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High Prevalence of Subclinical Hypercortisolism in Patients with Bilateral Adrenal Incidentalomas: a Challenge to Management.
MedLine Citation:
PMID:  21175735     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective:  The prevalence of subclinical hypercortisolism (SH) in unilateral incidentalomas (UI) has been extensively studied; however patients with bilateral incidentalomas (BI) have not been thoroughly investigated. We therefore aimed to describe the characteristics of patients with BI compared to their unilateral counterparts. The surgical outcome in a small number of patients is reported. Design:  Observational, retrospective study in a single secondary/tertiary centre. Patients:  172 patients with adrenal incidentalomas (41 with BI). Measurements:  Morning cortisol (F), ACTH, dehydroepiandrosterone sulfate (DHEA-S), midnight F, 24-h urine collection for cortisol (UFC), low-dose dexamethasone suppression test (LDDST), fasting glucose, insulin, and oral glucose tolerance test (OGTT). Primarily SH was defined as F-post-LDDST>70nmol/l and one more abnormality; several diverse cut-offs were also examined. Results:  No difference was noted in age, body mass index, or prevalence of diabetes and impaired glucose tolerance between patients with UI and those with BI. Patients with BI had higher F post-LDDST (119.3±112.8 vs. 54.3±71.5nmol/l, p<0.001) and lower DHEA-S (1.6±1.5 vs. 2.5±2.3μmol/l, p=0.003) but similar UFC, ACTH and midnight F levels, compared to UI. SH was significantly more prevalent in BI (41.5% vs 12.2%, p<0.001). Fourteen patients were operated on; 4 underwent bilateral interventions. In 10 patients, unilateral adrenalectomy on the side of the largest lesion resulted in significant improvement of F-post LDDST (p=0.008) and a decrease of midnight F (p=0.015) levels. Conclusions:  Subclinical hypercortisolism is significantly more prevalent in bilateral incidentaloma patients, posing great dilemmas for its optimum management.
Authors:
Dimitra A Vassiliadi; Georgia Ntali; Eirini Vicha; Stylianos Tsagarakis
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-22
Journal Detail:
Title:  Clinical endocrinology     Volume:  -     ISSN:  1365-2265     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2010 Blackwell Publishing Ltd.
Affiliation:
Department of Endocrinology Athens' Polyclinic Hospital, Athens, 105 52, Greece.
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