title: Role of adrenal gland scintigraphy in patients with subclinical hypercortisolism and incidentally discovered adrenal mass.
abstract: BACKGROUND
  The role of adrenal scintigraphy (AS) in the diagnosis of subclinical hypercortisolism (SH) in adrenal incidentaloma (AI) is debated.
  
  
  OBJECTIVE
  To evaluate the possible role of AS in identifying SH in AI patients.
  
  
  METHODS
  In the retrospective phase (2000-2004), 102 AI patients [71 females (F)/31 males (M)] referred to our center were reevaluated for SH. In the prospective phase (2005-2006), 42 patients (32F/10M) with suspected SH were evaluated performing AS and biochemical assessment of cortisol secretion. We report data of the prospective phase of the study. In these patients AS was performed at baseline; the difference between the uptake of the affected and the controlateral gland [mean Delta uptake (MDeltau)] was calculated. Cortisol secretion was evaluated in 3 different occasions. Patients were considered affected with SH if they presented at least twice 2 of the following criteria: urinary free cortisol >193 nmol/l, cortisol after 1 mg dexamethasone suppression test >83 nmol/l, ACTH levels <2.2 pmol/l.
  
  
  RESULTS
  MDeltau was higher in patients with SH (no.=27, 5/22 M/F) than in patients without SH (83.7+/-12.5 vs 54.7+/-24.1%, p<0.001), and directly correlated with UFC (beta=0.387, p=0.015) and was predictive of SH (odds ratio 1.12, 95% confidence interval 1.03-1.22, p=0.009) regardless of age, body mass index, and diameter of the mass. A 75% MDeltau cut-off has 86.7% specificity and 81.5% sensitivity in diagnosing SH.
  
  
  CONCLUSIONS
  AS is not recommended as screening test in AI patients, but it can be useful to exclude the presence of a subtle cortisol excess in patients with unclear biochemical diagnosis of SH.
authors.affiliation: Endocrinology and Diabetology Unit, Department of Medical Sciences, University of Milan, Fondazione Ospedale Maggiore Policlinico IRCCS, Mangiagalli e Regina Elena, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Donadio
authors.forename: V
authors.initials: V
authors.lastname: Morelli
authors.forename: A S
authors.initials: AS
authors.lastname: Salcuni
authors.forename: C
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: M
authors.initials: M
authors.lastname: Carletto
authors.forename: M
authors.initials: M
authors.lastname: Castellani
authors.forename: L
authors.initials: L
authors.lastname: Dellavedova
authors.forename: A
authors.initials: A
authors.lastname: Scillitani
authors.forename: P
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D011877:Radionuclide Imaging; D012189:Retrospective Studies