Division of Endocrinology, Theagenio Cancer Hospital, 2 Al Simeonidi Str., 54007, Thessaloniki, Greece.
Hormones (Athens). 2019 Mar;18(1):85-89. doi: 10.1007/s42000-019-00092-x. Epub 2019 Feb 9.
During follow-up in cancer patients, adrenal lesions are frequently found by computer tomography imaging. In these patients, the frequency of subclinical Cushing's syndrome (SCS) has not been fully explored. The aim of the present study was to investigate the presence of SCS in cancer patients with adrenal lesions in comparison to patients with true adrenal incidentalomas.
We studied 95 patients with adrenal lesions: 57 patients (group A, 20 males and 37 females) had a history of extra-adrenal malignancy and adrenal lesions were discovered during staging of the primary cancer, and 38 patients (group B, 6 males and 32 females) had adrenal incidentalomas. The two groups had similar BMI. All patients had unenhanced HU < 10 in computed tomography to ensure low risk of adrenal metastatic disease. Patients' morning plasma cortisol levels and ACTH were measured. An overnight 1 mg dexamethasone suppression test (ODST) was performed in all participants; in case of abnormal results, 24-h urine cortisol and the low-dose dexamethasone suppression test were additionally conducted. The cutoffs of morning cortisol values used for ODST were 1.8 and 5 μg/dl.
When the cutoff of 1.8 μg/dl for suppressed morning cortisol was used, 42.1% of group A and 39.5% of group B had abnormal results (p = 0.95). By using the threshold of 5 μg/dl after ODST, 5.3% of group A and 13.2% of group B did not have suppressed cortisol levels with the 1 mg ODST (p = 0.18). The main factors found to influence suppressed cortisol levels after ODST in both groups were BMI and size of the adrenal lesion.
Patients with extra-adrenal malignancies and adrenal lesions had similar rates of subclinical hypercortisolemia compared to patients with true adrenal incidentalomas.
在癌症患者的随访中，经常通过计算机断层扫描成像发现肾上腺病变。在这些患者中，亚临床库欣综合征（SCS）的频率尚未得到充分探讨。本研究旨在比较患有肾上腺病变的癌症患者和真正的肾上腺偶发瘤患者中 SCS 的存在情况。
我们研究了 95 例肾上腺病变患者：57 例患者（A 组，20 名男性和 37 名女性）有肾上腺外恶性肿瘤病史，在原发性癌症分期时发现肾上腺病变，38 例患者（B 组，6 名男性和 32 名女性）患有肾上腺偶发瘤。两组患者的 BMI 相似。所有患者的 CT 增强 HU 值均<10，以确保肾上腺转移疾病的风险较低。测量了患者的清晨血浆皮质醇水平和 ACTH。所有参与者均进行了过夜 1mg 地塞米松抑制试验（ODST）；如果结果异常，还进行了 24 小时尿皮质醇和小剂量地塞米松抑制试验。ODST 中使用的清晨皮质醇值截断值为 1.8 和 5μg/dl。
当使用 1.8μg/dl 的抑制性清晨皮质醇截断值时，A 组 42.1%和 B 组 39.5%的患者结果异常（p=0.95）。使用 ODST 后 5μg/dl 的阈值，A 组 5.3%和 B 组 13.2%的患者 1mg ODST 后皮质醇水平未被抑制（p=0.18）。在两组中，影响 ODST 后抑制性皮质醇水平的主要因素是 BMI 和肾上腺病变的大小。
与真正的肾上腺偶发瘤患者相比，患有肾上腺外恶性肿瘤和肾上腺病变的患者亚临床高皮质醇血症的发生率相似。
