Abnormalities of endocrine function in patients with clinically "silent" adrenal masses.
Because, in recent years, patients with incidentally discovered adrenal masses have been encountered increasingly, their endocrine function was investigated in basal conditions and after dynamic tests. Thirty-two patients (23 women and 9 men, aged 28-74 years) were studied. Lesion diameter, as documented by computed tomography and/or nuclear magnetic resonance imaging, ranged between 5 and 65 mm; the tumors were localized on the right in 22 patients, on the left in 5 and bilaterally in 5 cases. In basal conditions, urinary free cortisol (UFC) excretion, plasma adrenocorticotropin (ACTH) and cortisol levels were normal, except for 4 patients who showed high UFC and ACTH levels in the low-normal range. Ovine corticotropin-releasing hormone (CRH, 1 microgram/kg iv) was given to 18 patients, inducing normal ACTH and cortisol responses in 12, blunted responses in 4 and no response in 2 cases. No reduction in ACTH and cortisol levels after suppression tests was observed in 4 of 29 patients after dexamethasone (1 mg overnight) or in 6 of 29 after loperamide. The 4 patients who were unresponsive to both tests did not show any further inhibition after high-dose dexamethasone administration, had low plasma ACTH levels and showed impaired or absent responses to the CRH test: they were diagnosed as affected with preclinical Cushing's syndrome. An exogenous ACTH test performed in 30 patients caused a normal cortisol rise. Basal mean 17-hydroxy-progesterone (17-OHP) levels were not different from those in normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Ambrosi
B
B
Institute of Endocrine Sciences, University of Milan, Ospedale Maggiore IRCCS, Italy.
Peverelli
S
S
Passini
E
E
Re
T
T
Ferrario
R
R
Colombo
P
P
Sartorio
A
A
Faglia
G
G
D019326:17-alpha-Hydroxyprogesterone; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D000311:Adrenal Glands / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000735:Androstenedione / Q000097:blood; D001842:Bone and Bones / Q000378:metabolism; D003094:Collagen / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone; D003480:Cushing Syndrome / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D006908:Hydroxyprogesterones / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000378:metabolism; D010446:Peptide Fragments / Q000097:blood / Q000378:metabolism; D011347:Procollagen / Q000097:blood / Q000378:metabolism; D011863:Radioimmunoassay; D014057:Tomography, X-Ray Computed
D006908:Hydroxyprogesterones; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; C042813:procollagen type I carboxy terminal peptide; D015675:Osteocalcin; D000735:Androstenedione; D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D003094:Collagen; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone