bilateral adrenal tumors. Patients were screened for pheochromocytoma, primary hyperaldosteronism, and autonomous cortisol secretion. The possibility of late-onset congenital adrenal hyperplasia was ruled out by measuring 17-OH progesterone. In order to detect paradoxical receptor expression patients underwent dynamic tests, including the Synacthen test, mixed meal test, posture test, LHRH assay, TRH test, glucagon test, desmopressin test, and metoclopramide test. The response to these tests was evaluated based on changes in cortisol values, with an increase of <25% considered a non-response, 25-49% a partial response, and ≥50% a complete response.

Results: The study included 6 female patients with bilateral macronodular adrenal hyperplasia, with a mean age of 56.7±6.6 years and BMI of 30.6±9.8. Three patients had arterial hypertension, and four had dyslipidemia under treatment. Only one patient showed clinical features of Cushing’s syndrome. Based on the overnight dexamethasone suppression test, 3 patients were diagnosed with autonomous cortisol secretion, while 2 others had probable autonomous cortisol secretion. During the various dynamic tests, two patients exhibited a response to the mixed meal, one responded to metoclopramide, one responded to both metoclopramide and desmopressin, and one responded to the LHRH test. Notably, one patient did not show a response to any of the tests performed.

Conclusion: The majority of BMACD patients exhibit a mild autonomous cortisol secretion. Identifying paradoxical receptor expression can enhance our understanding of adrenal steroidogenesis and potentially guide personalized treatment.