Document Detail


The size of adrenal incidentalomas correlates with insulin resistance. Is there a cause-effect relationship?
MedLine Citation:
PMID:  21070314     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Adrenal incidentalomas (AI) have often been associated with a high prevalence of insulin resistance (IR) and cardiovascular risk factors, although direct measurement of insulin sensitivity (IS) has never been carried out.
OBJECTIVE: We aimed to investigate whether the morphological and hormonal features of AI correlate with the presence and severity of IR, using the hyperinsulinaemic euglycaemic clamp (HEC).
DESIGN AND MEASUREMENTS: Forty patients with AI (22 women) with a mean age of 58.5±11.1 years underwent hormonal and morphological evaluation. Nineteen patients with AI without known history of diabetes mellitus (DM) or impaired glucose tolerance (IGT) and 17 matched controls underwent oral glucose tolerance test (OGTT) and hyperinsulinaemic euglycaemic clamp (HEC).
RESULTS: Diabetes mellitus was observed in 13 patients (33%), while three (8%) had IGT. Thirty-one of the AI were nonfunctioning (82.5%), whereas two (5%) secreted cortisol (Cushing's syndrome) and seven (12.5%) showed subclinical secretion of cortisol. The 19 patients with nonfunctioning AI were more insulin resistant than controls (glucose up-take: 4.58±1.80 vs 5.85±2.48 mg/kg/min respectively; P=0.01); IS was inversely related to the mass size (r=-0.57; P=0.04), free urinary cortisol (r=-0.68; P=0.01), serum cortisol after 1-mg dexamethasone suppression (-0.65; P=0.02) and percentage of trunk fat mass (-0.77; P=0.02) and directly related to serum adreno cortico tropic hormone (ACTH) (r=0.62; P=0.03). After performing multivariate regression, the mass size was found to be the most powerful predictor of IR.
CONCLUSION: Our study showed a high prevalence of insulin resistance in patients with nonfunctioning AI and suggests its possible involvement in AI growth.
Authors:
Giovanna Muscogiuri; Gian Pio Sorice; Annamaria Prioletta; Teresa Mezza; Clelia Cipolla; Enrica Salomone; Andrea Giaccari; Alfredo Pontecorvi; Silvia Della Casa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical endocrinology     Volume:  74     ISSN:  1365-2265     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-08     Completed Date:  2011-06-09     Revised Date:  2011-12-06    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  300-5     Citation Subset:  IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Endocrinology and Metabolic Diseases, Catholic University-Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy. giovanna.muscogiuri@edu.rm.unicatt.it
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MeSH Terms
Descriptor/Qualifier:
Adrenal Gland Neoplasms* / blood,  pathology
Aged
Diabetes Mellitus / diagnosis
Female
Glucose Clamp Technique
Glucose Tolerance Test
Humans
Hydrocortisone / blood,  urine
Insulin Resistance*
Male
Middle Aged
Multivariate Analysis
Regression Analysis
Chemical
Reg. No./Substance:
50-23-7/Hydrocortisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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