title: Accuracy of several parameters of hypothalamic-pituitary-adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma.
abstract: BACKGROUND
  It is unknown whether the metabolic effects of the removal of an adrenal incidentaloma (AI) can be predicted by the assessment of cortisol hypersecretion before surgery.
  
  
  OBJECTIVE
  To evaluate the accuracy of several criteria of hypothalamic-pituitary-adrenal axis activity in predicting the metabolic outcome after adrenalectomy.
  
  
  METHODS
  Retrospective longitudinal study.
  
  
  METHODS
  In 55 surgically treated AI patients (Group 1) before surgery and in 53 nontreated AI patients (Group 2) at the baseline, urinary free cortisol (UFC), cortisol after 1 mg overnight dexamethasone-suppression test (1 mg-DST), ACTH, and midnight serum cortisol (MSC) were measured. In Groups 1 and 2, metabolic parameters were evaluated before and 29.6 ± 13.8 months after surgery and at the baseline and after 35.2 ± 10.9 months respectively.
  
  
  METHODS
  The improvement/worsening of weight, blood pressure, glucose, and cholesterol levels (endpoints) was defined by the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATP III criteria respectively. The accuracy of UFC, 1 mg-DST, ACTH, and MSC, singularly taken or in combination, in predicting the improvement/worsening of ≥ 2 endpoints was calculated.
  
  
  RESULTS
  The presence of ≥ 2 among UFC>70 μg/24 h (193 nmol/l), ACTH<10 pg/ml (2.2 pmol/l), 1 mg-DST>3.0 μg/dl (83 nmol/l) (UFC-ACTH-DST criterion) had the best accuracy in predicting the endpoints' improvement (sensitivity (SN) 65.2%, specificity (SP) 68.8%) after surgery. In the nontreated AI patients, this criterion predicted the worsening of ≥ 2 endpoints (SN 55.6%, SP 82.9%).
  
  
  CONCLUSIONS
  The UFC-ACTH-DST criterion seems to be the best for predicting the metabolic outcome in surgically treated AI patients.
authors.affiliation: Endocrinology and Diabetology Unit, Department of Medical Sciences, University of Milan, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Pad. Granelli, Via F. Sforza 35, 20122 Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.forename: Claudia
authors.initials: C
authors.lastname: Battista
authors.forename: Massimo
authors.initials: M
authors.lastname: Torlontano
authors.forename: Francesca
authors.initials: F
authors.lastname: Coletti
authors.forename: Laura
authors.initials: L
authors.lastname: Iorio
authors.forename: Elisa
authors.initials: E
authors.lastname: Cairoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000236:Adenoma / Q000378:metabolism / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000378:metabolism / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D033162:Incidental Findings; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone