title: High prevalence of autonomous cortisol and aldosterone secretion from adrenal adenomas.
abstract: OBJECTIVE
  Previous studies based on standard endocrine testing have shown a variable incidence of autonomous cortisol secretion (ACS) or autonomous aldosterone secretion (AAS) in patients with single adrenal adenomas (SAA). We tested whether the use of appropriate controls and modification of standard testing, aiming at eliminating interference from endogenous ACTH, reveals previously undetected subtle ACS and AAS by SAA.
  
  
  METHODS
  Case control study. Patients We investigated 151 patients with SAA and 72 matched controls with normal adrenal computerized tomography.
  
  
  METHODS
  All participants had arterial blood pressure recorded, and serum cortisol and aldosterone measured before and after intravenous administration of 250 mug of ACTH, and following dexamethasone administration. Eighty-three patients and all the controls had serum aldosterone and renin measured before and after saline infusion, and after a second saline infusion following dexamethasone administration.
  
  
  RESULTS
  Using the mean + 2 SD values obtained from controls after dexamethasone administration and saline infusion following dexamethasone administration, normal cut-off values for cortisol (30.11 nM), aldosterone (67.59 pM), and aldosterone/renin ratio (9.74 pM/mU/l) were developed. Using these cut-off values, the estimated incidence of ACS and AAS in patients with SAA was 56.63% and 24.10%, respectively, whereas 12.05% had autonomous secretion of both cortisol and aldosterone. Systolic and diastolic arterial blood pressure correlated significantly with the aldosterone/renin ratio following AlphaCTH stimulation (P < 0.0002 and P < 0.001, respectively), and after saline infusion following dexamethasone administration (P < 0.003 and P < 0.002, respectively).
  
  
  CONCLUSIONS
  By applying new cut-offs, ACS and AAS in patients with a SAA is very common, and aldosterone secretion correlates with arterial blood pressure.
authors.affiliation: Department of Endocrinology and Diabetes, General Hospital of Athens G Gennimatas, Athens, Greece. edk-pgna@otenet.gr
authors.forename: Georgios P
authors.initials: GP
authors.lastname: Piaditis
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Kaltsas
authors.forename: Ioannis I
authors.initials: II
authors.lastname: Androulakis
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Gouli
authors.forename: Polyzois
authors.initials: P
authors.lastname: Makras
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papadogias
authors.forename: Konstantina
authors.initials: K
authors.lastname: Dimitriou
authors.forename: Despina
authors.initials: D
authors.lastname: Ragkou
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Vamvakidis
authors.forename: Georgios
authors.initials: G
authors.lastname: Zografos
authors.forename: Georgios
authors.initials: G
authors.lastname: Chrousos
mesh_terms: D000311:Adrenal Glands / Q000187:drug effects / Q000378:metabolism; D018246:Adrenocortical Adenoma / Q000097:blood* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000494:pharmacology; D000450:Aldosterone / Q000097:blood*; D016022:Case-Control Studies; D003907:Dexamethasone / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011863:Radioimmunoassay
chemical_list: D000450:Aldosterone; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone